Pediatric Gastroenterology, Hepatology & Nutrition

The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition (대한소아소화기영양학회)
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Cyclic Vomiting Syndrome: A Functional Disorder

  • Kaul, Ajay (Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center) ;
  • Kaul, Kanwar K. (Department of Pediatrics, NSCB Medical College)
  • Received : 2015.08.18
  • Accepted : 2015.12.09
  • Published : 2015.12.30
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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.

Keywords

References

  1. Saps M, Nichols-Vinueza DX, Rosen JM, Velasco- Benítez CA. Prevalence of functional gastrointestinal disorders in Colombian school children. J Pediatr 2014;164:542-5.e1. https://doi.org/10.1016/j.jpeds.2013.10.088
  2. Devanarayana NM, Adhikari C, Pannala W, Rajindrajith S. Prevalence of functional gastrointestinal diseases in a cohort of Sri Lankan adolescents: comparison between Rome II and Rome III criteria. J Trop Pediatr 2011;57:34-9. https://doi.org/10.1093/tropej/fmq039
  3. Van Tilburg MAL, Walker LS, Palsson OS, Kim SM, Spiegel BM, Siller RC, et al. Prevalence of child/adolescent functional gastrointestinal disorders in a national U.S. community sample. Gastroenterology 2014;146(5 Suppl 1):S143-4.
  4. Fitzpatrick E, Bourke B, Drumm B, Rowland M. The incidence of cyclic vomiting syndrome in children: population-based study. Am J Gastroenterol 2008;103:991-5; quiz 996. https://doi.org/10.1111/j.1572-0241.2007.01668.x
  5. Liao KY, Chang FY, Wu LT, Wu TC. Cyclic vomiting syndrome in Taiwanese children. J Formos Med Assoc 2011;110:14-8. https://doi.org/10.1016/S0929-6646(11)60003-X
  6. Lin YP, Ni YH, Weng WC, Lee WT. Cyclic vomiting syndrome and migraine in children. J Formos Med Assoc 2011;110:382-7. https://doi.org/10.1016/S0929-6646(11)60056-9
  7. Withers GD, Silburn SR, Forbes DA. Precipitants and aetiology of cyclic vomiting syndrome. Acta Paediatr 1998;87:272-7. https://doi.org/10.1111/j.1651-2227.1998.tb01437.x
  8. Li BU, Balint JP. Cyclic vomiting syndrome: evolution in our understanding of a brain-gut disorder. Adv Pediatr 2000;47:117-60.
  9. Symon DN, Russell G. The relationship between cyclic vomiting syndrome and abdominal migraine. J Pediatr Gastroenterol Nutr 1995;21 Suppl 1:S42-3. https://doi.org/10.1097/00005176-199501001-00012
  10. Venkatesan T, Prieto T, Barboi A, Li B, Schroeder A, Hogan W, et al. Autonomic nerve function in adults with cyclic vomiting syndrome: a prospective study. Neurogastroenterol Motil 2010;22:1303-7, e339. https://doi.org/10.1111/j.1365-2982.2010.01577.x
  11. Tache Y. Cyclic vomiting syndrome: the corticotropinreleasing-factor hypothesis. Dig Dis Sci 1999;44(8 Suppl):79S-86S. https://doi.org/10.1023/A:1026602216846
  12. Zaki EA, Freilinger T, Klopstock T, Baldwin EE, Heisner KR, Adams K, et al. Two common mitochondrial DNA polymorphisms are highly associated with migraine headache and cyclic vomiting syndrome. Cephalalgia 2009;29:719-28. https://doi.org/10.1111/j.1468-2982.2008.01793.x
  13. Boles RG, Zaki EA, Lavenbarg T, Hejazi R, Foran P, Freeborn J, et al. Are pediatric and adult-onset cyclic vomiting syndrome (CVS) biologically different conditions? Relationship of adult-onset CVS with the migraine and pediatric CVS-associated common mtDNA polymorphisms 16519T and 3010A. Neurogastroenterol Motil 2009;21:936-e72. https://doi.org/10.1111/j.1365-2982.2009.01305.x
  14. Boles RG, Adams K, Li BU. Maternal inheritance in cyclic vomiting syndrome. Am J Med Genet A 2005;133A:71-7. https://doi.org/10.1002/ajmg.a.30524
  15. Wallace D, Martin AL, Park B. Cannabinoid hyperemesis: marijuana puts patients in hot water. Australas Psychiatry 2007;15:156-8. https://doi.org/10.1080/10398560701196778
  16. Chang YH, Windish DM. Cannabinoid hyperemesis relieved by compulsive bathing. Mayo Clin Proc 2009;84:76-8. https://doi.org/10.4065/84.1.76
  17. Wong BS, Camilleri M, Busciglio I, Carlson P, Szarka LA, Burton D, et al. Pharmacogenetic trial of a cannabinoid agonist shows reduced fasting colonic motility in patients with nonconstipated irritable bowel syndrome. Gastroenterology 2011;141:1638-47.e1-7. https://doi.org/10.1053/j.gastro.2011.07.036
  18. Sullivan S. Cannabinoid hyperemesis. Can J Gastroenterol 2010;24:284-5. https://doi.org/10.1155/2010/481940
  19. Patterson DA, Smith E, Monahan M, Medvecz A, Hagerty B, Krijger L, et al. Cannabinoid hyperemesis and compulsive bathing: a case series and paradoxical pathophysiological explanation. J Am Board Fam Med 2010;23:790-3. https://doi.org/10.3122/jabfm.2010.06.100117
  20. Noel RJ, Putnam PE, Rothenberg ME. Eosinophilic esophagitis. N Engl J Med 2004;351:940-1. https://doi.org/10.1056/NEJM200408263510924
  21. Landres RT, Kuster GG, Strum WB. Eosinophilic esophagitis in a patient with vigorous achalasia. Gastroenterology 1978;74:1298-1301.
  22. Liacouras CA, Furuta GT, Hirano I, Atkins D, Attwood SE, Bonis PA, et al. Eosinophilic esophagitis: updated consensus recommendations for children and adults. J Allergy Clin Immunol 2011;128:3-20. https://doi.org/10.1016/j.jaci.2011.02.040
  23. Wen T, Dellon ES, Moawad FJ, Furuta GT, Aceves SS, Rothenberg ME. Transcriptome analysis of proton pump inhibitor-responsive esophageal eosinophilia reveals proton pump inhibitor-reversible allergic inflammation. J Allergy Clin Immunol 2015;135:187-97. https://doi.org/10.1016/j.jaci.2014.08.043
  24. Papadopoulou A, Koletzko S, Heuschkel R, Dias JA, Allen KJ, Murch SH, et al; ESPGHAN Eosinophilic Esophagitis Working Group and the Gastroenterology Committee. Management guidelines of eosinophilic esophagitis in childhood. J Pediatr Gastroenterol Nutr 2014;58:107-18. https://doi.org/10.1097/MPG.0b013e3182a80be1
  25. Li BU, Lefevre F, Chelimsky GG, Boles RG, Nelson SP, Lewis DW, et al; North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition. North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition consensus statement on the diagnosis and management of cyclic vomiting syndrome. J Pediatr Gastroenterol Nutr 2008;47:379-93. https://doi.org/10.1097/MPG.0b013e318173ed39
  26. Paul SP, Barnard P, Soondrum K, Candy DC. Antimigraine (low-amine) diet may be helpful in children with cyclic vomiting syndrome. J Pediatr Gastroenterol Nutr 2012;54:698-9.
  27. Aanpreung P, Vajaradul C. Cyclic vomiting syndrome in Thai children. J Med Assoc Thai 2002;85 Suppl 2:S743-8.
  28. Hikita T, Kodama H, Nakamoto N, Kaga F, Amakata K, Ogita K, et al. Effective prophylactic therapy for cyclic vomiting syndrome in children using valproate. Brain Dev 2009;31:411-3. https://doi.org/10.1016/j.braindev.2008.07.005
  29. Boles RG, Lovett-Barr MR, Preston A, Li BU, Adams K. Treatment of cyclic vomiting syndrome with co-enzyme Q10 and amitriptyline, a retrospective study. BMC Neurol 2010;10:10. https://doi.org/10.1186/1471-2377-10-10
  30. Van Calcar SC, Harding CO, Wolff JA. L-carnitine administration reduces number of episodes in cyclic vomiting syndrome. Clin Pediatr (Phila) 2002;41:171-4. https://doi.org/10.1177/000992280204100307
  31. Hikita T, Kodama H, Kaneko S, Amakata K, Ogita K, Mochizuki D, et al. Sumatriptan as a treatment for cyclic vomiting syndrome: a clinical trial. Cephalalgia 2011;31:504-7. https://doi.org/10.1177/0333102410390398
  32. Palmer GM, Cameron DJ. Use of intravenous midazolam and clonidine in cyclical vomiting syndrome: a case report. Paediatr Anaesth 2005;15:68-72. https://doi.org/10.1111/j.1460-9592.2005.01369.x
  33. Sato T, Igarashi N, Minami S, Okabe T, Hashimoto H, Hasui M, et al. Recurrent attacks of vomiting, hypertension and psychotic depression: a syndrome of periodic catecholamine and prostaglandin discharge. Acta Endocrinol (Copenh) 1988;117:189-97.
  34. Lee LY, Abbott L, Moodie S, Anderson S. Cyclic vomiting syndrome in 28 patients: demographics, features and outcomes. Eur J Gastroenterol Hepatol 2012;24:939-43. https://doi.org/10.1097/MEG.0b013e328354fc83

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