Rapid or Normal Gastric Emptying as New Supportive Criteria for Diagnosing Cyclic Vomiting Syndrome in Adults

Abstract

BackgroundCyclic vomiting syndrome (CVS) in adults is a disorder characterized by recurrent and stereotypic episodes of severe nausea, vomiting and abdominal pain separated by symptom-free intervals. Our goal was to investigate gastric emptying (GE) in CVS patients.Material/MethodsThis was a retrospective study of 30 adult patients who met Rome III diagnostic criteria for CVS. Rapid GE was defined using two different predefined criteria as either <50% isotope retention or <65% isotope retention at 1st hour and/or <20% at 2nd hour.ResultsOf the 30 patients (25 had 4-hr GE) diagnosed with CVS, 22 were females and 8 males with a mean age of 39 years. Overall, 20 (80%) of the 25 CVS patients met the predefined criteria of <50% retention for rapid GE in the first hour. Fifteen (60%) met the 2-hour criteria for rapid emptying of <20% retention. Five (16.6%) patients of the 25 had a normal GE with a mean retention at the first hour of 65% (52–78%). Nine (36%) also met another predefined criteria of <35% retention for rapid GE in the first hour. Sixteen (64%) met criteria for normal GE.Conclusions(1) In adult CVS patients, GE is either rapid or normal, clearly distinguishing this entity from gastroparesis. (2) Cyclic vomiting syndrome is an important new etiology to explain the finding of rapid GE on a radionuclide test. (3) We suggest that rapid gastric emptying should be added as supportive criteria for diagnosing CVS in adults.

Cannabinoid hyperemesis and the cyclic vomiting syndrome in adults: recognition, diagnosis, acute and long-term treatment

“…However, applying our criteria for the diagnosis of CVS and CHS (Table 1 (Tab. 1) ) to a patient’s history of disease and clinical presentation will increase the likelihood of correct diagnosis significantly and may help avoid unnecessary diagnostic features [ 1 ], [ 2 ], [ 3 ], [ 4 ], [ 5 ], [ 6 ], [ 7 ], [ 8 ], [ 9 ], [ 10 ], [ 11 ], [ 13 ], [ 14 ], [ 15 ].…”

“…Upon clinical examination, most patients do not reveal findings indicating an organic cause of the disease [ 1 ], [ 8 ]. However, low grade fever, signs of dehydration, and abdominal tenderness were found in some patients [ 1 ], [ 2 ], [ 3 ], [ 4 ], [ 5 ], [ 6 ], [ 7 ], [ 8 ], [ 9 ], [ 10 ], [ 11 ], [ 13 ], [ 14 ], [ 15 ]. There should be no indication of a neurological cause of the displayed symptoms [ 1 ], [ 2 ], [ 3 ], [ 4 ], [ 5 ], [ 6 ], [ 7 ], [ 8 ], [ 9 ], [ 10 ], [ 11 ], [ 13 ], [ 14 ], [ 15 ].…”

“…Laboratory examination may reveal leucocytosis, electrolyte imbalances, elevated amylase levels and, rarely, acute renal failure [ 1 ], [ 2 ], [ 3 ], [ 4 ], [ 5 ], [ 6 ], [ 7 ], [ 8 ], [ 9 ], [ 10 ], [ 11 ], [ 13 ], [ 14 ]. Calcium levels, C-reactive protein levels, lipase, liver enzymes, thyroid parameters, transglutaminase and gliadin antibodies are generally normal [ 1 ], [ 2 ].…”

“…1) ) should be avoided where possible [ 1 ], [ 2 ]. Rapid gastric emptying indicates CVS whereas delayed gastric emptying is more frequently found in CHS patients [ 13 ], [ 14 ].…”

“…Reliable long-term follow up data (minimum follow up time: 12 months) of patients suffering from CVS or CHS is sparse [ 1 ], [ 2 ], [ 3 ], [ 4 ], [ 5 ], [ 6 ], [ 7 ], [ 8 ], [ 9 ], [ 10 ], [ 11 ], [ 13 ], [ 14 ], [ 15 ]. Differentiation between CVS and CHS is simple in patients who do not practise chronic marijuana abuse [ 1 ], [ 2 ].…”