Cyclic Vomiting Syndrome Research Articles

Mo1561 – Prevalence of Cyclic Vomiting Syndrome in Adults and Outcome of Cannabis Use in This Population: A National Study

Mo1561 – Prevalence of Cyclic Vomiting Syndrome in Adults and Outcome of Cannabis Use in This Population: A National Study

1000 – Symptomatic Control of Cyclic Vomiting Syndrome in Patients Can Be Achieved Independently of Central Nervous System Abnormalities Detected by Brain Mri

1000 – Symptomatic Control of Cyclic Vomiting Syndrome in Patients Can Be Achieved Independently of Central Nervous System Abnormalities Detected by Brain Mri

Su1617 – Neuroanatomical and Connectivity Abnormalities Identified in Cyclic Vomiting Syndrome Based on Brain Mri Analysis

Su1617 – Neuroanatomical and Connectivity Abnormalities Identified in Cyclic Vomiting Syndrome Based on Brain Mri Analysis

Cyclic vomiting syndrome and benign paroxysmal torticollis are associated with a high risk of developing primary headache: A longitudinal study.

Episodic syndromes that may be associated with migraine are a group of disorders affecting patients with migraine or with an increased risk of presenting it, and likely represent an early life expression of migraine. Cyclic vomiting syndrome and benign paroxysmal torticollis are well characterized and represent a frequent cause of request for specialist consultations. The aim of this study is to longitudinally assess the rate of headache in patients presenting with cyclic vomiting syndrome and benign paroxysmal torticollis during infancy, and to define the main clinical features of the disorder. We administered a questionnaire to the parents of all our pediatric patients with previous diagnosis of cyclic vomiting syndrome and/or benign paroxysmal torticollis according to ICHD-3; questions were focused on the main clinical features of the disorder as well as the prognosis, with particular emphasis on the development of headache. For the final analysis we considered 82 patients with cyclic vomiting syndrome and 33 with benign paroxysmal torticollis. Seventy-nine percent of patients with cyclic vomiting syndrome presented with headache during the follow-up, with a mean age at onset of 6 years; 67% of patients with benign paroxysmal torticollis suffered from headache during the follow-up, with a mean age at onset of 5 years. Cyclic vomiting syndrome and benign paroxysmal torticollis are associated with a very high risk of developing headache, mostly migraine, later in life. In both groups of patients, the vast majority presented with different episodic syndromes that may be associated with migraine at different ages, thus suggesting an age-dependent evolution of migraine-like symptoms before the onset of clear migrainous headache.

Cyclic Vomiting Syndrome: An Easily Overlooked Disorder

Cyclic Vomiting Syndrome: An Easily Overlooked Disorder

A UNIQUE CASE OF REVERSE TAKOTSUBO CARDIOMYOPATHY ASSOCIATED WITH CYCLIC VOMITING SYNDROME

Takotsubo cardiomyopathy is a condition associated with transient left ventricular dysfunction. One of the rare atypical variant is the reverse takotsubo cardiomyopathy. Most common etiology is stress related catecholamine release. Cyclic vomiting syndrome is a condition associated with recurrent

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.

A case series of cyclic vomiting syndrome in paediatric patients at a tertiary care hospital in Chennai, Tamil Nadu, India

Background: Cyclic vomiting syndrome is an increasingly recognized disorder with sudden, repeated episodes of severe nausea, vomiting, and physical exhaustion that occur with no apparent cause. It is more common in children than adults. However, we don’t often see a diagnosis of cyclic vomiting syndrome being made. Hereby we report 7 cases of cyclical vomiting.Methods: This is a retrospective study. Medical records of 5 years were review and consecutive paediatric patients discharged with a diagnosis of cyclic vomiting syndrome were identified, data collected and analysed.Results: Total of 7 cases were found, all of which were adolescents. The mean age was 13.28. 57.14% (4) were females and 42.86% (3) were boys. 42.86% (3) presented with complications. 14.28% (1) had an association with menstrual cycles and 14.28% (1) had an association with psychological stress.Conclusions: Cyclic vomiting syndrome should be kept in mind when a child presents with multiple episodes of vomiting, especially when repeated admissions have been made for the same. Early diagnosis and treatment can improve the quality of life.

Migraine, Cyclic Vomiting Syndrome, and Other Gastrointestinal Disorders.

Cyclic vomiting syndrome (CVS) is a chronic functional gastrointestinal disorder characterized by episodic nausea and vomiting and is diagnosed using Rome IV criteria. CVS is being recognized more frequently in adults with a prevalence of 2%. It is associated with several functional disorders like autonomic dysfunction, anxiety, and depression, but the strongest association is with migraine. We will elucidate the close relationship between migraine and CVS and briefly discuss its association with other gastrointestinal disorders. We highlight similarities in pathophysiology, clinical presentation, and response to medications between CVS and migraine (tricyclic antidepressants, triptans, antiepileptics). We also discuss novel therapies like CGRP inhibitors which are effective in migraine and have potential for adaptation in patients with CVS. Using migraine as a template should enable investigators to elucidate the mechanisms underlying this disorder, develop novel therapies, and direct future research in CVS.

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

A Need to Raise Awareness for Cyclic Vomiting Syndrome: An Underdiagnosed Clinical Entity

A Need to Raise Awareness for Cyclic Vomiting Syndrome: An Underdiagnosed Clinical Entity

Cyclic Vomiting Syndrome in Children and Adults: What Is New in 2018?

Cyclic vomiting syndrome (CVS) is a disabling functional gastrointestinal disorder characterized by severe vomiting episodes that alternate with symptom-free periods. The purpose of this review is to summarize current knowledge and highlight most recent data on prevalence, diagnosis, management, and impact of CVS in children and adults. Originally thought to be a pediatric disorder, the past decade has witnessed a considerable increase in CVS diagnosed in adults. Despite improved recognition of CVS, without a delineated pathophysiology and specific biomarker, it remains classified as a functional gastrointestinal disorder. Migraines and CVS share a common pathway based on several studies and response to migraine therapy. Recent work has begun to expand the list of comorbidities and identify plausible mechanisms and new therapeutic avenues. This review seeks to highlight best practices and novel therapies for CVS based on expert consensus and review of available literature.

Do pre-school episodic syndromes predict migraine in primary school children? A retrospective cohort study on health care data.

To assess the relative risk, predictive value and population attributable risk fraction of pre-school episodic syndromes for later migraine in primary school age children. This retrospective cohort study used health insurance data on 55,035 children born in 2006 with no diagnosis of migraine up to the age of 5 years. The relative risk, probability and population attributable risk fraction of migraine prompting a physician visit at the age of 6-10 years in children with episodic syndromes included in the International Classification of Headache Disorders (benign paroxysmal torticollis, benign paroxysmal vertigo, cyclic vomiting syndrome, recurrent abdominal symptoms and abdominal migraine) and those not included in the International Classification of Headache Disorders (pavor nocturnus, somnabulism and bruxism) diagnosed up to the age of 5 years were determined. The period prevalence of individual episodic syndromes ranged between 0.01% and 1.40%. For episodic syndromes included in the International Classification of Headache Disorders (recurrent abdominal symptoms and abdominal migraine) and for the episodic syndromes not included in the International Classification of Headache Disorders (somnambulism), the risk for later migraine was increased by factors of 2.08, 21.87 and 3.93, respectively. The proportion of risk for migraine in primary school children explained by any episodic syndromes included in the International Classification of Headache Disorders was 2.18% and for any episodic syndromes not included in the International Classification of Headache Disorders it was 0.59%. Several pre-school episodic syndromes are risk factors for migraine in primary school age children. The fraction of migraine in primary school age children explained by prior episodic syndromes, however, is below 3%. A probability to develop primary school age migraine above 50% was only observed for abdominal migraine.

Children with cyclic vomiting syndrome: phenotypes, disease burden and mitochondrial DNA analysis

BackgroundCyclic vomiting syndrome (CVS) is characterized by repeated, stereotypical vomiting episodes. It is possibly associated with mitochondrial DNA (mtDNA) variants. We examined the phenotype, disease burden, treatment and performed mtDNA analysis in pediatric CVS.MethodsThis retrospective study included 42 children with CVS in a tertiary care center. Information regarding medical history, clinical features, laboratory tests, and treatment were collected. mtDNA sequencing was performed among 13 patients.ResultsMean age of onset among patients was 4.0±3.4 years, and mean age at diagnosis was 6.7±4.2 years. CVS episodes in onset and features were stereotypic. Recognizable prodromes were reported in 54.8% patients. Neuroimaging showed previously unknown intracranial abnormalities. Gastrointestinal infection was found in four patients. Mean duration of hospitalization was 7.0±2.4 days, and mean hospitalization cost was 10,891 RMB. Sequencing showed that 4/13 patients had C16519T mtDNA polymorphism, and 2/13 patients had G3010A mtDNA polymorphism.ConclusionsCyclic vomiting syndrome is a disabling disorder, which causes huge disease burdens to the patients and their families. Early clinical suspicion and prompt diagnosis are crucial. mtDNA polymorphisms were found in some patients, but they were not significantly associated with pediatric CVS.

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.

Cyclical Vomiting Syndrome in Children

Cyclical Vomiting Syndrome in Children

Episodic syndromes of childhood associated with migraine.

This review covers recent advances in our understanding of episodic syndromes that may be associated with migraine in children and adolescents, as well as what is known about the treatment of these disorders. The episodic syndromes include benign paroxysmal torticollis, benign paroxysmal vertigo, abdominal migraine, and cyclic vomiting syndrome. Infant colic, or excessive crying in an otherwise healthy and well fed infant, may also fit into this category and is included in the appendix section of the most recent edition of the International Classification of Headache Disorders. Episodic syndromes are considered to be early life expressions of migraine in the developing brain. Additional research is needed to determine, which acute and preventive treatments are the most effective in managing these disorders.

Epidemiology, Clinical Characteristics, and Associations for Rome IV Functional Nausea and Vomiting Disorders in Adults

Functional nausea and vomiting disorders (FNVDs) are classified as chronic nausea and vomiting syndrome (CNVS) or cyclic vomiting syndrome (CVS)-CVS includes cannabinoid hyperemesis syndrome. We investigated the population prevalence of FNVDs, their characteristics, and associated factors. In the year 2015, an Internet cross-sectional health survey was completed by 5931 adults in the general populations of 3 English-speaking countries; 2100 participants were in the United States, Canada, or the United Kingdom. Quota-based sampling was used to generate demographically balanced and population-representative samples. The survey collected data on demographics, health care visits, medications, somatic symptom severity, quality of life, and symptom-based diagnostic criteria for Rome IV FNVDs as well as for irritable bowel syndrome and functional dyspepsia. Subsequent comparisons were made between Rome IV FNVD subjects and individuals without FNVDs (controls). Overall, 2.2% of the population (n= 131) fulfilled symptom-based diagnostic criteria for Rome IV FNVDs: the United States (3%) had a greater prevalence than Canada (1.9%) or the United Kingdom (1.8%) (P= .02). The prevalence of CNVS was similar among the countries, ranging from 0.8% to 1.2%. However, the prevalence of CVS was higher in the United States (2%) than in Canada (0.7%) or the United Kingdom (1%) (P= .03). The proportion of subjects with CVS taking cannabis did not differ significantly among countries (P= .31), although the 7 cases of cannabinoid hyperemesis syndrome were in the United States. A significantly higher proportion of subjects with CVS reported a compulsive need for hot water bathing to alleviate emetic symptoms than subjects with CNVS (44% vs 19%; P= .03); this behavior was independent of cannabis but augmented by its use. Subjects with FNVDs had significantly greater health impairment and health care utilization than controls. On multivariate analysis, independent factors associated with FNVDs were younger age, increasing somatic symptom severity, lower quality of life, presence of irritable bowel syndrome, and functional dyspepsia. However, on subgroup analysis, somatic symptom severity was associated with CVS but not CNVS, whereas poor quality of life was associated with CNVS but not CVS. Based on a cross-sectional health survey of adults in the general populations of 3 English-speaking countries, approximately 2% of subjects meet symptom-based criteria for Rome IV FNVDs and have considerable health impairments. Hot water bathing to alleviate emetic symptoms is reported for all FNVDs, and is perpetuated by cannabis use.

Family Health-related Quality of Life in Pediatric Cyclic Vomiting Syndrome.

The aim of the study was to evaluate the relationship of disease characteristics and child anxiety symptoms to family health-related quality of life (FHRQoL) in youth with cyclic vomiting syndrome (CVS). Forty-two parents of youth ages 8 to 18 years diagnosed with CVS completed the Family Impact Module of the PedsQL, a measure of the impact of the child's illness on the family. We evaluated the relationship of disease characteristics and child and parent proxy reports of anxiety symptoms on the Screen for Childhood Anxiety and Related Emotional Disorders to FHRQoL. Parent report of child anxiety symptoms and missed school days (mean = 11.93, standard deviation = 14.62) were the strongest predictors of FHRQoL (r = 0.33, df = 1.39, F = 8.51, P = 0.006). Other disease characteristics, including frequency, duration, chronicity of CVS episodes, and delay in initial CVS diagnosis were not significantly associated with the FHRQoL total score. Child anxiety symptoms by either parent and/or child report were associated with subscales of the FHRQoL, including family physical functioning, family communication, and family daily activities. HRQoL for the families assessed in this study was associated with anxiety symptoms to a greater extent than disease characteristics, indexing the importance of a biopsychosocial approach to CVS management. Screening for anxiety symptoms and support for school absences due to illness are indicated to help lessen the impact of CVS on the family as a whole.