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Heterogeneity of diagnoses presenting as cyclic vomiting
B U Li1, R D Murray, L A Heitlinger
1Department of Pediatrics, Ohio State University, Columbus, USA.
Insights
Cyclic vomiting in children often has an underlying cause, with most cases diagnosed as idiopathic cyclic vomiting syndrome. Systematic evaluation is crucial to identify potential contributing disorders in pediatric patients experiencing recurrent vomiting episodes.
Area of Science:
- Pediatric Gastroenterology
- Clinical Diagnostics
- Symptomology Research
Background:
- Cyclic vomiting is a complex symptom in children.
- Identifying the underlying cause is critical for effective management.
Purpose of the Study:
- To define the diagnostic profile of cyclic vomiting in pediatric patients.
- To investigate the range of disorders associated with cyclic vomiting.
Main Methods:
- Retrospective chart review and structured telephone interviews.
- Study included 225 children under 18 with at least three vomiting episodes.
- Diagnostic testing and treatment responses were analyzed.
Main Results:
- Idiopathic cyclic vomiting syndrome accounted for 88% of cases.
- Identified disorders (GI, renal, CNS, endocrine) were found in 49% of patients.
- Associated conditions like GERD and sinusitis were noted in 41% of idiopathic cases.
Conclusions:
- Cyclic vomiting can stem from diverse underlying conditions.
- Systematic diagnostic investigation is essential for children presenting with cyclic vomiting patterns.
Objective:
To establish the diagnostic profile in children who present with cyclic vomiting.
Methods:
We studied 225 children < 18 years of age who presented to our pediatric gastroenterology service from 1986 to 1997 with at least three discrete episodes of vomiting between which they were well. To determine the diagnoses in those presenting with a pattern of cyclic vomiting, the results of diagnostic testing and responses to various treatments were obtained from a combination of chart review and structured telephone interviews.
Results:
The largest diagnostic category included idiopathic cyclic vomiting syndrome (88%). Extraintestinal disorders (7%) and gastrointestinal disorders (5%) constituting the probable cause of vomiting were established in those having complete cessation of episodes after therapy. In 12%, serious surgical disorders of the gastrointestinal (malrotation), renal (acute hydronephrosis), and central nervous systems (neoplasm) were found. In 2%, serious endocrine (Addison's disease) and metabolic disorders (disorder of fatty acid oxidation) were found. Among those with idiopathic cyclic vomiting syndrome, 41% had associated disorders (gastroesophageal reflux and chronic sinusitis) that could contribute to the vomiting, but, based on a partial response to therapy, were not deemed to be the main cause. Altogether 49% had an identified disorder that probably caused or could contribute to the vomiting.
Conclusions:
The cyclic pattern of vomiting is a symptom complex that can be induced by heterogeneous disorders that either cause or contribute to the vomiting. Once the cyclic vomiting pattern is identified, systematic diagnostic testing is warranted to look for these underlying disorders.
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