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Related Experiment Videos

Cyclic vomiting syndrome: timing, targets, and treatment--a basic science perspective.

P L Andrews1

  • 1Department of Physiology, St. George's Hospital Medical School, London, UK.

Digestive Diseases and Sciences
|September 18, 1999
PubMed
Summary

Cyclic vomiting syndrome (CVS) involves inappropriate nausea and vomiting. Understanding the emetic episode may reveal mechanisms and guide the development of broad-spectrum antiemetic treatments for CVS.

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Area of Science:

  • Neuroscience
  • Gastroenterology
  • Pharmacology

Background:

  • Nausea and vomiting are protective reflexes against ingested toxins.
  • In clinical settings like chemotherapy or surgery, these responses can be inappropriate and detrimental.
  • Cyclic vomiting syndrome (CVS) represents an extreme, prolonged activation of these emetic reflexes.

Purpose of the Study:

  • To explore the underlying mechanisms of intense vomiting in CVS.
  • To investigate potential therapeutic strategies for CVS, even without fully identifying causal mechanisms.
  • To examine the emetic episode as a fundamental unit for understanding CVS patterns.

Main Methods:

  • Review of existing literature on emesis and CVS.
  • Discussion of potential defects in intrinsic emetic pathways (e.g., opioid neurons).

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  • Analysis of cellular regulatory defects in key brainstem areas (e.g., nucleus tractus solitarius, area postrema).

    • Main Results:

    • Two primary mechanisms for CVS vomiting are proposed: intrinsic pathway defects and cellular regulation defects.
    • The concept of the 'emetic episode' (retches followed by vomit) is central to understanding CVS patterns.
    • Preclinical studies with neurokinin-1 receptor antagonists show promise for broad-spectrum antiemetic approaches.

    Conclusions:

    • Identifying specific causal mechanisms for CVS may not be a prerequisite for effective treatment.
    • Broad-spectrum antiemetic agents, like neurokinin-1 receptor antagonists, offer a feasible therapeutic strategy for CVS.
    • Further research into emetic pathways and cellular mechanisms is crucial for advancing CVS treatment.