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Marijuana, Ondansetron, and Promethazine Are Perceived as Most Effective Treatments for Gastrointestinal Nausea.
Dig Dis Sci. 2020 Mar 17 [Online ahead of print]DD

Abstract

BACKGROUND

Many anti-nausea treatments are available for chronic gastrointestinal syndromes, but data on efficacy and comparative effectiveness are sparse.

AIMS

To conduct a sectional survey study of patients with chronic nausea to assess comparative effectiveness of commonly used anti-nausea treatments.

METHODS

Outpatients at a single center presenting for gastroenterology evaluation were asked to rate anti-nausea efficacy on a scale of 0 (no efficacy) to 5 (very effective) of 29 commonly used anti-nausea treatments and provide other information about their symptoms. Additional information was collected from the patients' chart. The primary outcome was to determine which treatments were better or worse than average using a t test. The secondary outcome was to assess differential response by individual patient characteristics using multiple linear regression.

RESULTS

One hundred and fifty-three patients completed the survey. The mean efficacy score of all anti-nausea treatments evaluated was 1.73. After adjustment, three treatments had scores statically higher than the mean, including marijuana (2.75, p < 0.0001), ondansetron (2.64, p < 0.0001), and promethazine (2.46, p < 0.0001). Several treatments, including many neuromodulators, complementary and alternative treatments, erythromycin, and diphenhydramine had scores statistically below average. Patients with more severe nausea responded better to marijuana (p = 0.036) and diphenhydramine (p < 0.001) and less so to metoclopramide (p = 0.020). There was otherwise no significant differential response by age, gender, nausea localization, underlying gastrointestinal cause of nausea, and GCSI.

CONCLUSIONS

When treating nausea in patients with chronic gastrointestinal syndromes, clinicians may consider trying higher performing treatments first, and forgoing lower performing treatments. Further prospective research is needed, particularly with respect to highly effective treatments.

Authors+Show Affiliations

Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 430 Broadway St., Pavilion C, 3rd Floor, GI Suite, Redwood City, CA, 94063, USA. zikosta@stanford.edu.Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 430 Broadway St., Pavilion C, 3rd Floor, GI Suite, Redwood City, CA, 94063, USA.Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 430 Broadway St., Pavilion C, 3rd Floor, GI Suite, Redwood City, CA, 94063, USA.Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 430 Broadway St., Pavilion C, 3rd Floor, GI Suite, Redwood City, CA, 94063, USA.Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 430 Broadway St., Pavilion C, 3rd Floor, GI Suite, Redwood City, CA, 94063, USA.Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 430 Broadway St., Pavilion C, 3rd Floor, GI Suite, Redwood City, CA, 94063, USA.Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 430 Broadway St., Pavilion C, 3rd Floor, GI Suite, Redwood City, CA, 94063, USA.Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 430 Broadway St., Pavilion C, 3rd Floor, GI Suite, Redwood City, CA, 94063, USA.Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 430 Broadway St., Pavilion C, 3rd Floor, GI Suite, Redwood City, CA, 94063, USA.Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 430 Broadway St., Pavilion C, 3rd Floor, GI Suite, Redwood City, CA, 94063, USA.Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 430 Broadway St., Pavilion C, 3rd Floor, GI Suite, Redwood City, CA, 94063, USA.Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 430 Broadway St., Pavilion C, 3rd Floor, GI Suite, Redwood City, CA, 94063, USA.Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 430 Broadway St., Pavilion C, 3rd Floor, GI Suite, Redwood City, CA, 94063, USA.Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 430 Broadway St., Pavilion C, 3rd Floor, GI Suite, Redwood City, CA, 94063, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32185665

Citation

Zikos, Thomas A., et al. "Marijuana, Ondansetron, and Promethazine Are Perceived as Most Effective Treatments for Gastrointestinal Nausea." Digestive Diseases and Sciences, 2020.
Zikos TA, Nguyen L, Kamal A, et al. Marijuana, Ondansetron, and Promethazine Are Perceived as Most Effective Treatments for Gastrointestinal Nausea. Dig Dis Sci. 2020.
Zikos, T. A., Nguyen, L., Kamal, A., Fernandez-Becker, N., Regalia, K., Nandwani, M., Sonu, I., Garcia, M., Okafor, P., Neshatian, L., Grewal, D., Garcia, P., Triadafilopoulos, G., & Clarke, J. O. (2020). Marijuana, Ondansetron, and Promethazine Are Perceived as Most Effective Treatments for Gastrointestinal Nausea. Digestive Diseases and Sciences. https://doi.org/10.1007/s10620-020-06195-5
Zikos TA, et al. Marijuana, Ondansetron, and Promethazine Are Perceived as Most Effective Treatments for Gastrointestinal Nausea. Dig Dis Sci. 2020 Mar 17; PubMed PMID: 32185665.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Marijuana, Ondansetron, and Promethazine Are Perceived as Most Effective Treatments for Gastrointestinal Nausea. AU - Zikos,Thomas A, AU - Nguyen,Linda, AU - Kamal,Afrin, AU - Fernandez-Becker,Nielsen, AU - Regalia,Kirsten, AU - Nandwani,Monica, AU - Sonu,Irene, AU - Garcia,Mildred, AU - Okafor,Philip, AU - Neshatian,Leila, AU - Grewal,Damanpreet, AU - Garcia,Patricia, AU - Triadafilopoulos,George, AU - Clarke,John O, Y1 - 2020/03/17/ PY - 2019/10/18/received PY - 2020/03/05/accepted PY - 2020/3/19/entrez KW - Alternative medicine KW - Cannabinoids KW - Functional gastrointestinal disorders KW - Gastroparesis KW - Nausea JF - Digestive diseases and sciences JO - Dig. Dis. Sci. N2 - BACKGROUND: Many anti-nausea treatments are available for chronic gastrointestinal syndromes, but data on efficacy and comparative effectiveness are sparse. AIMS: To conduct a sectional survey study of patients with chronic nausea to assess comparative effectiveness of commonly used anti-nausea treatments. METHODS: Outpatients at a single center presenting for gastroenterology evaluation were asked to rate anti-nausea efficacy on a scale of 0 (no efficacy) to 5 (very effective) of 29 commonly used anti-nausea treatments and provide other information about their symptoms. Additional information was collected from the patients' chart. The primary outcome was to determine which treatments were better or worse than average using a t test. The secondary outcome was to assess differential response by individual patient characteristics using multiple linear regression. RESULTS: One hundred and fifty-three patients completed the survey. The mean efficacy score of all anti-nausea treatments evaluated was 1.73. After adjustment, three treatments had scores statically higher than the mean, including marijuana (2.75, p < 0.0001), ondansetron (2.64, p < 0.0001), and promethazine (2.46, p < 0.0001). Several treatments, including many neuromodulators, complementary and alternative treatments, erythromycin, and diphenhydramine had scores statistically below average. Patients with more severe nausea responded better to marijuana (p = 0.036) and diphenhydramine (p < 0.001) and less so to metoclopramide (p = 0.020). There was otherwise no significant differential response by age, gender, nausea localization, underlying gastrointestinal cause of nausea, and GCSI. CONCLUSIONS: When treating nausea in patients with chronic gastrointestinal syndromes, clinicians may consider trying higher performing treatments first, and forgoing lower performing treatments. Further prospective research is needed, particularly with respect to highly effective treatments. SN - 1573-2568 UR - https://www.unboundmedicine.com/medline/citation/32185665/Marijuana,_Ondansetron,_and_Promethazine_Are_Perceived_as_Most_Effective_Treatments_for_Gastrointestinal_Nausea L2 - https://doi.org/10.1007/s10620-020-06195-5 DB - PRIME DP - Unbound Medicine ER -
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