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

Sagar, Rebecca; Sood, Ruchit; Gracie, David J.; Gold, Matthew; To, Natalie; Law, Graham; Ford, Alexander C

doi:10.1111/nmo.13174

Cited by 49 publications

(31 citation statements)

References 51 publications

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“…18 Hence, awareness of FNVDs is paramount, particularly because they frequently are underrecognized despite accounting for more than 10% of adult outpatient gastroenterology cases. 9 Moreover, there are no randomized controlled trials evaluating therapeutic options for FNVDs in adults. 19 Our findings hopefully will stimulate increased awareness and research efforts for these debilitating conditions.…”

Section: Discussionmentioning

confidence: 99%

“…Second, although well-recognized conditions such as irritable bowel syndrome and functional dyspepsia have documented associations with increasing psychological distress, somatization, poorer quality of life, overlapping functional gastrointestinal disorders, and greater health care utilization, 6,7 there is a general paucity of data regarding FNVDs. A few studies have evaluated some health-related parameters within FNVD subtypes, [8][9][10][11] but no study has concurrently overseen multiple health parameters among all FNVD subtypes while using a non-FNVD control group. Third, the association between cannabis use and repetitive hot water bathing behavior has not been established in FNVDs outside of CVS, such as in CNVS.…”

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confidence: 99%

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Epidemiology, Clinical Characteristics, and Associations for Rome IV Functional Nausea and Vomiting Disorders in Adults

Aziz

Palsson

Whitehead

et al. 2019

Clinical Gastroenterology and Hepatology

124

102

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Epidemiology, Clinical Characteristics, and Associations for Rome IV Functional Nausea and Vomiting Disorders in Adults

Aziz

Palsson

Whitehead

et al. 2019

Clinical Gastroenterology and Hepatology

124

102

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show abstract

“…Some studies have shown that CVS is more common in women, but there have been mixed results regarding gender predilection. [177][178][179][180] Abdominal pain is considered by some to be essential for CHS diagnosis, but pain is also reported by a substantial proportion of patients with CVS. 181 More significantly, CHS has been prominently linked to a pattern of hot bathing or showering to relieve symptoms.…”

Section: Epidemiology and Clinical Featuresmentioning

confidence: 99%

Role of chronic cannabis use: Cyclic vomiting syndrome vs cannabinoid hyperemesis syndrome

Venkatesan

Levinthal

et al. 2019

Neurogastroenterology Motil

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Cannabis is commonly used in cyclic vomiting syndrome (CVS) due to its antiemetic and anxiolytic properties. Paradoxically, chronic cannabis use in the context of cyclic vomiting has led to the recognition of a putative new disorder called cannabinoid hyperemesis syndrome (CHS). Since its first description in 2004, numerous case series and case reports have emerged describing this phenomenon. Although not pathognomonic, a patient behavior called “compulsive hot water bathing” has been associated with CHS. There is considerable controversy about how CHS is defined. Most of the data remain heterogenous with limited follow‐up, making it difficult to ascertain whether chronic cannabis use is causal, merely a clinical association with CVS, or unmasks or triggers symptoms in patients inherently predisposed to develop CVS. This article will discuss the role of cannabis in the regulation of nausea and vomiting, specifically focusing on both CVS and CHS, in order to address controversies in this context. To this objective, we have collated and analyzed published case series and case reports on CHS in order to determine the number of reported cases that meet current Rome IV criteria for CHS. We have also identified limitations in the existing diagnostic framework and propose revised criteria to diagnose CHS. Future research in this area should improve our understanding of the role of cannabis use in cyclic vomiting and help us better understand and manage this disorder.

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“…Most clinicians consider CVS in adults to be rare, but a recent report calculated a prevalence of 10.8% among outpatients in a specialty gastroenterology clinic, a rate that approaches that of gastroparesis, chronic constipation, and irritable bowel syndrome in tertiary outpatient cohorts. [3][4][5][6] However, another recent population-based survey estimated a lower prevalence of 2% of CVS in adults. 7 While these preliminary estimates are important, determining the actual prevalence of CVS in adults has fundamental implications for allocation of funding and future research.…”

Section: Introductionmentioning

confidence: 99%

Cyclic vomiting syndrome: Pathophysiology, comorbidities, and future research directions

Hasler

Levinthal

Tarbell

et al. 2019

Neurogastroenterology Motil

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Cyclic vomiting syndrome (CVS) is characterized by severe episodic emesis in adults and children. Cannabinoid hyperemesis syndrome is an increasingly recognized CVS‐like illness that has been associated with chronic cannabis use. There are significant gaps in our understanding of the pathophysiology, clinical features, comorbidities, and effective management options of CVS. Recommendations for treating CVS are based on limited clinical data, as no placebo‐controlled, randomized trials have yet been conducted. Diseases associated with CVS, including migraine, mitochondrial disorders, autonomic dysfunction, and psychiatric comorbidities, provide clues about pathophysiologic mechanisms and suggest potential therapies. We review our current understanding of CVS and propose future research directions with the aim of developing effective therapy. Establishing a multicenter, standardized registry of CVS patients could drive research on multiple fronts including developing CVS‐specific outcome measures to broaden our understanding of clinical profiles, to serve as treatment end points in clinical trials, and to provide a platform for patient recruitment for randomized clinical trials. Such a robust database would also facilitate conduct of research that aims to determine the underlying pathophysiological mechanisms and genetic basis for CVS, as well as identifying potential biomarkers for the disorder. Soliciting government and industry support is crucial to establishing the necessary infrastructure and achieving these goals. Patient advocacy groups such as the Cyclic Vomiting Syndrome Association (CVSA), which partner with clinicians and researchers to disseminate new information, to promote ongoing interactions between patients, their families, clinicians, investigators, to support ongoing CVS research and education, must be an integral part of this endeavor.

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

Abstract: Background: Cyclic vomiting syndrome (CVS) is a functional gastrointestinal disorder

Cited by 49 publications

References 51 publications

Epidemiology, Clinical Characteristics, and Associations for Rome IV Functional Nausea and Vomiting Disorders in Adults

Epidemiology, Clinical Characteristics, and Associations for Rome IV Functional Nausea and Vomiting Disorders in Adults

Role of chronic cannabis use: Cyclic vomiting syndrome vs cannabinoid hyperemesis syndrome

Cyclic vomiting syndrome: Pathophysiology, comorbidities, and future research directions

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