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Clinical features, response to therapy and outcome in pediatric cyclical vomiting syndrome: Experience from the
Rangachetana A1, Anshu Srivastava2, Ajay Aravind1
1Department of Pediatric Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, 226 014, India.
Insights
Cyclical vomiting syndrome (CVS) in children is often misdiagnosed, leading to delayed treatment. Early recognition and management of CVS are crucial for better outcomes, especially in younger patients.
Area of Science:
- Pediatric Gastroenterology
- Functional Gastrointestinal Disorders
Background:
- Cyclical vomiting syndrome (CVS) is a functional gastrointestinal disorder characterized by recurrent vomiting episodes.
- Lack of awareness and overlapping symptoms contribute to misdiagnosis, with limited data from developing regions, particularly concerning children's natural disease history.
Purpose of the Study:
- To evaluate the clinical presentation, natural history, treatment, and outcomes of cyclical vomiting syndrome in pediatric patients.
- To highlight the diagnostic challenges and impact of delayed diagnosis in children with CVS.
Main Methods:
- A retrospective audit was conducted on pediatric patients (≤18 years) diagnosed with CVS between January 2008 and December 2024.
- Clinical data was collected through hospital records and telephonic interviews.
Main Results:
- Seventy-one children were enrolled, with a median age of onset of 7 years. A significant diagnostic delay of 1.2 years was observed, and 43.6% were initially misdiagnosed.
- Most patients experienced frequent vomiting episodes (5 per year), with 77.5% requiring hospitalization. Psychological stress was a common trigger (32.4%), and 52.1% had a family history of migraine.
- Younger children (≤5 years) faced longer diagnostic delays and higher hospitalization rates. At follow-up, 50.7% achieved complete symptom resolution, and 35.3% had significant improvement.
Conclusions:
- Cyclical vomiting syndrome is frequently underdiagnosed in children, necessitating increased awareness for timely diagnosis and reduced morbidity.
- Younger children experience diagnostic delays and increased hospitalizations, underscoring the need for early recognition.
- Optimal management and timely intervention are associated with favorable outcomes in pediatric CVS patients.
Background And Objective:
Cyclical vomiting syndrome (CVS) is a functional gastrointestinal disorder marked by recurrent vomiting. Lack of awareness and symptom overlap often leads to incorrect diagnosis. There is limited data from the developing world, especially on the natural history of the disease in children. Thus, the aim of our study was to evaluate the clinical presentation, natural history, treatment and outcomes of CVS in children.
Methods:
Retrospective audit of children (≤ 18 years) diagnosed with CVS between January 2008 to December 2024. Clinical data was retrieved from hospital records and telephonic interviews.
Results:
Seventy-one patients (age of onset 7[IQR 4-9] years, boys [39, 54.9%]) were enrolled. Median diagnostic delay was 1.2 (IQR 1-3) years and 31(43.6%) were misdiagnosed elsewhere initially. Patients had five (IQR 4-8) episodes of vomiting per year. Most (n = 55, 77.5%) required hospitalization. Precipitants were identified in 48 (67.6%) cases, most common being psychological stress (n = 23, 32.4%). Family history of migraine was present in 37 (52.1%) cases. Rome IV, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) and International Classification of Headache Disorders, 3rd edition (ICHD-3) criteria fulfilled in 71(100%), 47 (66.2%) and 44 (62%) cases, respectively. Younger children (≤ 5 years) had longer delay in diagnosis, more often required hospitalization and had fewer early morning episodes as compared to older children. All patients presented with severe disease phenotype and received prophylaxis. At follow-up of eight (interquartile range [IQR] 5-12) years, 36 (50.7%) had complete, 25 (35.3%) significant, five (7.6%) partial and five (7.5%) no response. Prophylaxis was successfully stopped in 13 (36.1%) complete responders of which three relapsed post-withdrawal.
Conclusion:
CVS is often underdiagnosed in children. Awareness of CVS is necessary for early diagnosis and reduced morbidity. Younger children had longer diagnostic delay and more often required hospitalization. Timely recognition and optimal management were associated with favorable outcomes.
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