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Differentiating cyclic from chronic vomiting patterns in children: quantitative criteria and diagnostic implications
1Department of Pediatrics, Ohio State University, Columbus, OH 43205-2606, USA.
Insights
Recurrent vomiting in children can be classified into cyclic and chronic patterns. Cyclic vomiting is often linked to abdominal migraine, while chronic vomiting suggests gastrointestinal issues.
Area of Science:
- Pediatric Gastroenterology
- Clinical Diagnostics
- Etiology of Vomiting
Background:
- Recurrent vomiting is a common pediatric complaint.
- Differentiating vomiting patterns is crucial for accurate diagnosis and treatment.
Purpose of the Study:
- To establish criteria for differentiating cyclic and chronic vomiting patterns in children.
- To identify the primary diagnoses associated with each vomiting pattern.
Main Methods:
- Retrospective review of 106 children (2-18 years) with recurrent vomiting.
- Analysis of vomiting intensity (emesis/hour) and frequency (episodes/month).
- Comparison of diagnostic studies and therapeutic responses using statistical tests.
Main Results:
- Two distinct subgroups identified: cyclic (n=34) and chronic (n=72) vomiting patterns.
- Cyclic vomiting: higher peak intensity (12.6 vs 1.5 emesis/hour), lower frequency (1.9 vs 36.6 episodes/month).
- Cyclic vomiting predominantly caused by non-gastrointestinal disorders (65%), including abdominal migraine; chronic vomiting linked to peptic and infectious GI disorders (10%).
Conclusions:
- Quantitative criteria can differentiate clinically and etiologically distinct subgroups of recurrent pediatric vomiting.
- Cyclic vomiting is strongly associated with abdominal migraine.
- Chronic vomiting patterns indicate underlying peptic and infectious gastrointestinal disorders.
Objective:
To establish criteria to differentiate two patterns of vomiting and to identify the predominant diagnoses for each group.
Methods:
All children 2 to 18 years of age referred to a pediatric gastroenterology service who presented with recurrent vomiting (three episodes of vomiting within a 3-month period) as a primary complaint from 1985 to 1991 were retrospectively reviewed (n = 106). The vomiting pattern (emeses per hour and episodes per month), diagnostic studies, and therapeutic responses were compared by Mann-Whitney U and chi-squared tests.
Results:
Based on the criteria of peak intensity (four or more emeses per hour) and frequency (nine or fewer episodes per month), two subgroups were differentiated: chilcren with a cyclic pattern (n = 34), who vomited at a higher peak intensity (12.6 +/- 1.6 vs 1.5 +/- 0.1 emeses per hour) but at a lower frequency (1.9 +/- 4.8 vs 36.6 +/-0.3 episodes per month) than those with a chronic pattern (n = 72). Among children with a cyclic patern, nongastrointestinal (65%) causes, especially peptic and infectiouus disorders, predominated over nongastrointestinal ones (10%).
Conclusions:
On the basis of quantitative historical criteria, children with recurrent vomiting can be classified into two subgroups that seem to be clinically and etiologically distinct. Abdominal migraine was the dominant diagnosis in those with cyclic vomiting, whereas peptic and infectious gastrointestinal disorders predominated in those with chronic vomiting. This differentiation between cyclic and chronic patterns of vomiting may be a useful diagnostic clue to the clinician.
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