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Early pregnancy is characterized by nausea and vomiting which are the most frequent symptoms and the main reason for consulting the physician. This pathological aspect of pregnancy is not yet completely understood. The main doubts concern the etiology, the differential diagnosis and the management and follow-up of the patients. The question as to how and when to treat the symptom is still open. The purpose of this study is to examine, through a literature review, the problems and the appropriate medical approach regarding the severe cases or hyperemesis.

The efficacy and tolerability of Cisapride effervescent granules and a metoclopramide-dimethicone combination were compared double-blind in two comparable groups of 15 patients each with dyspepsia. All patients received three sachets daily of either drug for 6 consecutive weeks. As for efficacy, Cisapride effervescent granules was found to reduce 85% (11/13) of symptoms to a statistically significant extent, as against 42% (5/12) in the reference group. Statistical analysis showed Cisapride effervescent granules to be more effective than the reference drug for 6 out of 11 evaluable symptoms. Mean global improvement was 86% for Cisapride effervescent granules vs 41% for the reference combination. Final judgment by the physician was more favorable for Cisapride effervescent granules than for the reference drug (p < 0.0001). Treatment withdrawal was never necessary and no significant changes of laboratory values were observed. No statistically significant difference between the two treatments as to tolerability was observed. In conclusion, Cisapride effervescent granules was found to have a better risk/benefit ratio than the reference combination.

The Authors present a case who occurred to their observation concerning a patient undergoing subtotal gastrectomy for cancer four years ago which have developed a phytobezoar in the gastric stump, treated with enzymatic dissolution with acetylcysteine associated with metoclopramide . According to the Literature, the Authors point out the etiology, pathogenesis and therapy of this non rate consequence of the gastric surgery.

Having briefly summarized the physiology of lactogenesis and gactopoiesis, the authors stress the fundamental role played by prolactin. In this context, they suggest medical treatment intended to improve mammary function in cases of deficient lactation. Two different types of treatment were tried: direct administration of prolactin or administration of antidopaminergic drugs capable of increasing endogenous prolactin production. In addition to confirming once more the usefulness of early physiological stimulation by suckling, experience in a group of puerperae showed that treatment apt to increase prolactin serum levels was the best therapeutic choice.

Metoclopramide (M.) is a neurolectic drug used with good results in digestive tracts disorders. Even in minimum doses Metoclopramide may cause side effects to children. The most frequent are: localized hypertonia, oculogyric fits, trismus, cervical, oral and lingual dyskinesias, tremors and agitations. Symptoms seem to be serious but it is sufficient to stop the cure that all signs fade away. Manufactures show three personal side-effects' remarks by M. and advise to administer the drug to children with more caution since they are very sensitive to the substance.