Cyclic vomiting syndrome in children: a single-center experience

Abstract

Background Cyclic vomiting syndrome (CVS) is a functional disorder characterized by recurrent episodes of intractable vomiting separated by symptom-free periods. The onset starts at any age from infancy to adulthood. Little is known about its etiology. The diagnosis is based on the fulfillment of Rome IV criteria. CVS is usually a misrecognized disorder, and delayed diagnosis is very common. Aim The purpose was to evaluate the prevalence, clinical characteristics, prereferral management, and response to treatment among children with proved CVS in our institution. Patients and methods This was a retrospective study that included all children with CVS attending the Gastroenterology Clinic at Alexandria University Children’s Hospital between January 2016 and the end of June 2019. All patients were followed up for at least 6 months. The diagnosis is based on the fulfillment of Rome IV criteria. The following data were retrieved from the medical records including demographic information, evaluation steps performed for diagnosis, analysis of CVS characteristics, prereferral management, and finally, the treatment algorithm and response to treatment during follow-up. Results The study included 79 patients, and two-thirds of them were females. They constituted 2–5% of the cases referred yearly to our clinic. Evaluation for possible organic cause was indicated in 22.7%. No abnormalities were found in the barium studies. Other investigations including gastroscopies were not diagnostic for other organic causes. The mean age at onset of symptoms was 6±3.3 years. Overall, 25.3% of patients reported specific triggers, and 62.5% reported recognizable prodromes. The episodes were stereotypic among all patients. Overall, 52% experienced the start of the episodes at night. The interval between episodes was 2.5±1.8 months. The mean duration of each episode was 2.4±2 days. Listlessness and pallor were the commonest during the vomiting phase. The vomiting was bilious in 65.8%and contained blood in 50.8%. Personal history of migraine was positive in 9%. Family history of migraine and motion sickness was positive in two-thirds. The mean duration before referral of the patients was 12.5+8 months. Overall, 78% of the episodes were interpreted as episodes of gastroenteritis, food poisoning, or acid peptic disorders. Moreover, 54.4% were admitted at least once. The overall response to the first-line prophylactic therapy is 89.3%, with no significant adverse effects. Conclusion The prevalence and clinical characteristics were similar to other similar reports. Barium studies are not necessary in most of the patients. CVS is prevalent yet an underdiagnosed health problem. Propranolol is effective and safe and may be considered as a first-line prophylaxis in patients older than 5 years of age.