Cyclic Vomiting Syndrome Research Articles

Relapse Rate of Clinical Symptoms After Stopping Treatment in Children with Cyclic Vomiting Syndrome.

Background: Cyclic vomiting syndrome (CVS) is a chronic functional gastrointestinal disorder. It is characterized by recurrent episodes of vomiting typically separated by periods of symptom-free or baseline health. The present study aimed at evaluating the effectiveness of propranolol and the relapse rate of clinical symptoms after stopping treatment in children suffering from CVS. Methods: Records of 504 patients below the age of 18 years with CVS who were treated with propranolol from March 2008 to March 2018 were reviewed. The duration of follow-up was 10 years. Results: The average age of CVS affliction was 4.3 years and the average age at the diagnosis was 5.8 years. All subjects were treated with propranolol (for an average of 10 months). 92% of treated subjects were cured, causing a dramatic decrease in the rate of vomiting (P < 0.001). Only an average of 10.5% of the studied subjects (53 people) showed a relapse of symptoms after stopping the treatment. The results of a 10-year follow-up period of the patients showed that 24 had abdominal migraine and 6 had migraine headaches, all of whom lacked the symptoms of disease relapse (prognostic evaluation). Conclusion: The findings of this investigation show that the duration of treating CVS with propranolol could be shortened to 10 months with a low percent of symptoms relapse and this shortening may be effective in preventing the undesirable side effects of the drug. The presence of abdominal migraine and migraine headaches in patients after treatment accomplishment and the lack of disease relapse can be prognostic measures for this disease, which require intensive attention.

Cyclic Vomiting Syndrome: An underdiagnosed entity. Report of a case

Cyclic vomiting syndrome is a benign, chronic, functional gastrointestinal pathology that manifests clinically with intense nausea and vomiting interspersed with asymptomatic periods. Its diagnosis is made according to the Rome IV criteria, which require the presence of at least 2 episodes of vomiting in the past 6 months or 3 or more episodes in the past year, with the corresponding exclusion of secondary causes that can explain the vomiting. We present the case of a 44-year-old man who consulted for intermittent nausea and vomiting of 1 year evolution with hydroelectrolytic repercussion and multiple emergency consultations. The diagnosis of cyclic vomiting syndrome was made and treatment with amitriptyline was started due to odulatory effect to prevent the recurrence of episodes. After 6 months of establishing it, the patient is asymptomatic.

Positive outcome of administering palonosetron and haloperidol combination in cyclic vomiting syndrome: a case report.

Background: Cyclic vomiting syndrome (CVS) is a rare disorder in which a patient suffers from recurrent episodes of nausea and vomiting. Onset usually occurs early in childhood, later it might progress into a chronic condition highly affecting on the quality of life. No solid treatment protocol is available to treat CVS. There are many cases in which no improvements are observed after years of trying different treatment regimens. Case Presentation: Here we report a 15-year-old female who was diagnosed as a patient of CVS at the age of 7. She was admitted to the medicine ward within 3 hours of onset in the last year. The patient possesses a history of a unique pattern of onset. She has been hit by the recurrence of the disorder almost once in 8-11 months, lasting for 10-14 days, manifesting as intense nausea, and vomiting once in every 20-40 minutes followed by irregular asymptomatic intervals. Various treatment regimens of unsatisfactory outcome were applied on this patient over the years. After analyzing her previous treatment protocols, we decided to try something new and aggressive, moving with palonosetron and haloperidol, a combination that was never applied on this patient. Conclusion: The outcome was ‘magical&amp;apos; according to the parents of the patient marked by declining of the symptom immediately and complete relief within the next 72 hours, the earliest ever after having onset for this particular patient&amp;apos;s past history of encountering CVS.

Клиническое наблюдение пациентки с синдромом циклической рвоты

Aim. To demonstrate a clinical case of cyclic vomiting syndrome in a patient with central nervous system damage and pathology of the upper gastrointestinal tract. Main points. Cyclic vomiting syndrome is a chronic periodic disorder of childhood that can persist into adulthood. The causes of its occurrence include central nervous system disorders such as abdominal migraines, epilepsy, structural brain damage, mitochondrial diseases, autonomic disorders, and others. Gastrointestinal tract pathology can manifest as episodes of recurrent intense vomiting and nausea lasting from several hours to several days, with varying symptom-free intervals. Conclusion. Detailed study of cyclic vomiting syndrome can help reduce diagnostic search in patients with combined pathology requiring an interdisciplinary approach. Key words: cyclic vomiting syndrome.

Posterior reversible encephalopathy syndrome associated with cyclic vomiting syndrome.

Posterior reversible encephalopathy syndrome associated with cyclic vomiting syndrome.

Cyclic Vomiting Syndrome: Case Report and Review of Differential Diagnoses

Cyclic Vomiting Syndrome: Case Report and Review of Differential Diagnoses

Prevalence and incidence of cyclic vomiting syndrome in Japan: A study using Japanese claims data.

Cyclic vomiting syndrome (CVS) is a gastrointestinal disorder that is characterized by recurrent episodes of vomiting. Previous studies have provided reliable data on the prevalence of CVS among children in Japan; however, neither prevalence data nor incidence of CVS is available for adults. Hence, we obtained detailed prevalence and incidence data for CVS and estimated the total number of CVS cases in Japan. This retrospective cross-sectional study was conducted using the JMDC (JMDC, Inc.; formerly known as Japan Medical Data Center Co., Ltd.,) database, which is a de-identified Japanese claims database. Individuals enrolled between January 2017 and December 2017 were included in this study. Longitudinal data for eligible populations were used to identify patients who displayed CVS symptoms throughout the follow-up period. Due to the lack of a specific diagnosis code for CVS in 2017, the Rome IV criteria were applied to identify CVS cases in the pediatric and adult populations. The prevalence was standardized to the 2017 Japanese census and extrapolated to estimate the number of CVS cases. A total of 2,093 patients with CVS were identified from 3,506,144 individuals. The overall age-and-sex-standardized prevalence was 0.32 per 1,000 population (95% confidence interval [CI]: 0.30-0.34), projected to approximately 49,000 patients with CVS across Japan. The pediatric age-and-sex-standardized prevalence was 2.10 per 1,000 population (95% CI: 2.01-2.19), and the adult prevalence was 0.05 per 1,000 population (95% CI: 0.04-0.06). Marked sex differences were observed before and after 12 years of age. Thus our study provides the first large-population-based estimates of CVS prevalence and incidence in Japan, and currently, the only estimates for adult CVS in Japan.

Clinical and gastroscopic features of children with cyclic vomiting syndrome: an analysis of 63 cases

To study the clinical and gastroscopic features of children with cyclic vomiting syndrome. A retrospective analysis was performed on the medical data of 63 children with cyclic vomiting syndrome who were hospitalized and followed up in Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University from August 2019 to March 2022. Among the 63 children, there were 30 boys and 33 girls, with a mean age of 6.11 years, a mean course of disease of 2.57 years, and a mean vomiting period of 4.04 days. The most common accompanying symptom was listlessness or somnolence (55/63, 87%), followed by anorexia (45/63, 71%), abdominal pain or abdominal discomfort (40/63, 63%), constipation (19/63, 30%), salivation (12/63, 19%), nausea (11/63, 17%), headache (11/63, 17%), fever (6/63, 10%), and rash (1/63, 2%). All 63 children underwent gastroscopy, among whom 3 had no marked abnormalities, 22 (35%) had chronic superficial gastritis or chronic non-atrophic gastritis alone, and 38 (60%) had other abnormal changes aside from chronic gastritis (16 children with reflux esophagitis, 12 with bile reflux gastritis, 13 with duodenitis, 10 with erosive gastritis, and 5 with gastric or duodenal ulcer). Among the 63 children, 42 underwent pathological examinations of gastric mucosa, among whom 5 had no marked abnormalities, 34 had mild chronic gastritis, 2 had moderate chronic gastritis, and 1 had severe chronic gastritis. Among the 63 children, 15 received 24-hour dynamic esophageal pH monitoring during the interictal period, among whom 9 children were found to have pathological acid reflux. In addition to recurrent vomiting, most children with cyclic vomiting syndrome also have the symptoms such as somnolence or listlessness, anorexia, and abdominal pain. The main manifestation on gastroscopy is chronic gastritis, and most children may also have reflux esophagitis, bile reflux gastritis, and erosive gastritis. Mild chronic gastritis is the main pathological change of gastric mucosa.

A Patient Diagnosed with Mosaic Trisomy 18 Presenting New Symptoms: Diaphragmatic Relaxation and Cyclic Vomiting Syndrome. Updated Review of Mosaic Trisomy 18 Cases

AbstractAlthough data on T18 are widespread, there is a lack of knowledge on mosaic trisomy 18 (mT18). A current review of mT18 symptomatology, long-term follow-up, and potential health risks is lacking for health care professionals. Our paper addresses these, emphasizing the importance of regular tumor screening as a key message for mT18 patient follow-up. We also present the case of a female patient with mT18 who presented with diaphragmatic relaxation and cyclic vomiting syndrome (CVS), which had previously not been reported in this genetic condition. On further investigating the etiology of CVS, we revealed a novel mitochondrial mutation in the MT-ND6 gene in heteroplasmic form. Based on the literature, we hypothesize that the mitochondrial mutation together with mT18 could result in CVS.

How to Diagnose and Manage Cyclic Vomiting Syndrome?

1Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California, Los Angeles, California, USA; 2G Oppenheimer Center for Neurobiology of Stress and Resilience, David Geffen School of Medicine, University of California, Los Angeles, California, USA. Correspondence: Lin Chang, MD. E-mail: [email protected].

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.

Comparison of the Effect of Adding L-Carnitine to Propranolol in the Prevention of Cyclic Vomiting Syndrome Attacks in Children

Background: Cyclic Vomiting Syndrome (CVS) is an idiopathic, complex, multifactorial disorder that is often characterized by recurrent episodes of vomiting and is usually separated by asymptomatic episodes. Prophylaxis should be considered in children with frequent or severe periods. Prevention and treatment of CVS in children is very difficult and no specific and effective treatment has been proven in clinical trials. Propranolol is approved for the prophylaxis of CVS in children of all ages, but its effectiveness has been variable. In this study, we investigated the efficacy and safety of adding L-Carnitine to propranolol therapy in the prevention of pediatric CVS. Methods: 76 children who were diagnosed with CVS were included in this study. They were divided into two equal groups. The first group received high dose of Propranolol and the case group received L-Carnitine with low dose of propranolol for 6 months. Results: CVS attacks’ frequency in both groups of treatment with propranolol alone and in combination with L-Carnitine and propranolol, before and after the treatment was significantly reduced. But there is no significant difference between the two groups 70.6%) vs. 90.9%) (p-value=0.062). There was no significant reduction in the duration days between vomiting attack index in both groups (31.6 % vs.43.2%) (p-value= 0.345). Conclusion: Our research revealed that combination of low dose propranolol with L-Carnitine has comparable efficacy with high dose Propranolol in prophylaxis of CVS.

S1635 Gender-Related Difference on Demographics and Comorbidities of Gastroparesis

Introduction: Gastroparesis is known to be more prevalent in females than males, even though the pathophysiology behind it remains unclear. There is lack of gender specific comparison of gastroparesis in terms of demographics and comorbidities. The aim of the study was to compare the demographics and comorbidities of gastroparesis between female and male patients. Methods: Patients who had completed a gastric emptying study and diagnosed with gastroparesis were identified using a nationwide database, IBM Explorys (1999-2022). The following conditions were excluded: cyclical vomiting syndrome, psychoactive substance abuse, eating disorder, factitious disorder, chemotherapy, malignant tumor of esophagus and stomach, neoplasm of abdomen, gastric or intestinal obstruction, IBD, adhesion of intestine, carcinomatosis, perforation of intestine, Roux-en-Y gastrojejunostomy, and gastrectomy. Patients were subdivided into males and females. Demographic information, clinical symptoms and comorbidities were collected. Chi-square tests were performed to compare categorical data. Odds Ratios with a 95% confidence interval were reported. Results: A total of 17,570 patients were identified with gastroparesis, of which 13,090 (75%) patients were females and 4,390 (25%) patients were males. Females and males demonstrated similar trend in the distribution of ethnicity: most patients were White (76.6 vs 74.0%), followed by African American (13.0 vs 14.4%) and other races respectively (Table). There was a higher percentage of females than males in the younger age group: age 20-29 (F vs M: 5.3 vs 4.3%) and age 30-39 (F vs M: 13.8 vs 11.4%) respectively. Male patients with GP had a higher prevalence of diabetes mellitus (M vs F: 52.8 vs 42.8%) and other comorbidities, such as: hypertension (64.0 vs 54.5%), hyperlipidemia (57.2 vs 50.1%), chronic kidney disease (24.1 vs 15.8 %), coronary artery disease (26.4 vs 16.6 %) and smoking (16.6 vs 13.8%) (All P value < 0.0001) (Figure). Female patients had a higher prevalence of anxiety (F vs M: 41.3 vs 27.1%), depression (45.8 vs 31.7%), autoimmune conditions (13.8 vs 5.0%) and morbid obesity (15.6 vs 11.6%) (All P value < 0.0001). Conclusion: Female and male patients with gastroparesis demonstrate similar ethnic distribution. There is a higher percentage of female patients than males in the younger age group. However, female and male patients demonstrate different comorbidities.Figure 1.: Comparison of Comorbidities Between Female and Male patients with Gastroparesis. Table 1. - Comparison of Demographics and Comorbidities Between Female and Male Patients with Gastroparesis Female (N=13090) % Male (N=4390) % OR P Age 20-29 690 5.3% 190 4.3% 1.04-1.45 0.0135 30-39 1810 13.8% 500 11.4% 1.12-1.39 < 0.0001 40-49 2370 18.1% 740 16.9% 1.00-1.19 0.0612 50-59 2710 20.7% 1060 24.1% 0.76-0.89 < 0.0001 60-69 2810 21.5% 970 22.1% 0.89-1.05 0.3811 70-79 2000 15.3% 720 16.4% 0.84-1.01 0.0760 80-89 930 7.1% 290 6.6% 0.94-1.24 0.2618 90 above 260 2.0% 80 1.8% 0.85-1.41 0.4963 Race Caucasian 10030 76.6% 3250 74.0% 1.06-1.24 0.0005 African American 1700 13.0% 630 14.4% 0.81-0.98 0.0215 Asian 110 0.8% 50 1.1% 0.06-0.09 < 0.0001 Hispanic/Latino 120 0.9% 40 0.9% 0.70-1.44 0.9733 Unknown/Other 1130 8.6% 420 9.6% 0.79-1.00 0.0595 Comorbidities DM 5600 42.8% 2320 52.8% 0.62-0.71 < 0.0001 HTN 7130 54.5% 2810 64.0% 0.63-0.72 < 0.0001 HLD 6560 50.1% 2510 57.2% 0.70-0.81 < 0.0001 CKD 2070 15.8% 1060 24.1% 0.54-0.64 < 0.0001 CAD 2170 16.6% 1160 26.4% 0.51-0.60 < 0.0001 Smoking 1810 13.8% 730 16.6% 0.73-0.88 < 0.0001 Anxiety 5410 41.3% 1190 27.1% 1.76-2.04 < 0.0001 Depression 6000 45.8% 1390 31.7% 1.70-1.96 < 0.0001 Autoimmune disease 1800 13.8% 220 5.0% 2.62-3.49 < 0.0001 Morbid obesity 2040 15.6% 510 11.6% 1.27-1.56 < 0.0001

S582 Gastroparesis Is Associated With More Concurrent Gastrointestinal Symptoms and Motility Disorders Than Functional Dyspepsia

Introduction: Gastroparesis (GP) and functional dyspepsia (FD) present with overlapping upper gastrointestinal (GI) symptoms, such as: nausea, vomiting, early satiety, postprandial fullness, epigastric pain, and bloating. Other gastrointestinal motility disorders may be concurrent in patients with GP. The goal of study was to compare the presence of GI symptoms and other motility disorders in patients with GP and FD. Methods: A retrospective cohort study was performed on IBM Explorys (1999-2022), which contains de-identified healthcare information from more than 64 million patients across the United States. Adult patients who have completed gastric emptying study were selected, and subsequently divided into GP and FD cohorts. GP cohort consists of patients with a diagnosis of gastroparesis, with exclusion criteria: cyclical vomiting syndrome, psychoactive substance abuse, eating disorder, factitious disorder, malignant tumor of esophagus and stomach, neoplasm of abdomen, gastric or intestinal obstruction, IBD, adhesion of intestine, carcinomatosis, perforation of intestine, Roux-en-Y gastrojejunostomy, and gastrectomy. FD cohort was similarly constructed with additional exclusion criteria: gastroparesis, gastrointestinal ulcer, brain neoplasm and pancreatitis. The presence of GERD, IBS, GI symptoms and common GI medications were collected. Odds ratios (ORs) with 95% confidence interval were used to compare the cohorts. Results: GP and FD cohort consisted of 17,570 and 60,230 patients respectively (Table). There was a higher prevalence of concurrent motility disorders in patients with GP than FD, including GERD and IBS (65.1 vs 50.9%, 18.6 vs 13.3%). Patients with GP tend to present with more upper and lower GI symptoms than FD, including nausea (65.1 vs 46.3%), vomiting (53.0 vs 33.3%), epigastric pain (36.9 vs 27.2%), heartburn (8.6 vs 7.5%), diarrhea (34.6 vs 23.3%) and constipation (37.2 vs 21.8%) (P< 0.0001) (Figure). However, there was no difference in terms of early satiety and bloating when comparing the two groups. Acid reducing medications, anti-nausea medications and prokinetic agents were more commonly prescribed for patients with GP than FD, including proton pump inhibitors (PPIs), H2 receptor antagonists (H2RA), Metoclopramides and Ondansetron (p< 0.0001). Conclusion: GP is associated with more concurrent GI symptoms and motility disorders compared with FD. Acid reducing medications, anti-nausea and prokinetic medications are more commonly prescribed for patients with GP.Figure 1.: Comparison of GI symptoms between gastroparesis and functional dyspepsia Table 1. - Comparison of GI motility disorders, symptoms and medications between gastroparesis and functional dyspepsia GP (N=17570) % FD (N=60230) % OR P GI diseases GERD 11430 65.1% 30650 50.9% 1.74-1.86 < 0.0001 IBS 3260 18.6% 8030 13.3% 1.42-1.55 < 0.0001 Symptoms Upper GI symptoms Nausea 11430 65.1% 27910 46.3% 2.08-2.23 < 0.0001 Vomiting 9310 53.0% 20060 33.3% 2.18-2.34 < 0.0001 Early satiety 1660 9.5% 5780 9.6% 0.93-1.04 0.5556 Epigastric pain 6490 36.9% 16380 27.2% 1.51-1.62 < 0.0001 Heartburn 1510 8.6% 4500 7.5% 1.10-1.24 < 0.0001 Lower GI symptoms Diarrhea 6070 34.6% 14050 23.3% 1.67-1.80 < 0.0001 Constipation 6540 37.2% 13110 21.8% 2.06-2.21 < 0.0001 Bloating 60 0.3% 170 0.3% 0.90-1.63 0.2039 Medications PPI 13680 77.9% 35430 58.8% 2.37-2.56 < 0.0001 H2RA 7710 43.9% 18310 30.4% 1.73-1.85 < 0.0001 Metoclopramide 8630 49.1% 12490 20.7% 3.56-3.82 < 0.0001 Ondansetron 12570 71.5% 31330 52.0% 2.24-2.41 < 0.0001

S559 The Contribution of Psychiatric Comorbidity and Cannabis Usage to Cyclic Vomiting Syndrome Severity

S559 The Contribution of Psychiatric Comorbidity and Cannabis Usage to Cyclic Vomiting Syndrome Severity

A population-based study on prevalence and predisposing risk factors of infant functional gastrointestinal disorders in a single center in Southern Fujian.

Background and aimThe prevalence of infant functional gastrointestinal disorders (FGIDs) varies across different areas but is largely unknown in southern Fujian. The aim of this study is to evaluate the prevalence of infant FGIDs in southern Fujian according to Rome IV diagnostic criteria.MethodsA cross-sectional prospective questionnaire-based survey was conducted among healthy infants between 0 and 3 months of age in southern Fujian. A total of 1,006 infants who received a physical examination from October 2017 to October 2018 were recruited in this study. Parents or caregivers provided demographic information and completed the questionnaire on gastrointestinal symptoms for infants. Infants with FGIDs were diagnosed using the Rome IV criteria.ResultsBased on the Rome IV criteria, the prevalence of having a FGID in infants is 58.3% (586/1,006). The most common FGIDs in infants were regurgitation (45.7%, 460/1,006), followed by difficult defecation (3.6%, 36/1,006), functional constipation (3.2%, 32/1,006), and colic (2.4%, 24/1,006). No infants fulfilled diagnostic criteria for rumination syndrome and cyclic vomiting syndrome. Among the infants with FGIDs, 457 cases (78.0%, 457/586) were found with single FGID. Combined FGIDs were diagnosed in 129 (22.0%, 129/586) infants; of whom, 21.2% (124/586) had double disorders and 0.9% (5/586) had triple disorders. The most common combined FGIDs were regurgitation and difficult defecation (12.8%), followed by regurgitation and colic (2.4%). Risk factor analysis revealed that younger paternal age (B = 0.424, P = 0.004), paternal history of FGIDs (B = 0.821, P = 0.000), maternal history of FGIDs (B = 0.427, P = 0.012), and probiotics received in infant (B = 0.324, P = 0.032) were associated with an increased risk of infant FGIDs, whereas vitamin D supplementation after birth (B = −0.690, P = 0.000) can reduce the risk of developing FGIDs.ConclusionFGIDs are common in infants living in southern Fujian according to Rome IV diagnostic criteria. The most common FGIDs in infants were regurgitation, difficult defecation, and functional constipation. Factors including younger paternal age, parental history of FGIDs, and the probiotic supplementation in infant showed a significant association with infant FGIDs. Whereas, vitamin D supplementation in infant was found to be a protective factor against FGIDs.

Cyclic vomiting syndrome in children: a nationwide survey of current practice on behalf of the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition (SIGENP) and Italian Society of Pediatric Neurology (SINP)

BackgroundCyclic Vomiting Syndrome (CVS) is a rare functional gastrointestinal disorder, which has a considerable burden on quality of life of both children and their family. Aim of the study was to evaluate the diagnostic modalities and therapeutic approach to CVS among Italian tertiary care centers and the differences according to subspecialties, as well as to explore whether potential predictive factors associated with either a poor outcome or a response to a specific treatment.MethodsCross-sectional multicenter web-based survey involving members of the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition (SIGENP) and Italian Society of Pediatric Neurology (SINP).ResultsA total of 67 responses were received and analyzed. Most of the respondent units cared for less than 20 patients. More than half of the patients were referred after 3 to 5 episodes, and a quarter after 5 attacks. We report different diagnostic approaches among Italian clinicians, which was particularly evident when comparing gastroenterologists and neurologists. Moreover, our survey demonstrated a predilection of certain drugs during emetic phase according to specific clinic, which reflects the cultural background of physicians.ConclusionIn conclusion, our survey highlights poor consensus amongst clinicians in our country in the diagnosis and the management of children with CVS, raising the need for a national consensus guideline in order to standardize the practice.

Worldwide prevalence and burden of gastroparesis-like symptoms as defined by the United European Gastroenterology (UEG) and European Society for Neurogastroenterology and Motility (ESNM) consensus ongastroparesis.

Background/ObjectivesThe global epidemiology of gastroparesis is unknown. The European UEG and European Society for Neurogastroenterology and motility consensus defines Gastroparesis as a condition characterized by delayed gastric emptying in the absence of mechanical obstruction, with a symptom pattern of nausea and/or vomiting and overlapping postprandial distress syndrome (PDS). Real‐world evidence of this gastroparesis‐like symptom pattern is a crucial step in understanding the epidemiology of gastroparesis.MethodsIn the Rome Foundation Global Epidemiology Study, 54,127 respondents from 26 countries completed the Rome IV Diagnostic Questionnaire and variables associated with disorders of gut‐brain interaction via Internet. We selected subjects with gastroparesis‐like symptoms (GPLS) (nausea and/or vomiting ≥1 day/week and simultaneous PDS). Patients reporting organic gastrointestinal disease, or fulfilling criteria for self‐induced vomiting, cyclic vomiting or cannabinoid hyperemesis syndrome were excluded. We determined prevalence, associated comorbidities, quality of life (QoL) (PROMIS Global‐10), symptoms of anxiety and depression (PHQ‐4), somatic symptoms (PHQ‐12), and healthcare utilization.ResultsThe global prevalence of GPLS was 0.9% overall and 1.3% among diabetic individuals. Subjects with GPLS showed frequent overlapping of epigastric pain syndrome and irritable bowel syndrome. Subjects with GPLS had significantly lower body mass index, QoL, more non‐gastrointestinal somatic complaints, symptoms of anxiety and depression, higher medication usage and doctor visits in the overall and diabetic population, compared to subjects without these symptoms.ConclusionsGPLS are common worldwide and more common in diabetic patients. The symptom complex is associated with multiple aspects of illness and an increased healthcare consumption.

Cyclic Vomiting Syndrome in the Emergency Department: A 10-Year Review of Clinical Presentation and Management.

The aims of the study were (1) to determine how frequently patients with cyclic vomiting syndrome (CVS) present to the pediatric emergency department (ED) with CVS-related symptoms, (2) to identify variables in clinical presentation that occur frequently in patients with multiple ED visits, and (3) to compare ED management of CVS with recommended guidelines. This study is a retrospective chart review of all ED visits for CVS between April 1, 2008, and April 1, 2018, at a single center. Patients were identified from a master list of patients diagnosed with CVS in a pediatric gastroenterology clinic at the same center between June 1, 2004, and June 19, 2018. Of the 181 CVS clinic patients identified, 65 had visited to the ED (35.9%). Two hundred twenty-eight visits met inclusion criteria. A total of 42.5% of these visits were made by a small number of high-intensity patients (n = 6) who had an average of 16.1 visits each. These patients represented less than 10% of the total patient group. Patients with frequent visits had longer visits (536.52 vs 380.55 minutes), more frequent hospital admissions (57.73% vs 29.01%), and more visits to the ED before a formal diagnosis of CVS was made (5.83 vs 1.22), but few other distinguishing characteristics. Only 27% of eligible visits were managed with an available order set, and management varied from recommended guidelines. An ambiguous presentation makes the identification and consistent management of CVS in the ED difficult. Physicians should consider CVS for patients who present multiple times with unremitting vomiting to ensure appropriate referral for diagnosis and prophylactic treatment. Future studies are warranted to evaluate anticipatory processing and treatment of the "high-intensity patients" who account for much of the clinical morbidity and resource utilization.

Current perspectives on mitochondrial dysfunction in migraine.

Mitochondria are an autonomous organelle that plays a crucial role in the metabolic aspects of a cell. Cortical spreading depression (CSD) and fluctuations in the cerebral blood flow have for long been mechanisms underlying migraine. It is a neurovascular disorder with a unilateral manifestation of disturbing, throbbing and pulsating head pain. Migraine affects 2.6% and 21.7% of the general population and is the major cause of partial disability in the age group 15-49. Higher mutation rates, imbalance in concentration of physiologically relevant molecules and oxidative stress biomarkers have been the main themes of discussion in determining the role of mitochondrial disability in migraine. The correlation of migraine with other disorders like hemiplegic migraine; mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes [MELAS]; tension-type headache (TTH); cyclic vomiting syndrome (CVS), ischaemic stroke; and hypertension has helped in the assessment of the physiological and morphogenetic basis of migraine. Here, we have reviewed the different nuances of mitochondrial dysfunction and migraine. The different mtDNA polymorphisms that can affect the generation and transmission of nerve impulse has been highlighted and supported with research findings. In addition to this, the genetic basis of migraine pathogenesis as a consequence of mutations in nuclear DNA that can, in turn, affect the synthesis of defective mitochondrial proteins is discussed along with a brief overview of epigenetic profile. This review gives an overview of the pathophysiology of migraine and explores mitochondrial dysfunction as a potential underlying mechanism. Also, therapeutic supplements for managing migraine have been discussed at different junctures in this paper.