A committee of European experts, led by Dr Carolina Malagelada, a researcher in the Physiology and Digestive Pathophysiology research group at the Vall d'Hebron Research Institute (VHIR) and an assistant physician at the Digestive System Service of the Vall d'Hebron University Hospital, has developed a European medical guide for the diagnosis and treatment of patients with chronic vomiting. A patient is considered to have chronic vomiting if their symptoms last for more than 4 weeks. This disease can have multiple causes, both gastrointestinal and non-gastrointestinal, and can be difficult to diagnose and treat.

The new guideline aims to assist healthcare professionals with a consensus document, based on the latest scientific advances and the clinical experience of experts, in order to improve diagnosis and treatment. For its development, 35 experts from 13 European countries have joined forces under the umbrella of the European Society of Gastroenterology (UEG) and the European Society of Neurogastroenterology (ESNM). The guideline has been published in the journal of the UEG.

One of the main contributions of the guide is the creation of a diagnostic algorithm to address this symptomatology. In a schematic and visual way, it describes all the necessary steps to identify the cause of the problem. Firstly, it must be ruled out that it is a side effect of other diseases. To this end, 32 possible causative pathologies have been proposed, divided into 10 categories, ranging from endocrine issues to reactions to treatments and medications, through diseases of the nervous system.

Once secondary forms of vomiting have been ruled out, it must be determined whether the patient experiences vomiting. Or whether there are processes such as rumination or regurgitation, in which ingested food returns to the mouth without the need for physical effort on the part of the affected person. From there, various diagnoses are suggested, differentiating between motility disorders and brain-gut interaction issues, establishing the key criteria for distinguishing between the two types of issues.

Dr Malagelada stresses that guidelines such as this one are ‘crucial for advancing patient care, regardless of where the patient is, and for providing support and security in clinical decision-making’.

94 recommendations in total with a high degree of consensus

In overall, the document presents 94 recommendations, of which 89 have more than 70 % consensus among professionals and 31 have more than 90 %. These recommendations follow the structure of the diagnostic algorithm and are aimed at clarifying doubts and delving deeper into the tests needed to reach a definitive diagnosis. For the development of these recommendations, all the available scientific evidence has been reviewed, and they were subsequently voted individually and separately by each of the experts.