Cyclic vomiting syndrome: a case series and review of the literature

Shearer, Jessica; Luthra, Pavit; Ford, Alexander C

doi:10.1136/flgastro-2016-100705

Cited by 20 publications

(40 citation statements)

References 65 publications

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“…47 In addition, we did not evaluate the subsequent management of these patients, an issue that has been highlighted in the literature as problematic for gastroenterologists, 13 although we have reported data from our center regarding the treatment of CVS previously. 48 In conclusion, the prevalence of CVS among adult patients in secondary care gastroenterology clinics in this study was 10.8%, but the diagnosis was considered in fewer than one-in-twenty individuals with typical symptoms, who had no structural explanation for these, and who likely had CVS. Education of gastroenterologists, and other physicians who are likely to encounter such patients, including those in primary care and the emergency department, is paramount in order to eliminate the diagnostic delay seen in adults, reduce the financial impact of the condition on both primary and secondary healthcare services, and to institute prompt and appropriate treatment in order to improve quality of life for these patients.…”

Section: Discussionmentioning

confidence: 65%

“…These include activation of the corticotrophin‐releasing factor signaling system, abnormal gastric motility, mitochondrial DNA mutations, and other genetic factors including variants in the RYR2 gene, which is involved in stress‐induced calcium channels in autonomic neurons, and polymorphisms in genes encoding endogenous cannabinoid and opioid receptors . In addition, we did not evaluate the subsequent management of these patients, an issue that has been highlighted in the literature as problematic for gastroenterologists, although we have reported data from our center regarding the treatment of CVS previously …”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Cyclic vomiting syndrome is a prevalent and under‐recognized condition in the gastroenterology outpatient clinic

Sagar

Sood

Gracie

et al. 2017

Neurogastroenterology Motil

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Section: Discussionmentioning

confidence: 65%

Section: Discussionmentioning

confidence: 99%

Cyclic vomiting syndrome is a prevalent and under‐recognized condition in the gastroenterology outpatient clinic

Sagar

Sood

Gracie

et al. 2017

Neurogastroenterology Motil

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“…The evidence on the use of TCAs in adults with CVS is based on open‐label and retrospective studies and two randomized controlled trials (RCTs) in children . There were fourteen studies that included 600 adult and pediatric patients . Across these studies, 413/600 (70%) of patients reported complete or partial improvement with a decrease in frequency, duration, or severity of CVS symptoms when treated with a TCA, most commonly amitriptyline.…”

Section: Prophylactic Medications In Cvsmentioning

confidence: 99%

Guidelines on management of cyclic vomiting syndrome in adults by the American Neurogastroenterology and Motility Society and the Cyclic Vomiting Syndrome Association

Venkatesan

Levinthal

Tarbell

et al. 2019

Neurogastroenterology Motil

122

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The increasing recognition of cyclic vomiting syndrome (CVS) in adults prompted the development of these evidence‐based guidelines on the management of CVS in adults, which was sponsored by the American Neurogastroenterology and Motility Society (ANMS) and the Cyclic Vomiting Syndrome Association (CVSA). GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) framework was used and a professional librarian performed the literature search. The expert committee included the President of the CVSA who brought a patient perspective into the deliberations. The committee makes recommendations for the prophylaxis of CVS, treatment of acute attacks, diagnosis, and overall management of CVS. The committee strongly recommends that adults with moderate‐to‐severe CVS receive a tricyclic antidepressant (TCA), such as amitriptyline, as a first‐line prophylactic medication and receive topiramate or aprepitant as alternate prophylactic medications. Zonisamide or levetiracetam and mitochondrial supplements (Coenzyme Q10, L‐carnitine, and riboflavin) are conditionally recommended as alternate prophylactic medications, either alone or concurrently with other prophylactic medications. For acute attacks, the committee conditionally recommends using serotonin antagonists, such as ondansetron, and/or triptans, such as sumatriptan or aprepitant to abort symptoms. Emergency department treatment is best achieved with the use of an individualized treatment protocol and shared with the care team (example provided). The committee recommended screening and treatment for comorbid conditions such as anxiety, depression, migraine headache, autonomic dysfunction, sleep disorders, and substance use with referral to appropriate allied health services as indicated. Techniques like meditation, relaxation, and biofeedback may be offered as complementary therapy to improve overall well‐being and patient care outcomes.

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“…• CVS has also been linked to autonomic dysfunction, mitochondrial disorders, hypothalamic-pituitary-adrenal activation and food allergy. 4 Children with CVS have been found to have augmented sympathetic tone and normal to low parasympathetic tone. In mitochondrial disorders, metabolic crisis with vomiting can be the presentation.…”

Section: Discussionmentioning

confidence: 99%

A case series of cyclic vomiting syndrome in paediatric patients at a tertiary care hospital in Chennai, Tamil Nadu, India

Mittal

Ravichandran

Elayaraja

2018

Int J Contemp Pediatr

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Background: Cyclic vomiting syndrome is an increasingly recognized disorder with sudden, repeated episodes of severe nausea, vomiting, and physical exhaustion that occur with no apparent cause. It is more common in children than adults. However, we don’t often see a diagnosis of cyclic vomiting syndrome being made. Hereby we report 7 cases of cyclical vomiting.Methods: This is a retrospective study. Medical records of 5 years were review and consecutive paediatric patients discharged with a diagnosis of cyclic vomiting syndrome were identified, data collected and analysed.Results: Total of 7 cases were found, all of which were adolescents. The mean age was 13.28. 57.14% (4) were females and 42.86% (3) were boys. 42.86% (3) presented with complications. 14.28% (1) had an association with menstrual cycles and 14.28% (1) had an association with psychological stress.Conclusions: Cyclic vomiting syndrome should be kept in mind when a child presents with multiple episodes of vomiting, especially when repeated admissions have been made for the same. Early diagnosis and treatment can improve the quality of life.

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Cyclic vomiting syndrome: a case series and review of the literature

Cited by 20 publications

References 65 publications

Cyclic vomiting syndrome is a prevalent and under‐recognized condition in the gastroenterology outpatient clinic

Cyclic vomiting syndrome is a prevalent and under‐recognized condition in the gastroenterology outpatient clinic

Guidelines on management of cyclic vomiting syndrome in adults by the American Neurogastroenterology and Motility Society and the Cyclic Vomiting Syndrome Association

A case series of cyclic vomiting syndrome in paediatric patients at a tertiary care hospital in Chennai, Tamil Nadu, India

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