Use of Antiemetic Agents and Other Symptomatic Treatment of Abdominal Conditions: Which are the best?

INTRODUCTION: The urgent management of the patient with acute abdominal pain and other conditions comprises a rapid cardiorespiratory evaluation and resuscitation to maintain hemodynamic stability and obtain an elaborate and focused history and examination. Following the exclusion of life-threatening diagnoses, symptomatic improvement in patients with gastrointestinal conditions is vital. Vomiting causes mild to severe dehydration, leading to hypovolemia, electrolyte imbalances, and other consequences. This narrative review provides an overview of symptomatic care and antiemetic management in the acute setting. METHODS: A systematic literature search was used to identify relevant articles. Consecutive trials in English published between 2005 and 2025 investigating the indications and use of antiemetic agents were abstracted from Google Scholar, PubMed, Scopus, and Web of Science. Case reports, editorials, and expert opinions were excluded from the analysis. RESULTS: Replacement of IV fluids combined with antiemetic agents is administered to patients with conditions causing intractable vomiting, such as pancreatitis, renal colic, hollow viscus obstruction, and appendicitis, based on the patient's clinical course. Emptying and decompression of the stomach contents with the nasogastric catheters may be necessary, as aspiration can often be encountered in patients with repeated vomiting. 5-Hydroxytryptamine 3 receptor antagonists are preferred as they act on central and peripheral receptors to prevent and treat vomiting. CONCLUSION: Patients with chief complaints of nausea and vomiting should prompt scrutiny for lifethreatening diagnoses initially, and then ruling out the other differential diagnoses, which need emergent interventions to prevent further deterioration. A `symptomatic` treatment not only ensures optimal cooperation and communication with the patient but also achieves physiological homeostasis. Measures to treat dehydration, pain, nausea, and vomiting should be individualized and implemented promptly with a multidisciplinary approach. Appropriate antiemetic agents should be selected to treat nausea and vomiting per evidence-based guidelines.