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Differential diagnosis of cyclic vomiting syndrome
1Department of Paediatrics, University of Western Australia, Princess Margaret Hospital for Children, Perth, Australia.
Insights
Cyclic vomiting syndrome in children requires thorough investigation to rule out serious conditions. Early assessment of gastrointestinal, metabolic, and neurological health is crucial for accurate diagnosis and management.
Area of Science:
- Pediatrics
- Gastroenterology
- Neurology
Background:
- Cyclic vomiting is a complex symptom potentially linked to various organ system disorders.
- Cyclic vomiting syndrome (CVS) in children necessitates prompt evaluation to exclude life-threatening conditions like intestinal volvulus, metabolic disorders, and neurological lesions.
Purpose of the Study:
- To highlight the diverse range of potential underlying causes for cyclic vomiting syndrome in pediatric patients.
- To emphasize the importance of comprehensive diagnostic approaches for children presenting with cyclic vomiting.
Main Methods:
- Review of potential differential diagnoses for cyclic vomiting syndrome.
- Emphasis on detailed patient history taking to identify subtle clues.
- Recommendation for baseline gastrointestinal morphology assessment and screening for metabolic and renal diseases.
Main Results:
- Cyclic vomiting syndrome can be associated with gastrointestinal, pancreatic, metabolic, renal, neurological, and psychiatric conditions.
- Specific metabolic disorders include amino acid-opathies, organic acidurias, fatty acid oxidation defects, and acute intermittent porphyria.
- Thorough history and baseline investigations are key to uncovering uncommon causes.
Conclusions:
- Cyclic vomiting syndrome is a nonspecific symptom complex requiring broad differential diagnosis.
- Early and comprehensive investigation is vital to identify and manage potentially serious underlying pathologies in children.
- A systematic approach including history, imaging, and laboratory screening is recommended.
Abstract:
Vomiting is a nonspecific symptom and cyclic vomiting is a symptom complex that may result from a disorder of any major organ system. Children with cyclic vomiting syndrome (CVS) need careful review and investigation at their earliest presentations to exclude potentially lethal abnormalities such as intestinal volvulus, metabolic disorders, and neurologic space-occupying lesions. The range of abnormalities that may present with features consistent with CVS includes gastrointestinal obstructive, inflammatory and motility abnormalities, pancreatic disease, metabolic disease (particularly the amino acid-opathies, organic acidurias, fatty acid oxidation defects, and acute intermittent porphyria), renal disease, epilepsy, migraine, and psychiatric disorders. Careful history taking will usually provide clues to these uncommon problems, but all children should undergo baseline assessment of gastrointestinal morphology and screening tests for renal and metabolic disease.