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Cyclic Vomiting Syndrome Needs Improved Diagnosis and Treatment

Cyclic vomiting syndrome, or CVS, is a disorder marked by recurrent and severe episodes of vomiting and is believed to be related to migraine. It is frequently misdiagnosed, and B.U.K. Li, MD, a professor of pediatrics (gastroenterology) at the Medical College of Wisconsin in Milwaukee, provided insights into its diagnosis and treatment at the Annual Academy of Pediatrics conference in October in San Diego.

Children with the syndrome typically seek medical care in emergency departments and doctor’s offices and have repeated, rapid vomiting and dehydration, according to a report of the presentation in Contemporary Pediatrics. Unfortunately, health professionals often believe the young patients have a virus or food poisoning, and research shows the correct diagnosis is not determined until after an average of 10 emergency department visits over more than 2 years.

“In the meantime, these children may undergo a lot of unnecessary testing and face burdens of missed school, missed work for the parents, and decreased health-related quality of life,” Dr. Li said.

NauseaVomiting episodes are often triggered by stressful life events, from respiratory infections to emotional stress that occurs at school or during holidays, vacations, and birthdays.

Dr. Li advised health professionals to consider CVS when a child experiences three bouts of high-frequency vomiting—3 to 6 times per hour at the peak of the worst episode—within 6 months to a year with no other apparent cause. A family history of migraine also raises the likelihood of the disorder. CVS most often affects children between the ages of 4 and 11, although it also develops in younger and older age groups, including adults.

The primary test for the disorder is an upper gastrointestinal X-ray to rule out a twisted small intestine. If the X-ray is normal, Dr. Li said medications to prevent migraine are called for, specifically cyproheptadine in children under 5, and amitriptyline for older children and adolescents.

As with migraine, other disorders often exist in patients with CVS, including anxiety, irritable bowel syndrome, and problematic sleep.

Most often, CVS resolves as children enter adolescence, although it can continue into adulthood. When it resolves, one-third of the patients will eventually develop migraine headaches.

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