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Cyclic vomiting syndrome in pediatric population: characteristics and prophylactic response to cyproheptadine

Alessandro Ferretti1, Claudia Fanfoni2, Federica Vadrucci2

  • 1Unit of Pediatrics, Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University, Rome, Italy - alessandro.ferretti@uniroma1.it.

Minerva Pediatrics
|September 19, 2024
PubMed

Insights

This study on cyclic vomiting syndrome (CVS) in children found that assessing prodromes, triggers, and comorbidities aids diagnosis. Cyproheptadine is a safe and effective treatment for pediatric CVS across all age groups.

Area of Science:

  • Pediatric Gastroenterology
  • Neurology
  • Pharmacology

Background:

  • Cyclic vomiting syndrome (CVS) is a functional gastrointestinal disorder characterized by recurrent episodes of intense nausea and vomiting.
  • Understanding the specific features of CVS in children is crucial for accurate diagnosis and effective management.
  • Identifying triggers, prodromal symptoms, and comorbidities can aid in the diagnostic process for pediatric CVS.

Purpose of the Study:

  • To investigate the clinical features of cyclic vomiting syndrome (CVS) in a pediatric cohort.
  • To evaluate the safety and efficacy of cyproheptadine as a prophylactic treatment for pediatric CVS.
  • To compare the efficacy of cyproheptadine in children younger than 5 years versus those 5 years or older.

Main Methods:

  • Retrospective, monocentric study of children diagnosed with CVS.
  • Data collection through medical records and caregiver interviews.
  • Analysis of prodromal symptoms, triggers, comorbidities, and cyproheptadine's safety and efficacy.

Main Results:

  • 24 pediatric patients with CVS were included; 58.3% had comorbidities, and 54% had migraine.
  • Cyproheptadine was prescribed to 62.5% of patients, with 40% and 80% experiencing >75% reduction in vomiting frequency at 6 and 12 months, respectively.
  • No significant differences in CVS features or cyproheptadine response were found between age groups (<5 vs. ≥5 years), with no serious adverse effects reported.

Conclusions:

  • Prodromes, triggers, and comorbidities are valuable indicators for diagnosing pediatric CVS.
  • Cyproheptadine demonstrates effectiveness and a favorable safety profile for managing pediatric CVS in children of all ages.
  • The findings support the use of cyproheptadine as a first-line prophylactic therapy for cyclic vomiting syndrome in pediatric populations.
Abstract

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