5 Commonest Causes of Vomiting Immediately After Eating.

A. Causes of ACUTE vomiting immediately after eating.

1. Acute viral gastroenteritis (Commonest, especially in children).

Acute gastroenteritis is often an infectious disease. It is the second most common infectious disease worldwide (after the common cold) (reference).

In children, it can cause persistent vomiting immediately after eating or breastfeeding. In adults, it can also cause persistent vomiting but to a lesser extent.

Also, acute viral gastroenteritis can cause vomiting before the onset of diarrhea or without diarrhea at all.

Common causes include:

• Viral gastroenteritis (stomach flu): Commonly caused by Norovirus and Rotavirus.
• Bacterial gastroenteritis (such as E. Coli and salmonella).
• Protozoal (such as Giardiasis).

Viral gastroenteritis (stomach flu) is commonly associated with vomiting immediately after eating.

The symptoms of stomach flu are:

• The symptoms often start suddenly with nausea, vomiting, stomach cramps, and diarrhea.
• Anorexia (loss of appetite).
• Nausea and loss of appetite.
• Vomiting immediately after eating (especially in infants).
• Acute onset of severe non-stop diarrhea (usually watery and yellow).
• Diarrhea usually lasts for a few days (2-5 days) but may last longer.
• Abdominal cramps (usually at the lower abdomen).
• Fever is usually present (often of low grade).
• The fever may be unnoticeable (only a cold sensation or sense of fatigue or muscle aches).

Stomach flu symptoms (including persistent vomiting after meals) typically last 12 hours to 2 days. However, it may last longer (up to a week).

Infants and older adults (age extremities) risk complications such as dehydration and collapse.

Call your doctor if vomiting after meals persists for more than 12 6 hours in infants or for more than a day in adults.

2. Food poisoning (foodborne illnesses).

Food poisoning or foodborne illness is a term that refers to gut and non-gut-related illnesses that result from eating contaminated foods or drinks.

The contamination is by either:

• Bacteria (commonest) include salmonella, clostridium, campylobacter, E. Coli, and Staph. Aureus, etc.
• Viruses (such as norovirus or rotavirus).
• Protozoal such as giardiasis, and amoebiasis.

The symptoms are typically more severe than viral gastroenteritis and may cause persistent vomiting every time you eat.

Common symptoms of food poisoning include:

• The diarrhea is severe, non-stop.
• Bloody and mucoid diarrhea are common.
• Tenesmus (an urge to poop, but only mucus or scanty stool comes out).
• Fever is high grade.
• Vomiting is more common and severe (it occurs immediately after eating and may become persistent for hours or days).
• More severe systemic illnesses can also occur(headache, fatigue, muscle aches, and dizziness).
• Some food poisoning types may cause life-threatening symptoms such as shock, sepsis, extreme dehydration, and coma).

3. An acute attack of gastritis or GERD.

GERD (gastroesophageal reflux disease), chronic gastritis, and peptic ulcer diseases are one of the commonest diseases that result in recurrent attacks of vomiting immediately after eating.

Originally, they were chronic diseases. However, many people may experience acute attacks after a period of remission.

So, we explained them (in-depth) in the next section under the causes of chronic or recurrent vomiting immediately after eating.

4. Acute small intestinal obstruction.

Acute small intestinal obstruction occurs when the normal flow of gut contents is interrupted (often due to mechanical causes).

As a result, food and other gut contents cannot pass through the obstruction, resulting in persistent vomiting (often immediately after eating).

Small intestinal obstruction is more common and accounts for 20% of emergency surgical operations for abdominal pain (reference).

Common causes (reference):

• Intra-abdominal adhesions (often due to previous abdominal operation) are the most common cause.
• Tumors of the duodenum and small intestine.
• Complicated (obstructed) hernias.
• Strictures of the small intestine (as with Crohn’s disease).
• Others such as gallstone ileus, foreign bodies, etc.

Symptoms:

• Proximal small intestine obstruction (in the duodenum and the early parts of the jejunum) may cause persistent vomiting immediately after eating.
• Distal obstruction (in the ileum) often causes delayed vomiting.
• Severe abdominal distension.
• Anorexia.
• Nausea.
• Abdominal pain
• Absolute constipation and inability to pass flatus.
• In severe cases, systemic symptoms often occur, including fast heartbeats, dyspnea, fever, confusion, dry mouth, etc.

Acute intestinal obstruction is a surgical emergency. Call your doctor or go to ER immediately if you suspect an intestinal obstruction.

Learn More about the symptoms of intestinal obstruction.

5. Acute Vestibular Neuritis.

The vestibular system is the organ of balance in your body. It is in the internal ear and supplied by the 8th cranial nerve (vestibulocochlear nerve).

Inflammation of the nerve (often due to viral infection) can cause acute vertigo, severe nausea, and persistent vomiting.

Vertigo is the feeling that everything around you is spinning.

Suspect acute vestibular neuritis if the vomiting immediately after eating is associated with vertigo.

If the vomiting is not associated with vertigo, it is unlikely to be vestibular neuritis.

6. Other acute intra-abdominal conditions.

Any severe intra-abdominal inflammatory condition can lead to persistent vomiting immediately after eating.

However, these condition is often associated with extreme abdominal pain and other symptoms. These causes are unlikely to cause vomiting without severe pain/tenderness in your abdomen.

Common examples:

• Biliary colic (gallbladder pain due to gallstone): it causes an attack of severe upper right or upper central abdominal pain associated with nausea or vomiting.
• Acute cholecystitis: It is a complication of gallstone disease. Patients with acute cholecystitis experience a more severe and prolonged biliary colic (as described above) with more frequent vomiting. Fever may also be present.
• Acute pancreatitis: It causes severe intolerable upper abdominal pain that is referred to the back.
• Acute appendicitis: Its pain starts around the umbilicus and then shifts to the right lower abdomen. It is often associated with severe abdominal tenderness. Persistent vomiting may occur.
• Mesenteric vascular occlusion (intestinal gangrene): often causes severe abdominal pain, tenderness, and persistent vomiting after eating.
• Perforated viscus: perforation of any part of your gut (such as perforated peptic ulcers) can lead to persistent vomiting and severe abdominal pain.
• Others include acute diverticulitis, ovarian portion, inferior myocardial infarction (heart attack), ruptured aortic aneurysm, etc.

Learn more about the cause of acute abdomen that may cause persistent vomiting after eating HERE.

7. Postoperative nausea and vomiting (general anesthesia).

About one-third of surgical patients have nausea, vomiting, or both after general anesthesia (reference).

It is most common among patients who undergo intra-abdominal operations.

Risk factors include female sex, non-smokers, and use of opioid anoanorectalgesics in the postoperative period.

8. Chemotherapy-induced vomiting.

Patients who are receiving cancer chemotherapy commonly experience persistent vomiting immediately after eating. It is more common in the few days following the chemotherapy session.

The vomiting is often severe; contact your oncologist if you have post-chemotherapy vomiting that does not respond to home treatments.

Common chemotherapeutic drugs that cause vomiting:

• Severe vomiting: Cisplatinum, Dacarbazine, Nitrogen mustard.
• Moderate vomiting: Etoposide, methotrexate, Cytarabine.
• Mild vomiting: Fluorouracil, Vinblastine, Tamoxifen.

B. Causes of CHRONIC vomiting immediately after eating.

1. GERD and/or Hiatal Hernia.

Gastroesophageal reflux disease (GERD or chronic acid reflux) is the most common cause of heartburn. It is a very common disease worldwide. In The USA, GERD affects 18.1% to 27.8% of people (reference.

It is usually caused by a weakness in the sphincter between your stomach and esophagus. Also, it may be caused by a herniation of a part of the stomach into your chest (through the diaphragm) called a Hiatal hernia.

People with GERD (particularly those with hiatal hernia) may suffer from persistent vomiting immediately after eating.

Symptoms:

• Heartburn: burning sensation in the central chest (behind the breast bone).
• Regurgitation of acidic fluid into the throat or mouth.
• Nausea.
• Vomiting (it may become persistent immediately after eating, especially in patients with hiatal hernia).
• Loss of appetite.
• Sore throat, recurrent cough.
• Difficulty swallowing
• Attacks of choking, especially during the nighttime.
• Globus sensation.

2. Achalasia.

Achalasia is an esophageal motility disorder of unknown cause. In achalasia, the lower part of the esophagus loses its motility, and the lower esophageal sphincter (LES) fails to relax.

The failure of LES relaxation causes fluid to get stuck in your chest (inside the esophagus) after eating.

It is an uncommon disease that can occur at any age. However, achalasia is commonly diagnosed in patients between 25 and 60 years (reference).

Symptoms:

• Dysphagia is the most common symptom of achalasia. It means difficulty swallowing solid, fluids, or both.
• Regurgitation of undigested food or alive immediately after eating (not vomiting).
• Vomiting may also occur (often self-induced) to relieve the sense of retrosternal fullness.
• Difficulty bleaching (burping).
• Chest pain and sense of fullness (behind the sternum or breastbone).
• Heartburn (similar to GERD).
• Hiccups.
• In severe cases, weight loss may occur.

3. Chronic gastritis or peptic ulcer disease.

Chronic gastritis is the inflammation of the lining of your stomach. It is a prevalent condition. Faulty diet habits, H. pylori infection, and Non-steroidal anti-inflammatory drug use are the most common causes (reference).

Chronic gastritis causes burning or gnawing pain in the upper central part of your abdomen (a few inches above your belly button.

As the chronic inflammation continues, a disruption in the lining of your stomach or duodenum develops. As a result, stomach and duodenal ulcers are often a result of gastritis.

Symptoms:

• Epigastric pain: chronic or recurrent burning or gnawing pain in the upper middle abdomen.
• Nausea.
• Loss of appetite.
• In severe cases, vomiting immediately after eating may occur (in attacks).
• Bloating and abdominal fullness.
• Complicated ulcers include vomiting blood or passing black stool (melena).

4. Pregnancy (Hyperemesis Gravidarum).

Pregnant women (especially in their first trimester) commonly experience recurrent attacks of nausea and vomiting.

However, some pregnant females may experience a more severe and persistent form of vomiting called (Hyperemesis Gravidarum) (reference).

Symptoms of hyperemsis gravidarum:

• Persistent vomiting (immediately after eating, common in the morning).
• The onset of vomiting is often after the first month of pregnancy. However, it may last till the 20th week of pregnancy.
• Weight loss.
• Severe nausea.

5. Others.

• Eating disorders such as bulimia nervosa.
• Cyclic vomiting syndrome (unknown cause).
• Drugs such as Aspirin, NSAIDs, Digoxin overdose, hormonal contraception, and others.
• Chronic otitis media.
• Gastroparesis (often causes delayed vomiting after eating rather than immediate).
• Functional dyspepsia.
• Cancers of the stomach, pancreas, duodenum, and esophagus.
• Crohn’s disease.
• Retroperitoneal fibrosis.
• Migraine.
• Brain tumors, abscess, stroke, or hydrocephalus.
• Psychiatric diseases such as psychogenic vomiting, anxiety, depression, etc.
• Kidney failure.
• Diabetic ketoacidosis.
• Heart failure, myocardial infarction.
• Radiation therapy of the upper abdomen.