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Cyclic Vomiting Syndrome in Children.

Anne Donnet1, Sylvain Redon2

  • 1Department of Evaluation and Treatment of Pain, Clinical Neuroscience Federation, La Timone Hospital, FHU INOVPAIN, Marseille, France. anne.donnet@mail.ap-hm.fr.

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Summary

Cyclic vomiting syndrome (CVS) is a childhood-onset migraine-associated disorder. Recent findings highlight its complex phenotype, suggest chronobiological links, and propose diagnostic red flags, with sumatriptan and lifestyle changes showing therapeutic promise.

Keywords:
ChildrenCyclic vomiting syndromeMigraine

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Area of Science:

  • Pediatric Gastroenterology
  • Neurology
  • Chronobiology

Background:

  • Cyclic vomiting syndrome (CVS) is an underdiagnosed episodic disorder often linked to migraine, predominantly affecting children.
  • Attacks are characterized by stereotyped, periodic episodes with distinct prodromal, vomiting, and recovery phases.

Purpose of the Study:

  • To review recent clinical and paraclinical findings in CVS.
  • To summarize current diagnostic and therapeutic strategies for CVS.

Main Methods:

  • Review of recent clinical observations and paraclinical studies.
  • Analysis of functional neuroimaging data (fMRI) in CVS and migraine patients.
  • Evaluation of therapeutic outcomes for acute and prophylactic treatments.

Main Results:

  • CVS presents with visceral, neuropsychological, cranial, and systemic symptoms, with potential chronobiological underpinnings.
  • fMRI studies indicate reduced insular connectivity in CVS and migraine, suggesting shared pathophysiology.
  • Diagnostic challenges exist, necessitating further research, especially functional imaging studies.
  • Injectable/intranasal sumatriptan is effective for acute attacks; amitriptyline, cyproheptadine, propranolol, and lifestyle modifications are common prophylactic treatments.

Conclusions:

  • CVS likely has a multifactorial origin and shares pathophysiological links with migraine.
  • Distinguishing CVS from other gastrointestinal disorders remains challenging.
  • Further research, including controlled trials in pediatric populations, is needed to elucidate pathophysiology and optimize treatment.