Background: Typical symptoms of gastroesophageal reflux disease are he
artburn and regurgitation. A subset of patients present with atypical
symptoms, such as chest pain, cough, wheezing, and hoarseness. Objecti
ve: To review the clinical presentation and treatment of patients who
presented with nausea as the primary symptom of gastroesophageal reflu
x disease. Design: Case series. Setting: Outpatient department of a un
iversity hospital. Patients: 10 outpatients who had chronic, intractab
le nausea and had not responded to empirical therapies. Measurements:
Patients were evaluated by esophagogastroduodenoscopy, 24-hour esophag
eal pH studies, gastric-emptying tests, electrogastrography, or a Bern
stein test. Results: Abnormal acid reflux was found to be the cause of
intractable nausea in all 10 patients. In 5 of the 10 patients, esoph
agitis was documented by esophagogastroduodenoscopy. Six patients had
abnormal results on the 24-hour esophageal pH study. In these 6 patien
ts, 32 of 33 episodes of nausea were accompanied by an episode of acid
reflux. One patient had positive results on the Bernstein test. Nause
a resolved after treatment with omeprazole in 7 patients, after treatm
ent with cisapride or ranitidine in 2 patients, and after Nissen fundo
plication in 1 patient. Conclusions: Intractable nausea is an atypical
symptom that can occur in a subset of patients with gastroesophageal
reflux disease. A 24-hour esophageal pH study should be considered in
patients who have unexplained nausea but normal findings on esophagoga
stroduodenoscopy, a gastric-emptying test, and electrogastrography. Na
usea related to gastroesophageal reflux disease resolves or is markedl
y reduced with proton-pump inhibitors or promotility drugs.