Vomitting and Nerves

My daughter has been having early morning vomiting.  She has had an upper G.I. and a head CT.  The CT came back normal, but we found out that she has mild reflux.  The vomiting stopped for about a month, but is starting up again.  My daughter is in athletics and has also been diagnosed with exercised induced asthma.  She has been having problems in athletics, and I am beginning to think that she has been vomiting due to her nerves.  She has lost a total of 13 pounds since this began, and I am not sure what else to do.  Could there be any other reason she would be having vomiting in the morning like this?

[Kevin Pho, MD]

Hello - thanks for asking your question.  

There are several causes of chronic vomiting.  Given the weight loss, this would seem to be a chronic problem.  I would suggest a referral to a pediatric gastroenterologist.

If she has mild reflux, then empiric treatment with a proton pump inhibitor (i.e. omeprazole) or H2 blocker (i.e. zantac) may be tried to see if that can control the symptoms.  

She has had the upper GI series, but if there is no diagnosis, then an upper endoscopy may be necessary.  This can evaluate to see if there are any anatomical abnormalities or inflammation (i.e. gastritis/esophagitis) causing her symptoms.  

An abdominal ultrasound may be considered to evaluate for gall bladder disease and CT be performed to evaluate for pancreatitic disease.  

Depending on your daughter's age, a pregnancy test may also be considered.  

Anxiety can cause the vomiting, but this should only be assumed if all the other diagnoses are ruled out.  

I would obtain a pediatric gastroenterologist referral and discuss the option of further testing.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.