= Solution
\b[The guide is the diagnosis and the physiological cost of persistent <vomiting>, not the symptom alone. Establish whether material is truly vomited, search for local and extra-gastric causes, correct depletion and then treat the cause.] A distinction between <vomiting>, passive <regurgitation> and <rumination syndrome> prevents several different disorders being forced into one category. First assess inability to retain fluid, weight loss, <dehydration>, <gastrointestinal bleeding>, severe abdominal pain or distension and <neurological signs>. Significant danger requires prompt investigation and support before a prolonged trial of symptom remedies.<European Guideline on Chronic Nausea and Vomiting by UEG and ESNM>[2025, diagnostic algorithm; exclusion of secondary causes; distinction from regurgitation and rumination]{ref}
The history should establish duration, relation to meals, retained undigested food, pain, <nausea>, the character of the material, bowel function, weight change, pregnancy possibility and exposure to drugs or <ethanol>. Delayed large-volume <vomiting> of food with weight loss suggests retention, but does not distinguish <gastric outlet obstruction> from impaired emptying by itself. Early postprandial discomfort, <haematemesis> or an abdominal mass changes the investigation. <Bilious vomiting> with distension and failure to pass stool raises concern for <gastrointestinal obstruction>. Headache, visual disturbance or focal <neurological signs> directs attention beyond the <stomach>; <kidney> disease, metabolic disturbances and pregnancy are also possible causes. None can be chosen as the diagnosis from the short source question alone.<European Guideline on Chronic Nausea and Vomiting by UEG and ESNM>[2025, secondary causes, obstruction, medication effects, metabolic and central nervous system causes]{ref}
An 1867 physician could already distinguish suspected <gastric ulcer>, chronic <gastritis>, <cancer>, obstruction near the <pylorus>, pregnancy-related <vomiting>, <uraemia> and “sympathetic” <vomiting> accompanying disease elsewhere. The therapeutic reasoning was to remove a provoking dietary or medicinal cause, adapt food to what could be retained, investigate an obstructive or destructive lesion and address the associated systemic disease. Symptom suppression alone could conceal continued starvation. A 1867 digest reproduces an account of opium controlling <vomiting> in advanced consumption. It establishes an example of period palliation, not proof of cure and not a general prescription for chronic <vomiting>.<Half-yearly abstract of the medical sciences (January–June 1867)>[Art. 41, Vomiting, extract from The Indigestions; symptomatic palliation in advanced pulmonary disease]{ref}
Modern investigations are chosen by that differential: examination and appropriate <blood tests> for depletion or systemic disease, a <pregnancy test> where relevant, <endoscopy> for a suspected upper digestive lesion, and imaging when <gastrointestinal obstruction> is possible. <Gastroparesis> specifically means delayed <gastric emptying> without mechanical obstruction. After excluding obstruction, demonstrate abnormal emptying rather than diagnosing it from <vomiting> alone. A standardized <gastric emptying scintigraphy> follows a labelled meal with a <gamma camera>; serial measurements test how much remains in the <stomach>. This apparatus addresses a physiological question that simple inspection of vomited food cannot answer.<Diagnosis of Gastroparesis by NIDDK>[Exclusion of blockage; gastric-emptying scan and measurement after a labelled meal]{ref}
Treatment then branches with the diagnosis. \b[Obstruction needs decompression and treatment of the obstructing lesion; escalating an <antiemetic> does not remove it.] A confirmed <peptic ulcer> may require <Helicobacter pylori> eradication, <proton pump inhibitor> treatment and withdrawal of an ulcer-provoking <nonsteroidal anti-inflammatory drug> where possible. A suspected malignant lesion needs tissue diagnosis and appropriate specialist treatment.<Gastro-oesophageal reflux disease and dyspepsia in adults by NICE>[CG184, 1.7, interventions for peptic ulcer disease and exclusion of malignancy in unhealed ulcer]{ref} In confirmed <gastroparesis>, smaller suitable meals, nutritional planning, correction of a contributing <diabetes> problem and selected prokinetic or <antiemetic> treatment have distinct purposes: an <antiemetic> may reduce <nausea> without accelerating <gastric emptying>. Persistent nutritional failure may require feeding beyond the <stomach>.<Treatment for Gastroparesis by NIDDK>[Changing eating habits; Medicines; Oral or nasal tube feeding and Jejunostomy tube feeding]{ref}
Medication-induced <vomiting>, metabolic disease, pregnancy-related illness and central causes require their own treatment pathways. Fluid and <electrolyte> losses need assessment and correction throughout. Reassess intake, weight and function as well as the frequency of <vomiting>. If no structural or metabolic explanation is established, investigate the relevant disorder of motility or gut–brain interaction on positive criteria; “nothing found yet” does not justify either a fabricated diagnosis or a dismissal of the symptom.
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