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Cyclic vomiting syndrome in children: experience with 181 cases from southern Iran
Mahmood Haghighat1, Seyed Mohammad Rafie, Seyed Mohsen Dehghani
1Department of Pediatric Gastroenterology/Gastroenterohepatology Research Center of Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
Insights
Cyclic vomiting syndrome (CVS) in children often has a significant diagnostic delay. Propranolol demonstrated superior effectiveness compared to amitriptyline for prophylactic treatment in pediatric CVS patients.
Area of Science:
- Pediatric Gastroenterology
- Neurology
- Clinical Pharmacology
Background:
- Cyclic vomiting syndrome (CVS) is a functional gastrointestinal disorder characterized by recurrent episodes of intense nausea and vomiting.
- Diagnosis of CVS can be challenging, often involving a significant delay from symptom onset to confirmation.
Purpose of the Study:
- To investigate the clinical characteristics, treatment responses, and outcomes of pediatric patients diagnosed with CVS.
- To compare the efficacy of amitriptyline versus propranolol as prophylactic therapies for CVS in children.
Main Methods:
- An 11-year observational study involving 181 children diagnosed with CVS.
- Randomized prophylactic treatment with either amitriptyline or propranolol.
Main Results:
- The mean age of symptom onset was 4.9 years, with a mean diagnostic delay of 2 years.
- Propranolol was effective in 92% of patients, significantly outperforming amitriptyline, which was effective in 56%.
Conclusions:
- A notable delay exists between symptom presentation and CVS diagnosis in the studied region.
- Invasive diagnostic procedures are often unnecessary for typical CVS presentations managed by experienced physicians.
- Propranolol is a more effective prophylactic agent than amitriptyline for managing pediatric CVS.
Aim:
To evaluate the clinical presentation, response to prophylactic therapy and outcome of children with cyclic vomiting syndrome (CVS) in Shiraz, Iran.
Methods:
During a period of 11 years (March 1994 to March 2005), 181 consecutive children with a final diagnosis of CVS were evaluated, treated and followed in our center. Patients were randomized to receive either amitriptyline or propranolol as prophylactic treatments.
Results:
There were 88 boys and 93 girls with mean age of onset of symptoms of 4.9 +/- 3.3 years (range, neonatal period to 14 years), the mean age at final diagnosis was 6.9 years (range, 1.5 to 14), and the mean duration between the onset of the first attack and the final diagnosis of CVS was 2 +/- 1.81 years (range, 1/6 to 8). The mean duration of each attack was 4.26 days (range, from few hours to 10 d) and the mean interval between the attacks was 1.8 mo (range, 1 wk to 12 mo). The time of onset of the attacks was midnight to early morning in about 70% of cases. Amitriptyline was effective in 46 out of 81 (56%) patients (P < 0.001). Propranolol appeared to have a superior action and was effective in 74 out of 83 (92%) patients (P < 0.0001).
Conclusion:
There is a significant lag time between the onset of clinical symptoms and the final diagnosis of CVS in our area. In patients with typical clinical presentations of CVS, who are examined by an experienced physician, invasive workup is not necessary. Propranolol appears more effective than amitriptyline for prophylactic use in children with CVS.
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