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Diagnostic characteristics of pediatric cyclic vomiting syndrome
Malgorzata Bujarska1, Geetanjali Bora2, B U K Li1
1Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Insights
Cyclic vomiting syndrome (CVS) in children presents with distinct patterns and symptoms, differing quantitatively from other vomiting conditions. These findings can refine diagnostic criteria for better identification of pediatric CVS.
Area of Science:
- Pediatric Gastroenterology
- Clinical Diagnostics
- Symptomology Research
Background:
- Cyclic vomiting syndrome (CVS) diagnosis is challenging due to nonspecific symptoms.
- Current diagnostic criteria for CVS may lack sufficient sensitivity in pediatric populations.
- There is a need for improved, evidence-based diagnostic criteria for pediatric CVS.
Purpose of the Study:
- To quantitatively compare symptoms between children with CVS and other vomiting conditions.
- To evaluate the sensitivity of current diagnostic criteria for pediatric CVS.
- To identify distinct quantitative and qualitative features differentiating pediatric CVS.
Main Methods:
- An observational, prospective study involving children aged 3-18 with unexplained vomiting.
- Data collection included parent symptom surveys at 0, 3, and 6 months.
- Receiver operating characteristic (ROC) analysis was used to determine diagnostic cutoffs.
Main Results:
- Children with CVS showed significantly higher episode frequencies (≥4/12 months) and longer episode durations (>2 hours) compared to non-CVS.
- Specific CVS symptoms included photophobia, diaphoresis, multiple emeses/hour, stereotypical episodes, and continued retching.
- Fewer than half of CVS patients met existing Rome IV and NASPGHAN diagnostic criteria.
Conclusions:
- Pediatric CVS is characterized by a unique vomiting pattern and specific clinical features.
- The identified quantitative differences and symptoms can aid in improving diagnostic accuracy for CVS in children.
- Findings support the development of more sensitive and evidence-based diagnostic criteria for pediatric CVS.
Objectives:
Cyclic vomiting syndrome (CVS) remains a diagnostic challenge due to its nonspecific presentation despite consensus-based diagnostic criteria. There is a need for improved, evidence-based diagnostic criteria. We hypothesized that symptoms differ quantitatively between children with CVS versus other vomiting conditions and that current diagnostic criteria are not sufficiently sensitive for diagnosing CVS.
Methods:
Observational, prospective study of children ages 3-18 years with unexplained vomiting episodes evaluated in the outpatient gastroenterology clinic, emergency department, and inpatient units at Children's Wisconsin. Parents completed symptom surveys at 0, 3, and 6 months. Diagnostic workup and treatment response were monitored by chart review. A final diagnosis (CVS vs. non-CVS) was assigned for group comparisons and receiver operating characteristics (ROC) analysis of diagnostic cutoffs.
Results:
Of 108 subjects enrolled, 46 CVS and 54 non-CVS patients were analyzed. The groups reported overall different episode frequencies with more CVS versus non-CVS (81% vs. 55%) having ≥4 episodes/preceding 12 months (p = 0.013). CVS patients also had longer vomiting episodes (p = 0.03). To distinguish CVS from non-CVS, ROC analyses demonstrated the highest sensitivity for a frequency of 4-10 episodes/12 months (p = 0.002) and a duration threshold of >2 h (p < 0.001). CVS patients reported specific episode characteristics: photophobia (p = 0.003), diaphoresis (p = 0.002), multiple emeses/hour (p = 0.001), stereotypical episodes (p = 0.008), and continued retching after gastric emptying (p = 0.008). Less than half of CVS patients met Rome IV and North American Society for Pediatric Gastroenterology, Hepatology & Nutrition diagnostic criteria.
Conclusions:
Children with CVS display a distinctive vomiting pattern and clinical features compared to other vomiting conditions. Our findings will help improve current diagnostic criteria.
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