Q: I am very concerned about my son-in-law who is in his early 30s. He has been having stomach problems and for the last six or seven years, has been leaving the dinner table to throw up. This usually occurs immediately after the first or second bite of his dinner. If possible, he then returns to finish his dinner. Recently he had this problem at a restaurant and said that he had some blood in his vomit. The doctor he sees says that it nothing and my daughter thinks it is because he does not eat dinner very often since he works far into the night. He does have allergies for which he is taking medication. He is of average weight and seems healthy. I am worried that this is more serious than he makes it out to be. Can you suggest a plan or some possibilities that he can discuss with his doctor? Thanks for your help and concern. I appreciate your insights.
A: There are a number of possible reasons for your son-in-law to vomit. They include anxiety, stress, infection of the stomach, having headaches, being on prescription medication, swelling of the pancreas or liver, consuming too much alcohol, and more. He could have cyclic vomiting syndrome. blood in the stool, liver inflammation, and more. Cyclic vomiting syndrome is characterized with episodes of severe vomiting without apparent cause that may last for hours or days. Generally speaking, these episodes tend to begin at the same time of the day and are similar in length and intensity to those that precede it. The condition may be related to migraine headaches. Cyclic vomiting syndrome is often difficult to diagnose because vomiting is a symptom of another disorder, not a condition in itself and treatment may include making lifestyle changes and managing symptoms to prevent triggers that cause the vomiting. I would be remiss if I didn’t mention the possibility of him having a reaction to specific odors in the kitchen such as cooking oils, food poisoning, gallbladder disease, intestinal blockage, food poisoning, and a milk allergy.
You indicate he takes medication for allergies. Is there a possibility he takes the drug prior to dinner time on an empty stomach and the vomiting is induced by the drug and isn’t connected with sitting down at the table? He might speak with his physician regarding the potential side effects of his allergy medication and discuss switching to another product if vomiting is mentioned. Or, he might modify his schedule and take the drug at a different time of the day. Most individuals eat three meals a day. Does he have a problem with vomiting at other times of the day, or only in the evening?
Is he under stress because of his work and long hours on the job, feeling he is not “giving his all” if he takes time out for dinner? If so, his family may choose to modify their “big meal” schedule and eat at noon or around 2 PM instead of later in the evening. People who have somewhat erratic meal schedules, and we all do on occasion, might go long hours without thinking about eating. Then to face a large meal might be difficult to manage. Taking a break with a few Saltine crackers and juice night help bridge the gap and keep him more stable. Or, he might consider eating smaller, more frequent meals throughout the day instead of facing a larger one. To eat something every two to three hours may decrease any nausea. Is there a degree of tension you are unaware of that surfaces at meal time? For example, if sitting around the table is a time when homework issues arise, late payments on loans or credit cards are discussed, or reprimanding children for making bad decisions throughout the day surface, it may be more than he is able to deal with.
He should be seen by his primary care physician and perhaps have some laboratory testing and imaging studies performed to rule out an ulcer or other medical condition that could be the cause. He needs to determine why he is having hemoptysis (the coughing up of blood) on occasion. Only then can a determination be made on how to handle what is going on, since treatment will depend on the cause. For example, if he feels queasy before dinner, there are medications he can take to calm his stomach. If he feels anxious, perhaps anti-anxiety drugs will be appropriate.
Speak with your son-in-law and your daughter. There is a trigger causing his problem and I’m sure he will be relieved to get to the bottom of the issue.
