Intractable Nausea and Vomiting From Autoantibodies Against a Brain Water Channel

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Abstract

Background & Aims: Antibodies against the water channel protein aquaporin (AQP)-4 cause a spectrum of inflammatory, demyelinating, central nervous system disorders called neuromyelitis optica spectrum disorders (NMOSDs); these primarily affect the optic nerves and spinal cord but also the brain. Symptoms of intractable nausea, vomiting, and hiccups reflect involvement of AQP4 in the brainstem area postrema and account for gastroenterological presentations. We investigated the frequency of intractable nausea, vomiting, or hiccups in patients with NMOSD who tested positive for immunoglobulin G against AQP4 (AQP4-IgG). We also analyzed sera from patients with idiopathic nausea or vomiting for the presence of AQP4-IgG. Methods: We reviewed the Mayo Clinic AQP4-IgG positive NMOSD database (n = 70) to identify patients who presented with vomiting, focusing on results from gastroenterological evaluations. We also tested serum samples (from the Gastroparesis Clinical Research Consortium repository) from patients who presented with idiopathic nausea or vomiting for AQP4-IgG (controls, n = 318 with gastroparesis and 117 without gastroparesis). Results: Ten AQP4-IgG-positive patients diagnosed with NMOSD (14% of patients in the database) initially presented with intractable vomiting. Extensive gastroenterological evaluation was noninformative. AQP4-IgG was not detected in any of the controls. Conclusions: Although NMOSDs are rare, tests for AQP4-IgG should be considered for patients who present with unexplained, intractable vomiting. Detection of the antibody before the development of optic neuritis or transverse myelitis allows patients to receive immunosuppressive therapy before the development of neurologic disabilities.

Original languageEnglish (US)
Pages (from-to)240-245
Number of pages6
JournalClinical Gastroenterology and Hepatology
Volume11
Issue number3
DOIs
StatePublished - Mar 2013

Fingerprint

Aquaporins
Autoantibodies
Nausea
Vomiting
Neuromyelitis Optica
Immunoglobulin G
Brain
Gastroparesis
Hiccup
Databases
Transverse Myelitis
Aquaporin 4
Area Postrema
Optic Neuritis
Antibodies
Central Nervous System Diseases
Immunosuppressive Agents
Optic Nerve
Serum
Nervous System

Keywords

  • Aquaporin-4 Antibody
  • Central Nervous System
  • Chronic Nausea and Vomiting
  • Diagnosis

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

Cite this

@article{62f36ee2b6fd41cc9a2dbfb3c5a02be2,
title = "Intractable Nausea and Vomiting From Autoantibodies Against a Brain Water Channel",
abstract = "Background & Aims: Antibodies against the water channel protein aquaporin (AQP)-4 cause a spectrum of inflammatory, demyelinating, central nervous system disorders called neuromyelitis optica spectrum disorders (NMOSDs); these primarily affect the optic nerves and spinal cord but also the brain. Symptoms of intractable nausea, vomiting, and hiccups reflect involvement of AQP4 in the brainstem area postrema and account for gastroenterological presentations. We investigated the frequency of intractable nausea, vomiting, or hiccups in patients with NMOSD who tested positive for immunoglobulin G against AQP4 (AQP4-IgG). We also analyzed sera from patients with idiopathic nausea or vomiting for the presence of AQP4-IgG. Methods: We reviewed the Mayo Clinic AQP4-IgG positive NMOSD database (n = 70) to identify patients who presented with vomiting, focusing on results from gastroenterological evaluations. We also tested serum samples (from the Gastroparesis Clinical Research Consortium repository) from patients who presented with idiopathic nausea or vomiting for AQP4-IgG (controls, n = 318 with gastroparesis and 117 without gastroparesis). Results: Ten AQP4-IgG-positive patients diagnosed with NMOSD (14{\%} of patients in the database) initially presented with intractable vomiting. Extensive gastroenterological evaluation was noninformative. AQP4-IgG was not detected in any of the controls. Conclusions: Although NMOSDs are rare, tests for AQP4-IgG should be considered for patients who present with unexplained, intractable vomiting. Detection of the antibody before the development of optic neuritis or transverse myelitis allows patients to receive immunosuppressive therapy before the development of neurologic disabilities.",
keywords = "Aquaporin-4 Antibody, Central Nervous System, Chronic Nausea and Vomiting, Diagnosis",
author = "Raffaele Iorio and Lucchinetti, {Claudia F} and Lennon, {Vanda A} and Gianrico Farrugia and Pasricha, {Pankaj J.} and Weinshenker, {Brian G} and Pittock, {Sean J}",
year = "2013",
month = "3",
doi = "10.1016/j.cgh.2012.11.021",
language = "English (US)",
volume = "11",
pages = "240--245",
journal = "Clinical Gastroenterology and Hepatology",
issn = "1542-3565",
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TY - JOUR

T1 - Intractable Nausea and Vomiting From Autoantibodies Against a Brain Water Channel

AU - Iorio, Raffaele

AU - Lucchinetti, Claudia F

AU - Lennon, Vanda A

AU - Farrugia, Gianrico

AU - Pasricha, Pankaj J.

AU - Weinshenker, Brian G

AU - Pittock, Sean J

PY - 2013/3

Y1 - 2013/3

N2 - Background & Aims: Antibodies against the water channel protein aquaporin (AQP)-4 cause a spectrum of inflammatory, demyelinating, central nervous system disorders called neuromyelitis optica spectrum disorders (NMOSDs); these primarily affect the optic nerves and spinal cord but also the brain. Symptoms of intractable nausea, vomiting, and hiccups reflect involvement of AQP4 in the brainstem area postrema and account for gastroenterological presentations. We investigated the frequency of intractable nausea, vomiting, or hiccups in patients with NMOSD who tested positive for immunoglobulin G against AQP4 (AQP4-IgG). We also analyzed sera from patients with idiopathic nausea or vomiting for the presence of AQP4-IgG. Methods: We reviewed the Mayo Clinic AQP4-IgG positive NMOSD database (n = 70) to identify patients who presented with vomiting, focusing on results from gastroenterological evaluations. We also tested serum samples (from the Gastroparesis Clinical Research Consortium repository) from patients who presented with idiopathic nausea or vomiting for AQP4-IgG (controls, n = 318 with gastroparesis and 117 without gastroparesis). Results: Ten AQP4-IgG-positive patients diagnosed with NMOSD (14% of patients in the database) initially presented with intractable vomiting. Extensive gastroenterological evaluation was noninformative. AQP4-IgG was not detected in any of the controls. Conclusions: Although NMOSDs are rare, tests for AQP4-IgG should be considered for patients who present with unexplained, intractable vomiting. Detection of the antibody before the development of optic neuritis or transverse myelitis allows patients to receive immunosuppressive therapy before the development of neurologic disabilities.

AB - Background & Aims: Antibodies against the water channel protein aquaporin (AQP)-4 cause a spectrum of inflammatory, demyelinating, central nervous system disorders called neuromyelitis optica spectrum disorders (NMOSDs); these primarily affect the optic nerves and spinal cord but also the brain. Symptoms of intractable nausea, vomiting, and hiccups reflect involvement of AQP4 in the brainstem area postrema and account for gastroenterological presentations. We investigated the frequency of intractable nausea, vomiting, or hiccups in patients with NMOSD who tested positive for immunoglobulin G against AQP4 (AQP4-IgG). We also analyzed sera from patients with idiopathic nausea or vomiting for the presence of AQP4-IgG. Methods: We reviewed the Mayo Clinic AQP4-IgG positive NMOSD database (n = 70) to identify patients who presented with vomiting, focusing on results from gastroenterological evaluations. We also tested serum samples (from the Gastroparesis Clinical Research Consortium repository) from patients who presented with idiopathic nausea or vomiting for AQP4-IgG (controls, n = 318 with gastroparesis and 117 without gastroparesis). Results: Ten AQP4-IgG-positive patients diagnosed with NMOSD (14% of patients in the database) initially presented with intractable vomiting. Extensive gastroenterological evaluation was noninformative. AQP4-IgG was not detected in any of the controls. Conclusions: Although NMOSDs are rare, tests for AQP4-IgG should be considered for patients who present with unexplained, intractable vomiting. Detection of the antibody before the development of optic neuritis or transverse myelitis allows patients to receive immunosuppressive therapy before the development of neurologic disabilities.

KW - Aquaporin-4 Antibody

KW - Central Nervous System

KW - Chronic Nausea and Vomiting

KW - Diagnosis

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U2 - 10.1016/j.cgh.2012.11.021

DO - 10.1016/j.cgh.2012.11.021

M3 - Article

VL - 11

SP - 240

EP - 245

JO - Clinical Gastroenterology and Hepatology

JF - Clinical Gastroenterology and Hepatology

SN - 1542-3565

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