Cyclic Vomiting Syndrome Patients Research Articles

Distinguishing Clinical Features of Cannabinoid Hyperemesis Syndrome and Cyclic Vomiting Syndrome: A Retrospective Cohort Study

ObjectiveTo identify clinical characteristics that distinguish cannabinoid hyperemesis syndrome (CHS) from cyclic vomiting syndrome (CVS), two conditions marked by episodes of nausea, vomiting, and abdominal pain. Study designWe performed a retrospective chart review of patients admitted to a large children’s healthcare system from 2015 through 2022. CHS and CVS patients were identified by the electronic medical record using ICD-9/10 codes. ResultsOf 201 patients screened, 125 were included. CHS patients were older than those with CVS (mean [SD] 18.06 [1.41] vs. 14.50 [2.91] years, p<0.001). There were no significant differences in gender, race, ethnicity, or hospital length of stay between groups. CHS patients were more likely to have a positive urine drug screen (86% vs. 2.9%, p<0.001), lower mean (SD) serum potassium (3.62 [0.77] vs. 3.88 [0.49], p<0.001), and higher mean (SD) serum creatinine (0.83 (0.41) vs. 0.63 (0.17), p<0.001). The average (SD) systolic blood pressure (SBP) was significantly higher in CHS patients (SBP 124.46 [10.66] vs. 118.55 [10.99], p=0.032) compared with CVS children of comparable age range. Imaging was obtained in 36% of all patients and only 2.4% had abnormalities. ConclusionsClinical features including older age, higher systolic blood pressure, positive urine drug screen, and select electrolyte findings might distinguish CHS from CVS. Abdominal imaging in both conditions is of low yield. These findings may allow for early recognition and appropriate therapy in CHS patients.

EXPRESS: Plasma endocannabinoids and cannabimimetic fatty acid derivatives are altered in cyclic vomiting syndrome: The effects of sham feeding.

Cyclic vomiting syndrome (CVS) is an underdiagnosed disorder of the gut-brain interaction. Our understanding of the pathophysiology of CVS is evolving. Here, we tested the hypotheses that: (1) the levels of endocannabinoids and related lipids are altered in CVS, and (2) cephalic-vagal stimulation drive changes in endolipid levels. Ten adult patients with CVS and 8 healthy controls were included. Indirect measurements of parasympathetic (RFa) functions were performed with spectral analysis of heart rate variability and respiratory activity. Plasma levels of endocannabinoids and related lipids were measured at baseline and during a sham feeding. Values are reported as mean ± SEM and compared using t-test or ANONA. CVS patients had a lower parasympathetic tone and response to Valsalva maneuver and deep breathing than the controls. The baseline 2-Arachidonoylglycerol (2-AG) had a significantly higher concentration in CVS (5.9e-008 ± 3.7e-008 mole/L) than control (3.7e-008 ± 1.3e-008 mole/; p<0.05). Sham feeding did not change the concentration of 2-AG. 2-linoleoylglycerol and 2-oleoylglycerol were significantly higher in CVS than control and did not change with sham feeding. Levels of N-acyl ethanolamines, including Anandamide (AEA), were not different in CVS vs. control. After sham feeding, AEA showed a trend toward increasing (P=0.08) in CVS, but not in control. With sham feeding, palmitoyl ethanolamine significantly increased in both CVS and control groups; oleoyl ethanolamine in CVS only, and stearoyl ethanolamine in the control group. Levels of endocannabinoids and related lipids are altered in CVS patients. Sham feeding affects endogenous signaling lipids in a disease and time-dependent manner.

Clinical characteristics and long-term outcomes in patients with cyclic vomiting syndrome: A 15-year experience at a tertiary referral center.

Cyclic vomiting syndrome (CVS) is a disorder of gut-brain interaction (DGBI) characterized by recurrent episodes of nausea and vomiting. Most children outgrow their CVS symptoms and develop migraine headaches, but there are limited data in adults. We thus sought to determine the natural history of CVS in adults. We conducted a retrospective analysis of patients at a specialized tertiary care clinic. Frequency of CVS episodes, emergency department (ED) visits, and hospitalizations were recorded at the index visit and at follow-up. Of 455 CVS patients with complete data, mean age was 33 ± 13 years, 294 (65%) were female, and 392 (86%) were Caucasian. Mean duration of follow-up was 47.4 ± 37.2 months. There was a significant reduction in frequency of CVS episodes/year (18 to 6.8), ED visits (6.1 to 2), and hospitalizations (2.3 to 0.7) (all p-values < 0.001) but only 88 (19%) of patients had complete resolution of episodes at follow-up. On multivariable regression analysis, non-white race [0.33 (0.11-0.98) p = 0.01], comorbidity count [0.77 (0.62-0.95) p = 0.01], cannabis use [0.36 (0.2-0.65) p = 0.0007], and aprepitant use [0.2 (0.08-0.005) p < 0.001] were associated with a reduced odds of complete resolution of CVS episodes. Of note, 19 patients (4%) died. While most adults with CVS improved with specialized care, in contrast to children, only a small subset (~1 in 5) had complete resolution of symptoms. Reasons for the effects of race, cannabis use, and comorbidity burden on outcomes in CVS are unclear and warrant further investigation.

Efficacy of aprepitant as a prophylactic medication in adults with cyclic vomiting syndrome.

Aprepitant is a neurokinin-1 receptor antagonist, and recent guidelines by the American Neurogastoenterology and Motility Society recommend its use as prophylaxis in moderate-to severe cyclic vomiting syndrome (CVS). Data are limited to small studies in children. We aimed to determine its efficacy in adults with CVS. A retrospective review of CVS patients diagnosed using Rome criteria at a tertiary referral center was conducted. Drug response was defined as >50% reduction in symptoms and/or healthcare utilization. An intent-to-treat (ITT) analysis was conducted. Of 96 patients prescribed aprepitant, 26 (27%) were unable to start due to cost/lack of insurance coverage. Of 70 receiving therapy, mean age was 33 ± 11 years; 51 (73%) were female and 56 (80%) Caucasian. The majority (93%) were refractory to other prophylactic medications. Aprepitant was taken thrice weekly in 51 (73%), daily in 16 (23%) and a few times a month in 3 (4%) due to cost. Fifty (71.4%) had a global symptom response to aprepitant. There was significant reduction in the number of CVS episodes (14.5± 11.7 to 6.2± 8.0, p< 0.0001), emergency department visits (4.2± 7.7 to 1.8± 3.4, p= 0.006), and hospital admissions (1.6± 3.9 to 0.8± 2.1, p= 0.02) in patients treated with aprepitant. Seven (10%) discontinued the drug due to minor side effects. Aprepitant is a safe and effective prophylactic medication in adults with refractory CVS. Adequate insurance coverage is a major barrier preventing its use.

Nutrient Drink Test to Assess Gastric Accommodation in Cyclic Vomiting Syndrome: Single-blinded Parallel Grouped Prospective Study

Cyclic vomiting syndrome (CVS) is characterized by episodes of nausea and vomiting, separated by symptom-free intervals. The pathogenesis of CVS is poorly understood. Limited data exist on evaluating impaired gastric accommodation as a mechanistic means for symptoms. We aim to determine if CVS patients demonstrate impaired gastric accommodation applying a nutrient drink test (NDT) protocol. Through this single-blinded pilot clinical trial, patients with CVS per Rome IV critera and healthy controls were assessed for presence of impaired gastric accommodation by administering an established NDT protocol. Statistical analysis was performed, with data presented as medians and interquartile range. Eleven CVS patients and 15 healthy controls participated in the study between January 2018 and October 2018. Median age was 42.0 years and 37.0 years; majority of subjects were female, 72.7% and 73.3%, respectively. Demographics were similar between CVS and healthy controls. Almost all healthy controls (93.3%) ingested the complete 500 mL protocol, whereas a smaller proportion (72.7%) were able to complete all 4 doses in the CVS group (P = 0.188). Post-prandial visual analogue scale scores of nausea and abdominal pain were found to be significantly higher in CVS patients compared to healthy controls. To our knowledge, this is the first NDT protocol in CVS evaluating the role of impaired gastric accommodation and hypersensitivity as a possible pathophysiologic mechanism. Findings from this study suggest the presence of gastric hypersensitivity in a subset of CVS patients. These results provide the foundational data necessary for future larger testing of NDT and diagnostic accuracy in CVS.

Prevalence of Undiagnosed Acute Hepatic Porphyria in Cyclic Vomiting Syndrome and Overlap in Clinical Symptoms.

Acute hepatic porphyria (AHP) presents with nausea and vomiting and can mimic cyclic vomiting syndrome (CVS). The prevalence of AHP in CVS and overlap in clinical symptomatology is not known. We thus sought to determine the prevalence of pathogenic variants for AHP and characterize symptom overlap between CVS and AHP. We conducted a cross-sectional study of 234 CVS patients using Rome criteria. Patients were eligible for AHP genetic testing if they had recurrent episodes of severe, diffuse abdominal pain with ≥ 2 of the following-peripheral nervous system (muscle weakness/aching, numbness, tingling), central nervous system (confusion, anxiety, seizures, hallucinations), autonomic nervous system (hyponatremia, tachycardia, hypertension, constipation) symptoms, red/brownish urine, or blistering skin lesions on sun-exposed areas. A family history of AHP or elevated urinary porphobilinogen (PBG)/aminolaevulinic acid (ALA) were also criteria for genetic testing and was performed using a 4-gene panel. Mean age was 38.7 ± 14.5years, 180 (76.9%) were female and 200 (85.5%) were Caucasian. During a CVS attack, 173 (92%) reported abdominal pain, 166 (87.2%) had peripheral nervous system, 164 (86.8%) had central nervous system and 173 (92) % had autonomic symptoms. Ninety-one eligible patients completed genetic testing. None were positive for AHP but two had variants of uncertain significance (VUS) in the HMBS gene. There is a high prevalence of non-gastrointestinal symptoms in CVS, like AHP, which is important for clinicians to recognize. AHP was not detected in this study and larger studies are warranted to ascertain its prevalence.

Low patient engagement is associated with reduced health-related quality of life in adults with cyclic vomiting syndrome

Introduction Patient engagement, adaptation and self-management play a critical role in improving Health Related Quality of Life (HRQOL) and reducing health care utilization in chronic disorders. There is no data on the level of patient engagement in patients with cyclic vomiting syndrome (CVS); we thus sought to determine their level of engagement and its association with clinical covariates. Methods The Patient Activation Measure (PAM-13), a validated tool that measures the degree of patient engagement in their health was administered prospectively to patients with CVS. Data on demographics, health care utilization, and HRQOL (using the NIH PROMIS 10) were obtained. Patients were stratified into low engagement (PAM 1 & 2) and high engagement (PAM 3 & 4). The Fisher’s exact test and Wilcoxon rank-sum tests were used to identifying significant differences between the groups. Results Of 96 patients, 45% of patients had low levels of patient engagement. On multivariate analysis, low patient engagement was significantly associated with an increased number of CVS hospitalizations in the past year (aOR 1.26 [1.07, 1.54] p = .010), lower mental HRQOL scores (aOR 0.88 [0.78, 0.97] p = .022), current tobacco use (aOR 4.85 [1.24, 22.74] p = .031), and patients who were newly established in a specialized CVS clinic (aOR 44.40 [5.38, 70.02] p = .002). Conclusion Almost half of CVS patients demonstrate poor patient engagement, which is associated with poor outcomes. Identifying these patients and treatment in a specialized CVS center can potentially improve HRQOL, reduce health care utilization and improve overall healthcare outcomes.

Burden of psychiatric disorders in patients with cyclic vomiting syndrome - Need for aggressive screening and early intervention

Cyclic vomiting syndrome (CVS) is a debilitating disorder with stereotypical episodes of recurrent vomiting lasting from hours to days. Prior studies have shown that CVS is associated with increased psychiatric comorbid conditions both in pediatric and adult population [1,2]. Psychiatric disorders such as anxiety may have profound effect in the general well-being and may also decrease the health-related quality of life among patients with CVS [3]. Further, cognitive behavioral therapy, relaxation techniques, and psychopharmacotherapies have been proven to be helpful in treating CVS patients and implies the complex association between CVS and psychiatric disorders [4].

Cyclic Vomiting

The novel corona virus disease (COVID-19) has caused a great pandemic since the end of 2019. A variety of symptoms has been identified for this disease. In this case series we report 5 patients in different age groups who presented with cyclic vomiting as a late complication of COVID-19. All patients have gone through complete diagnostic process for cyclic vomiting syndrome (CVS) including endoscopy. However, they all showed normal findings. The diagnosis of cyclic vomiting syndrome was made based on the symptoms and normal endoscopic and laboratory findings. We treated all of the patients applying the guideline we previously published regarding treatment of CVS patients. According to the results of the present study, CVS might be a late complication of COVID-19 infection. So, it is necessary for physicians to consider it as a differential diagnosis in patients with recent COVID-19 infection and to be aware of its management in each phase.

Greater intolerance to uncertainty predicts poorer quality of life in adults with cyclic vomiting syndrome.

Cyclic vomiting syndrome (CVS) is an idiopathic disorder of gut-brain interaction characterized by recurrent bouts of nausea and vomiting. Although CVS negatively impacts quality of life (QOL), the determinants of impaired QOL among adult CVS sufferers are not fully understood. The unpredictability of CVS attacks may generate anticipatory anxiety and worsen quality of life in a substantial proportion of patients with CVS. Intolerance to uncertainty (IU) is a cognitive trait in which individuals experience distress when faced with unpredictable situations, particularly those with potentially negative consequences. Higher trait IU is a well-established vulnerability factor linked to the development of multiple psychiatric conditions, including anxiety. However, the extent to which higher IU is associated with impaired QOL in adults with CVS is not known. To explore this issue, we surveyed 118 adult CVS patients and obtained demographic information, clinical features, reported healthcare utilization, and standardized assessments of IU, anxiety and panic, and QOL. Adult CVS patients with higher IU did not report a greater frequency of CVS attacks or overall CVS-related healthcare utilization than those with lower IU. Yet, this group demonstrated substantially poorer physical and mental health-related QOL and higher rates of anxiety-spectrum disorders. Higher degrees of IU are associated with increased anxiety and reduced QOL in patients with CVS. IU is a malleable cognitive trait that can be targeted by cognitive behavioral therapy (CBT). Our results suggest that some CVS patients may benefit from non-pharmacologic therapies such as CBT.

Efficacy of Coenzyme Q10 in the Treatment of Cyclic Vomiting Syndrome in Children

Cyclic Vomiting Syndrome (CVS) is a chronic functional gastrointestinal disorder related to migraine, characterized by episodic nausea and vomiting. The treatment of CVS remains based on tricyclic antidepressants, triptans and antiepileptics. As mitochondriopathy has been involved in the pathophysiology of CVS, Coenzyme Q10 (CoQ10), a mitochondrial cofactor, has been used as the third line treatment in CVS. Considering the excellent safety profile of CoQ10, we decided to use it as the first line treatment in CVS. We retrospectively studied the evolution of 23 CVS patients who were treated for one year by CoQ10 alone. We recorded the characteristics of patients and their CVS history and compared data obtained the year before and the year following the prescription of CoQ10 treatment. We found a significant decrease in the number of vomiting episodes between the year before and the year after the start of CoQ10 (median [IQR]: 18.0 [15.75] vs. 3.00 [5.0]; p &lt;0.001). This decrease persisted with time (2 and 3 years of treatment). The treatment was very efficient in 17/23 patients and did not decrease the number of vomiting episodes in 3 patients. Only one mild side effect related to the drug has been reported. Conclusions: CoQ10 is an efficient and safe treatment of CVS and should be used as the first line treatment in this episodic syndrome related to migraine.

Prevalence of cannabis use has significantly increased in patients with cyclic vomiting syndrome.

Cyclic vomiting syndrome (CVS) is a functional gastrointestinal disorder which leads to multiple hospitalizations and causes significant impairment of quality of life. Cannabis use is common in patients with CVS, and there are limited data on the national trends in the prevalence of its use in the United States. We used the National Inpatient Sample (NIS) database from 2005 to 2014 and identified hospitalizations with a primary diagnosis of CVS by utilizing the International Classification of Diseases, 9th revision Clinical Modification (ICD-9 CM) coding system. The primary objective of the study was to analyze the prevalence and trends in cannabis use in CVS patients. We also assessed healthcare resource utilization associated with cannabis use. A total of 129090 hospitalizations with a primary diagnosis of CVS were identified and included in the study. In the United States, the overall rate of cannabis use among these patients was 104 per 1000 hospitalizations (N=13460). Over the last decade, the prevalence of cannabis use increased by 10-fold, from 2.2% in 2005 to 21.2% in 2014. Our analysis of the national database suggests that nearly 1 in 5 CVS hospitalizations have concurrent cannabis use. This prevalence is significantly rising over the last decade, perhaps due to changing legislation and increased utilization of cannabis. Age younger than 35, male gender, African American and Native American race, personal history of alcohol abuse and tobacco use were some of the strongest predictors of cannabis use.

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

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.

Comparison of the Efficacy of Amitriptyline and Topiramate in Prophylaxis of Cyclic Vomiting Syndrome.

Cyclic vomiting syndrome (CVS) is a chronic functional gastrointestinal disorder with no certain treatment. We aimed to compare the efficacy of amitriptyline and topiramate on prophylactic therapy of CVS. This randomized clinical trial (registration number: IRCT2015102316844N2) was conducted during 2016 in Isfahan, central Iran. The inclusion criteria were CVS patients (based on Rome III) aging 3-15 yr with normal physical examination, no metabolic disorder, and no gastrointestinal obstruction or renal impairment. Recruited patients were divided into two groups of amitriptyline (1 mg/kg/d) and topiramate (1-2 mg/kg/d) and were followed for 3-months. The outcome was evaluated by comparing severity of attacks (monthly frequency and duration of attacks) before and after intervention. Thirty-six children entered each group and two patients left the amitriptyline group. Patients and disease characteristics were similar between groups before intervention (P>0.05). The frequency of attacks (standard deviation) after intervention in amitriptyline and topiramate group was 0.91 (0.40) and 1.07 (0.55), respectively (P=0.368) and the duration of attacks (SD) after intervention were 3.43 (2.46) and 4.90 (3.03), respectively (P=0.017). Twenty-three patients (68%) in amitriptyline group and 14 patients (39%) in topiramate group stopped having attacks after intervention (P=0.016). Amitriptyline is a better choice to reduce severity of CVS attacks compared to topiramate, in a short-term evaluation. Studies with longer follow-up are required to investigate these findings in a longer period.

Specific Neuroanatomical Abnormalities Identified in Cyclical Vomiting Syndrome Based on Brain MRI Analysis

Introduction: Cyclic vomiting syndrome (CVS) in adults is a disorder characterized by recurrent abrupt bouts of nausea, vomiting, and abdominal pain separated by variable symptom-free periods. Major etiological factors include migraine, stress, and marijuana use (MU). A dysregulation of central neural pathways and neuro-endocrine mediators are hypothesized to play a role in pathophysiology. This study investigated whether there are neuroanatomical differences in CVS. Methods: 21 CVS patients and 15 healthy controls (HC) participated (Table 1). CVS patients were scanned during a symptomatic episode. 13 reported migraines, 12 high levels of stress, 10 chronic MU, and 6 all 3. High-resolution anatomical MPRAGE images were obtained in each participant. Images were preprocessed using standard pipelines in Freesurfer and tested for differences in cortical thickness and subcortical volume between CVS and HC. Surface-based results were thresholded and corrected for multiple comparisons using Monte Carlo simulation. Results: Surface-based cortical thickness analysis (Figure 1) revealed that CVS had significantly lower cortical thickness in bilateral precuneus (left: p =.001; right: p=.0002), left superior frontal gyrus (p=.008), and right precentral gyrus (p=.0084) than a HC. No cortical differences were found between MU and non-marijuana use (Non-MU) subgroup of CVS patients. Subcortical results (Figure 2) identified reduced cortical volumes in Non-MU in bilateral hippocampus (left: p=.002; right: p=.001) and amygdala (left: p=.023; right: p=.038). The MU had significantly greater cortical volumes in bilateral putamen (left: p=.05; right: p=.03) and pallidum (left: p=.004; right: p=.01) vs. non-MU but did not significantly differ from HC.437_A Figure 1. Subject demographics437_B Figure 2. Clusters showing lower cortical thickness in CVS patients relative to controls. Results are presented on the inflated cortical surface of the Freesurfer template. A) Medial view of left hemisphere showing precuneus cluster. B) Lateral view of left hemisphere showing superior frontal gyrus cluster. C) Medial view of right hemisphere showing precuneus cluster. D) Lateral view of right hemisphere showing precentral gyrus cluster.Conclusion: Based on brain MRI analysis we conclude that symptomatic CVS patients had cortical thinning relative to HC in precuneus and caudal regions of prefrontal/premotor cortex. Non-MU also had lower subcortical volume measures in the amygdala and hippocampus vs. HC. The precuneus is involved in visuo-spatial, vestibular processing and self-awareness, which suggests a potential sensory-integration or vestibular basis for CVS, while the amygdala and hippocampus are involved in processing pain, emotion, and stress. MU had greater basal ganglion cortical volumes consistent with increased dopaminergic stimulation. Our results provide evidence for a neuroanatomical basis of CVS with possible implications for future therapy.437_C Figure 3. Subcortical volumetric results. Error bars depict 95% Confidence Intervals (CI) within each Region of Interest (ROI).

Acute Management of Cyclic Vomiting Syndrome Patients in the Emergency Department Setting

Acute Management of Cyclic Vomiting Syndrome Patients in the Emergency Department Setting

Yield and Costs of Evaluating Children With Cyclic Vomiting Syndrome.

Cyclic vomiting syndrome (CVS) clinical guidelines recommend an algorithm of basic testing for standard patients, and more targeted testing, including laboratory and imaging studies, in the presence of specific red flags. The cost-effectiveness of this screening of children with suspected CVS is lacking. The objectives of this study are to determine whether screening studies in CVS patients results in diagnostic change and to estimate their healthcare cost. Charts of patients (1-18 years) with suspected CVS were retrospectively reviewed at a single center. Results and cost of laboratory and imaging studies were analyzed. A total of 503 charts were reviewed from electronic medical records with the International Classification of Diseases-9 (ICD-9) code 536.2 or search terms "CVS, cyclic vomiting, persistent emesis/vomiting, hyperemesis, or intractable/ periodic vomiting." Of these, 165 (33%) had a diagnosis of CVS and 135 (82%) children (mean age 7.7 ± 4.3; 73 (54%) girls) met CVS criteria based on North American Society for Pediatric Gastroenterology, Hepatology and Nutrition diagnostic criteria. Of those meeting CVS criteria, 6 (4%) had a change in management based on the CVS screening evaluation. The mean cost of screening per patient that met CVS criteria was $6125.02 and the estimated total cost for all patients who met CVS criteria was $826,877.88. The screening metabolic laboratory results, pelvic ultrasound, magnetic resonance imaging, and upper endoscopy resulted in a diagnosis change in few patients screened for CVS. Most children who met criteria for CVS did not benefit from screening evaluation as results did not change clinical diagnosis or management, and were associated with higher cost.

Mo1658 - Frequent Flyers' in Emergency Departments: Why Should we Understand and Care about Cyclic Vomiting Syndrome Patients?

Mo1658 - Frequent Flyers' in Emergency Departments: Why Should we Understand and Care about Cyclic Vomiting Syndrome Patients?

Clinical Characteristics, Comorbidities and Hospital Outcomes in Hospitalizations with Cyclic Vomiting Syndrome: A Nationwide Analysis.

Data on cyclic vomiting syndrome (CVS) are limited to studies from tertiary care centers. There is a paucity of information about CVS on a national scale. To study the clinical characteristics, comorbidities, and hospital outcomes in patients hospitalized with CVS using a nationwide database. We identified all hospitalizations associated with a primary diagnosis of CVS in 2010 and 2011 using the Nationwide Inpatient Sample with an age category of 18-55years. A 1:2 random sample of non-CVS hospitalizations with the same age category was obtained, and comparisons between groups were made. Multivariate logistic regression analysis was used to determine comorbidities independently associated with CVS. Our study included 20,952 CVS and 44,262 non-CVS patients. CVS patients tended to be younger, male, and white compared to non-CVS patients. On multivariate analysis, CVS was significantly associated with comorbidities including dysautonomia, migraine, anxiety, marijuana use, irritable bowel syndrome, gastroparesis, gastroesophageal reflux disease, asthma, cigarette smoking, and hypertension. CVS patients underwent esophagogastroduodenoscopy, colonoscopy, and gastric emptying tests more frequently. They had more favorable hospital outcomes like more routine discharges (discharge to home/self-care), lower mortality, and shorter length of stay but tended to leave against medical advice more frequently. CVS patients incurred total hospital charges of about $400 million over the 2years. Our study showed that CVS is associated with several comorbidities and incurred substantial health care costs despite benign outcomes. Efforts to optimize therapy of CVS, manage comorbid conditions and reduce healthcare utilization are warranted.

Gastric Electrical Stimulation Is an Option for Patients with Refractory Cyclic Vomiting Syndrome.

Background/AimsCyclic vomiting syndrome (CVS) is a disabling migraine variant manifesting as severe episodes of nausea and vomiting and often refractory to many therapies. Gastric electrical stimulation (GES), which can reduce nausea and vomiting in gastroparesis, may provide symptomatic relief for drug-refractory CVS. This study assessed the utility GES in reducing the symptoms of CVS and improving the quality of life.MethodsA one-year, non-randomized, clinical study was conducted. Eleven consecutive patients with drug refractory, cyclic vomiting syndrome based on Rome III criteria and North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN), underwent treatment with temporary GES (Temp GES) and permanent GES (Perm GES). Post-treatment follow up was done up to one year after permanent gastric electrical stimulation therapy.ResultsTotal symptom score decreased by 68% and 40% after temporary and permanent GES therapies, respectively. Hospital admission events significantly decreased to 1.50 (± 1.00) events from 9.14 (± 7.21) annual admissions prior to treatment with permanent GES. Vomiting episodes fell by 83% post Temp GES and 69% after Perm GES treatments. Mucosal electrogram values also changed after temporary stimulation.ConclusionsIn a small group of drug-refractory CVS patients, treatments with temporary and permanent GES significantly reduced the severity of gastrointestinal symptoms and frequency of hospital admissions.