Natural History of Pediatric Cyclic Vomiting Syndrome: Progression to Dysautonomia

Abstract

Background: The clinical features of pediatric cyclic vomiting syndrome (CVS) often evolve over time. Many patients develop a constellation of chronic symptoms that suggest autonomic nervous system (ANS) dysfunction during adolescence. We aimed to determine the proportion of children with CVS who develop chronic rather than episodic symptoms consistent with ANS dysfunction. Methods: Retrospective chart review of children ages 0–18 years followed in an outpatient tertiary care CVS center. Patients completed standardized questionnaires at intake and follow-up visits, documenting clinical symptom pattern. Continuous variables are summarized as median [interquartile range (IQR)]. A Mann-Whitney test was used for group comparisons. Results: One hundred subjects were included. A total of 40% developed symptoms of ANS dysfunction (ANS+); 20% were confirmed by comprehensive ANS testing, 11% by orthostatic vital sign abnormalities, and 9% by clinical symptoms. The median (IQR) age at onset of chronic symptoms was 14 (10.02, 15) years. The presence of another disorder of gut-brain interaction (P = 0.018) and a greater number of comorbidities (P = 0.031) were more common in the ANS+ group. ANS+ subjects missed more school days (P= 0.047) and were seen less frequently in the emergency department (P = 0.023). Conclusions: Many children with CVS (40%) develop symptoms consistent with clinical dysautonomia in adolescence. These patients experience more comorbid conditions and a greater impact on school attendance, possibly representing a worsened quality of life as their disease course transitions to daily symptoms. When symptoms of CVS change over time, therapeutic interventions may need to be adjusted and targeted accordingly.

Cardiac Vagal Regulation Is Impeded in Children With Cyclic Vomiting Syndrome

“…Patients with CVS are at risk of developing additional autonomic symptoms over time, often during postpubertal adolescence, which has been termed “coalescent CVS,” and often manifest with chronic nausea and postural symptoms (41). In a recent study of the natural history of CVS, 40% of children were found to develop autonomic dysfunction with chronic symptoms (including nausea) during adolescence (44). A pediatric case series using comprehensive autonomic testing documented postural tachycardia syndrome in half of patients with CVS (6).…”

Síndrome de vomito cíclico en niños: ¿cuál es la evidencia?

“…En otro estudio publicado recientemente, de Gosálvez-Tejada et al, el 40% de los pacientes con SVC finalmente desarrollaron síntomas crónicos de disautonomía 25 .…”

Association of Anxiety and Gastrointestinal Comorbidities in Repeat Hospital Admissions in Pediatric Cyclic Vomiting Syndrome

“…Furthermore, hospitalized patients with CVS often have comorbidities such as dyspepsia, gastroesophageal reflux disease (GERD), irritable bowel syndrome (IBS), migraines, and dysautonomia (5,(26)(27)(28)(29)(30)(31)(32)(33). On average, each patient with CVS has been noted to have approximately 3 comorbid symptoms/conditions (34).…”