Cyclic Vomiting Syndrome: A Functional Disorder

Abstract

Cyclic vomiting syndrome (CVS) is a functional disorder characterized by stereotypical episodes of intense vomiting separated by weeks to months. Although it can occur at any age, the most common age at presentation is 3-7 years. There is no gender predominance. The precise pathophysiology of CVS is not known but a strong association with migraine headaches, in the patient as well as the mother indicates that it may represent a mitochondriopathy. Studies have also suggested the role of an underlying autonomic neuropathy involving the sympathetic nervous system in its pathogenesis. CVS has known triggers in many individuals and avoiding these triggers can help prevent the onset of the episodes. It typically presents in four phases: a prodrome, vomiting phase, recovery phase and an asymptomatic phase until the next episode. Complications such as dehydration and hematemesis from Mallory Wise tear of the esophageal mucosa may occur in more severe cases. Blood and urine tests and abdominal imaging may be indicated depending upon the severity of symptoms. Brain magnetic resonance imaging and upper gastrointestinal endoscopy may also be indicated in certain circumstances. Management of an episode after it has started ('abortive treatment') includes keeping the patient in a dark and quiet room, intravenous hydration, ondansetron, sumatriptan, clonidine, and benzodiazepines. Prophylactic treatment includes cyproheptadine, propranolol and amitriptyline. No mortality has been reported as a direct result of CVS and many children outgrow it over time. A subset may develop other functional disorders like irritable bowel syndrome and migraine headaches.

Children with cyclic vomiting syndrome: phenotypes, disease burden and mitochondrial DNA analysis

“…After admission to our institution, ten underwent upper endoscopy, and only one was diagnosed with esophagitis. Repetitive nausea, vomiting, and retching in severe cases might cause hematemesis because of mucosal tear (Mallory-Wise syndrome) [ 27 ]. Pediatric CVS might be under-diagnosed and misdiagnosed in local hospitals, simply as “gastritis, food poisoning” due to physicians’ inadequate knowledge about pediatric functional gastrointestinal disorders.…”

Ramosetron as a Treatment for Cyclic Vomiting Syndrome: A Small-Scale Patient Trial

“…Many CVS patients experience abdominal pain and diarrhea during vomiting attacks, and some develop other functional disorders, including IBS. 7 Ondansetron, another specific serotonin 5-HT3 receptor blocker, has also been reported to reduce frequency of nausea, vomiting, and anorexia in cancer patients undergoing chemotherapy. Application of ondansetron for CVS treatment has been described in some review articles, [6][7][8] but no clinical trial of its efficacy has been performed.…”

“…1 Sumatriptan, a serotonin 1B/1D receptor agonist, was reportedly effective in acute treatment of migraine, and of some (but not all) CVS cases. [2][3][4][5] Ondansetron, a serotonin 5-HT3 receptor antagonist, has been suggested as a therapeutic agent for CVS treatment, [6][7][8] but there has been no clinical trial of its efficacy. Ramosetron, another selective serotonin 5-HT3 receptor antagonist, [9][10][11] has been applied clinically for treatment of irritable bowel syndrome (IBS) in Japan.…”

Корекція Метаболічних Порушень При Ацетонемічному Синдромі У Дітей На Фоні Функціональних Розладів Біліарного Тракту

“…Метаболические нарушения при ацетоне-мическом синдроме обусловлены повышением в крови продуктов неполного окисления жирных кислот -кетоновых тел: ацетона, ацетоуксусной кислоты и бета-оксимасляной кислоты. Кетоно-вые тела образуются преимущественно в печени и представляют собой промежуточные продукты углеводного и жирового обмена [10,11]. Возмож-ные варианты утилизации кетоновых тел (ацето-уксусная, бета-оксимасляная кислота и ацетон): окисление в тканях до углекислого газа и воды либо выведение из организма в неизмененном виде почками, легкими и ЖКТ.…”

“…Були проаналізовані результати обстеження і лікуван-ня 40 дітей віком 3-10 років з АС на фоні функціональних розладів біліарного тракту. Обстеження проводилося за загальноприйнятою схемою [10]. Для діагностики рівня кетонових тіл у сечі використана методика визначення ацетоацетату в сечі, згідно з якою ступінь кетонурії оці-нювався від «+» до «++++».…”