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Liu B, Sun H, Liu Y, Yuan ML, Zhu HR, Zhang W. Comprehensive interventions for adult cyclic vomiting syndrome complicated by superior mesenteric artery syndrome: A case report. World J Clin Cases 2024; 12:6327-6334. [DOI: 10.12998/wjcc.v12.i29.6327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 07/04/2024] [Accepted: 07/23/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND Cyclic vomiting syndrome (CVS) is a chronic functional gastrointestinal disorder involving the gut–brain interaction that is characterized by recurring episodes of nausea, vomiting, abdominal pain, and interspersed complete normal periods. Superior mesenteric artery (SMA) syndrome (SMAS) is a vascular condition in which the horizontal portion of the duodenum is compressed due to a reduced angle between the aorta and the SMA. This condition presents with symptoms similar to CVS, posing challenges in distinguishing between the two and often resulting in misdiagnosis or inappropriate treatment.
CASE SUMMARY A 20-year-old female patient presented with recurrent episodes of vomiting and experienced a persistent fear of vomiting for the past 2 years. She adopted conscious dietary restrictions, which led to severe malnutrition. Initially, she was diagnosed with SMAS, as revealed by computed tomography angiography. Despite efforts to increase the angle between the aorta and the SMA through weight gain, her vomiting did not improve. Finally, she was diagnosed with comorbidities including CVS, SMAS and anxiety disorder. She underwent comprehensive interventions, including enteral and parenteral nutritional supplementation, administration of antiemetic and anti-anxiety agents, and participation in mindfulness-based cognitive therapy. The patient eventually experienced a notable improvement in both body weight and clinical symptoms.
CONCLUSION We present a rare case of CVS in an adult complicated with SMAS and propose additional treatment with nutritional support, pharmacological intervention, and psychotherapy.
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Affiliation(s)
- Bo Liu
- Department of Psychiatry, Zigong Mental Health Center, Zigong 643020, Sichuan Province, China
| | - Hui Sun
- Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Yang Liu
- Mental Health Center and Psychiatric Laboratory, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Min-Lan Yuan
- Mental Health Center and Psychiatric Laboratory, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Hong-Ru Zhu
- Mental Health Center and Psychiatric Laboratory, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Wei Zhang
- Mental Health Center and Psychiatric Laboratory, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
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2
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Rosen JM, Reeves PT. A call to action [plans] for cyclic vomiting syndrome. Neurogastroenterol Motil 2024:e14896. [PMID: 39189212 DOI: 10.1111/nmo.14896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 07/10/2024] [Accepted: 07/31/2024] [Indexed: 08/28/2024]
Abstract
Cyclic vomiting syndrome (CVS) is a disorder of gut-brain interaction which has a wide clinical spectrum. Clinical action plans have been developed to address and to facilitate treatment in the setting of complex, chronic medical conditions. The CVS Action Plan was developed to meet the chronic and acute care needs of children and adults with CVS. While this tool has not been tested for clinical efficacy as was shown with action plans for functional constipation, anecdotal and indirect evidence supports its use. The CVS Action Plan has the potential to enhance outcomes by simplifying home management and streamlining disease recognition and acute care in the emergency department.
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Affiliation(s)
- John M Rosen
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Children's Mercy Hospital, University of Missouri, Kansas, Missouri, USA
| | - Patrick T Reeves
- Department of Pediatrics, Uniformed Services university of the Health Sciences, Bethesda, Maryland, USA
- Department of Pediatrics, Pediatric Colorectal Center, Brooke Army Medical Center, Fort Sam Houston, Texas, USA
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Jiménez-Castillo RA, Frazier R, Venkatesan T, Remes-Troche JM. Cyclic vomiting syndrome: From pathophysiology to treatment. REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 2024; 89:389-403. [PMID: 39034267 DOI: 10.1016/j.rgmxen.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 06/04/2024] [Indexed: 07/23/2024]
Abstract
Cyclic vomiting syndrome (CVS) is a disorder characterized by recurrent and unpredictable episodes of intense vomiting, interspersed with periods of apparent wellbeing. This disorder, which primarily affects children and adolescents but can persist into adulthood, has recently been the subject of extensive study and analysis in the medical literature. The aim of the present review is to examine the most important aspects of the epidemiology, pathophysiology, subtypes, diagnostic criteria, and current management of CVS. Even though the exact etiology remains unknown, genetic factors (polymorphisms), nervous system alterations and autonomic dysregulation, and environmental factors (use and abuse of cannabinoids) are postulated as possible triggers. CVS has significant diagnostic challenges, given that there is no specific test for confirming its presence. Thorough evaluation of symptoms and the ruling out of other possible causes of recurrent vomiting are required. Management of CVS typically involves a multidisciplinary approach. Pharmacologic options are explored, such as antiemetics and preventive medications, as well as behavioral and psychologic support therapies. Treatment personalization is essential, adapting it to the individual needs of each patient. Despite advances in the understanding of CVS, it remains a significant clinical challenge. This disorder impacts the quality of life of those affected and their families, underscoring the ongoing need for research and the development of more effective treatment strategies.
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Affiliation(s)
- R A Jiménez-Castillo
- Servicio de Gastroenterología y Endoscopía Digestiva, Hospital Universitario «Dr. José E. González», Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - R Frazier
- Servicio de Gastroenterología y Hepatología, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - T Venkatesan
- Servicio de Gastroenterología, Hepatología y Nutrición, The Ohio State University, Columbus, Ohio, USA
| | - J M Remes-Troche
- Laboratorio de Fisiología Digestiva y Motilidad Gastrointestinal, Instituto de Investigaciones Médico-Biológicas, Universidad Veracruzana, Veracruz, Mexico.
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Do MT, Bery SK, Joyce EL, Gipsman AI. New-Onset Hypertension and Seizures in a 10-year-old Girl with Cyclic Vomiting Syndrome. Pediatr Rev 2024; 45:230-233. [PMID: 38556509 DOI: 10.1542/pir.2022-005598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Affiliation(s)
- Michael T Do
- Case Western Reserve University School of Medicine, Cleveland, OH
| | - Saya K Bery
- Department of Pediatrics, Rainbow Babies and Children's Hospital, Cleveland, OH
| | - Emily L Joyce
- Division of Pediatric Nephrology, Department of Pediatrics, Rainbow Babies and Children's Hospital, Cleveland, OH
| | - Alexander I Gipsman
- Department of Pediatrics, Rainbow Babies and Children's Hospital, Cleveland, OH
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Rastogi RG, Hastriter EV, Evans RL, Bassal F, Hickman C, Karnik KT, Little R, Lewis KS. Advances in the Acute and Preventive Treatment of Pediatric Migraine. Curr Pain Headache Rep 2023; 27:521-529. [PMID: 37561313 DOI: 10.1007/s11916-023-01157-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 08/11/2023]
Abstract
PURPOSE OF REVIEW Headaches are common in children and adolescents. Treatments for debilitating migraine are often not FDA approved or lack evidence of efficacy for children. This narrative review looks at the evidence for acute and preventative pharmacologic and non-pharmacologic treatment of pediatric migraine, as well as reviewing any recent or ongoing clinical trials. RECENT FINDINGS Studies have been published on pharmacological treatments for headache, as well as non-pharmacological treatments. Recent findings in pediatric migraine using onabotulinumtoxinA, calcitonin gene related peptide antagonists, interventional procedures, and devices are reviewed. Pharmacologic as well as non-pharmacologic approaches for the prevention and treatment of migraine show safety and efficacy data that is promising. These treatments should be incorporated in a multi-modal approach to the management of pediatric migraine. Continued studies, prospective and randomized, are needed to further assess these newer treatments for migraine in the pediatric setting.
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Affiliation(s)
- Reena Gogia Rastogi
- Department of Neurology, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, USA.
| | - Eric Vance Hastriter
- Department of Neurology, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, USA
| | - Rachel L Evans
- Department of Neurology, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, USA
| | - Frederick Bassal
- Department of Neurology, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, USA
| | - Carolyn Hickman
- Department of Neurology, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, USA
| | - Kavitha T Karnik
- Department of Neurology, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, USA
| | - Robert Little
- Department of Neurology, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, USA
| | - Kara Stuart Lewis
- Department of Neurology, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, USA
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Caffarelli C, Santamaria F, Piro E, Basilicata S, D'Antonio L, Tchana B, Bernasconi S, Corsello G. Advances for pediatricians in 2022: allergy, anesthesiology, cardiology, dermatology, endocrinology, gastroenterology, genetics, global health, infectious diseases, metabolism, neonatology, neurology, oncology, pulmonology. Ital J Pediatr 2023; 49:115. [PMID: 37679850 PMCID: PMC10485969 DOI: 10.1186/s13052-023-01522-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 08/30/2023] [Indexed: 09/09/2023] Open
Abstract
The last year saw intensive efforts to advance knowledge in pediatric medicine. This review highlights important publications that have been issued in the Italian Journal of Pediatrics in 2022. We have chosen papers in the fields of allergy, anesthesiology, cardiology, dermatology, endocrinology, gastroenterology, genetics, global health, infectious diseases, metabolism, neonatology, neurology, oncology, pulmonology. Novel valuable developments in epidemiology, pathophysiology, prevention, diagnosis and treatment that can rapidly change the approach to diseases in childhood have been included and discussed.
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Affiliation(s)
- Carlo Caffarelli
- Clinica Pediatrica, Department of Medicine and Surgery, Azienda Ospedaliera- Universitaria, University of Parma, Parma, Italy.
| | - Francesca Santamaria
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Ettore Piro
- Department of Sciences for Health Promotion and Mother and Child Care "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Simona Basilicata
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Lorenzo D'Antonio
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Bertrand Tchana
- Cardiologia Pediatrica, Azienda-Ospedaliero Universitaria, Parma, Italy
| | | | - Giovanni Corsello
- Department of Sciences for Health Promotion and Mother and Child Care "G. D'Alessandro", University of Palermo, Palermo, Italy
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Kizhakkayil Tency N, Roy A, Krishnakumaran N, Thomas AM. Unraveling Abdominal Migraine in Adults: A Comprehensive Narrative Review. Cureus 2023; 15:e43760. [PMID: 37727183 PMCID: PMC10506737 DOI: 10.7759/cureus.43760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2023] [Indexed: 09/21/2023] Open
Abstract
Abdominal migraine is a condition characterized by recurrent episodes of abdominal pain accompanied by migraine-associated symptoms, primarily affecting pediatric populations. Its occurrence in adults is often overlooked due to limited literature on adult abdominal migraine. This article provides an overview of the current understanding and management of abdominal migraine in adult populations, including the diagnostic criteria, pathophysiology, differentiating features of other associated gastrointestinal pain syndromes, and various treatment approaches based on available literature. The review acknowledges the limitations, including the scarcity of literature on adult abdominal migraine and the absence of a systematic approach. It emphasizes the need for further research to enhance our understanding of this condition and establish evidence-based treatment guidelines specifically for adults. Accurate diagnosis and patient education are crucial for physicians in recognizing abdominal migraine as a differential diagnosis in cases of long-standing recurrent abdominal pain, promoting the importance of further research to advance our knowledge and improve patient outcomes.
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Affiliation(s)
| | - Archa Roy
- Department of Internal Medicine, Government T D Medical College, Alappuzha, IND
| | | | - Anju Maria Thomas
- Department of Internal Medicine, Government T D Medical College, Alappuzha, IND
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Thavamani A, Velayuthan S, Patel D, Al-Hammadi N, Sferra TJ, Sankararaman S. Association of Anxiety and Gastrointestinal Comorbidities in Repeat Hospital Admissions in Pediatric Cyclic Vomiting Syndrome. Am J Gastroenterol 2023; 118:1439-1445. [PMID: 37052354 DOI: 10.14309/ajg.0000000000002292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 03/28/2023] [Indexed: 04/14/2023]
Abstract
INTRODUCTION Cyclic vomiting syndrome (CVS) is a functional gastrointestinal disorder with recurrent episodes of intense nausea and vomiting and thus may require frequent hospitalizations. There is paucity of data exploring the association of psychiatric and gastrointestinal comorbidities in repeat hospitalizations among pediatric patients with CVS. METHODS We analyzed the Pediatric Health Information System database and included all patients up to 18 years of age with a diagnosis of CVS between 2016 and 2020. We excluded patients with chronic conditions, which mimic CVS. The primary outcome variable was 90-day admission rate, which was defined as a visit to emergency department or admission to observation/inpatient unit with a primary diagnosis of CVS within 90 days after an index CVS hospitalization. RESULTS We evaluated a total of 2,604 hospitalizations represented by 1,370 unique individuals. The overall 90-day admission rate was 28.5%, which steadily decreased from 35.7% in 2016 to 23% in 2019 ( P < 0.001). Patients in the repeat hospitalization cohort were slightly older and more often men. Patients with repeat admissions had an increased proportion of anxiety and other gastrointestinal disorders. Multivariable logistic regression showed that anxiety, gastroesophageal reflux disease, functional dyspepsia, and abdominal migraine were associated with increased odds of repeat admissions. DISCUSSION Ninety-day admission rates in pediatric CVS are decreasing overall, although still contributing to significant healthcare expenditure. Anxiety and gastrointestinal comorbidities were associated with increased risk of repeat admissions. Further prospective studies are needed to better understand the complex interactions of these comorbidities and their management affecting the natural course of CVS.
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Affiliation(s)
- Aravind Thavamani
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, UH Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Sujithra Velayuthan
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, UH Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Dhiren Patel
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, SSM Health Cardinal Glennon Children's Medical Center, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Noor Al-Hammadi
- The Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Thomas J Sferra
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, UH Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Senthilkumar Sankararaman
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, UH Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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9
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Gosalvez-Tejada A, Li BUK, Simpson P, Zhang L, Kovacic K. Natural History of Pediatric Cyclic Vomiting Syndrome: Progression to Dysautonomia. J Pediatr Gastroenterol Nutr 2023; 76:737-742. [PMID: 36800281 DOI: 10.1097/mpg.0000000000003738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
BACKGROUND The clinical features of pediatric cyclic vomiting syndrome (CVS) often evolve over time. Many patients develop a constellation of chronic symptoms that suggest autonomic nervous system (ANS) dysfunction during adolescence. We aimed to determine the proportion of children with CVS who develop chronic rather than episodic symptoms consistent with ANS dysfunction. METHODS Retrospective chart review of children ages 0-18 years followed in an outpatient tertiary care CVS center. Patients completed standardized questionnaires at intake and follow-up visits, documenting clinical symptom pattern. Continuous variables are summarized as median [interquartile range (IQR)]. A Mann-Whitney test was used for group comparisons. RESULTS One hundred subjects were included. A total of 40% developed symptoms of ANS dysfunction (ANS+); 20% were confirmed by comprehensive ANS testing, 11% by orthostatic vital sign abnormalities, and 9% by clinical symptoms. The median (IQR) age at onset of chronic symptoms was 14 (10.02, 15) years. The presence of another disorder of gut-brain interaction ( P = 0.018) and a greater number of comorbidities ( P = 0.031) were more common in the ANS+ group. ANS+ subjects missed more school days ( P = 0.047) and were seen less frequently in the emergency department ( P = 0.023). CONCLUSIONS Many children with CVS (40%) develop symptoms consistent with clinical dysautonomia in adolescence. These patients experience more comorbid conditions and a greater impact on school attendance, possibly representing a worsened quality of life as their disease course transitions to daily symptoms. When symptoms of CVS change over time, therapeutic interventions may need to be adjusted and targeted accordingly.
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Affiliation(s)
- Andrea Gosalvez-Tejada
- From the Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - B U K Li
- From the Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - Pippa Simpson
- the Division of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - Liyun Zhang
- the Division of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - Katja Kovacic
- From the Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
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Beckman M, Lendner N, Sferra TJ, Moses J. A Case of Cyclic Vomiting Syndrome-Induced Hypertension Causing Posterior Reversible Encephalopathy Syndrome. JPGN REPORTS 2023; 4:e294. [PMID: 37200718 PMCID: PMC10187832 DOI: 10.1097/pg9.0000000000000294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 01/17/2023] [Indexed: 05/20/2023]
Abstract
Cyclic vomiting syndrome (CVS) is characterized by repeated episodes of vomiting in a stereotyped pattern and is a known cause of hypertension. Our patient is a 10-year-old female who presented with nonbilious, nonbloody vomiting, and constipation concerning for a flare of her known CVS. During the hospital course, she developed intermittent severe hypertensive episodes, leading to an acute episode of altered mental status and a tonic-clonic seizure. Magnetic resonance imaging confirmed diagnosis of posterior reversible encephalopathy syndrome (PRES) after eliminating other organic etiologies. This is one of the first documented cases of CVS-induced hypertension causing PRES.
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Affiliation(s)
- Madeline Beckman
- From the Case Western Reserve University School of Medicine, Cleveland, OH
| | - Nuphar Lendner
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, UH Rainbow Babies Children’s Hospital, Cleveland, OH
| | - Thomas J. Sferra
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, UH Rainbow Babies Children’s Hospital, Cleveland, OH
| | - Jonathan Moses
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, UH Rainbow Babies Children’s Hospital, Cleveland, OH
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Matuleviciene A, Siauryte K, Kuiper E. Consensus recommendations on chewing, swallowing and gastrointestinal problems in Phelan-McDermid syndrome. Eur J Med Genet 2023; 66:104763. [PMID: 37054968 DOI: 10.1016/j.ejmg.2023.104763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 03/22/2023] [Accepted: 03/30/2023] [Indexed: 04/15/2023]
Abstract
Gastrointestinal (GI) problems are common in Phelan-McDermid syndrome (PMS). Chewing and swallowing difficulties, dental problems, reflux disease, cyclic vomiting, constipation, incontinence, diarrhoea, and nutritional deficiencies have been most frequently reported. Therefore, this review summarises current findings on GI problems and addresses the fundamental questions, which were based on parental surveys, of how frequent GI problems occur in PMS, what GI problems occur, what consequences (e.g., nutritional deficiencies) GI problems cause for individuals with PMS, and how GI problems can be treated in individuals with PMS. Our findings show that gastrointestinal problems have a detrimental effect on the health of people with PMS and are a significant burden for their families. Therefore, we advise evaluation for these problems and formulate care recommendations.
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Affiliation(s)
- Ausra Matuleviciene
- Dept. of Human and Medical Genetics, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
| | - Kamile Siauryte
- Dept. of Human and Medical Genetics, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Els Kuiper
- Patient Representative from the European Consensus PMS Group, the Netherlands
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12
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Frazier R, Li BUK, Venkatesan T. Diagnosis and Management of Cyclic Vomiting Syndrome: A Critical Review. Am J Gastroenterol 2023:00000434-990000000-00677. [PMID: 36791365 DOI: 10.14309/ajg.0000000000002216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 02/10/2023] [Indexed: 02/17/2023]
Abstract
Cyclic vomiting syndrome (CVS) is a chronic disorder of gut-brain interaction characterized by recurrent disabling episodes of nausea, vomiting, and abdominal pain. CVS affects both children and adults with a prevalence of approximately 2% in the United States. CVS is more common in female individuals and affects all races. The pathophysiology of CVS is unknown and a combination of genetic, environmental, autonomic, and neurohormonal factors is believed to play a role. CVS is also closely associated with migraine headaches and likely have a shared pathophysiology. The diagnosis of CVS is based on the Rome criteria, and minimal recommended testing includes an upper endoscopy and imaging studies of the abdomen. CVS is frequently associated with anxiety, depression, and autonomic dysfunction. Patients with CVS commonly use cannabis therapeutically for symptom relief. By contrast, cannabinoid hyperemesis syndrome is believed to be a subset of CVS with chronic heavy cannabis use leading to hyperemesis. Due to the recalcitrant nature of the illness, patients often visit the emergency department and are hospitalized for acute CVS flares. Guidelines on the management of CVS recommend a biopsychosocial approach. Prophylactic therapy consists of tricyclic antidepressants (amitriptyline), antiepileptics (topiramate), and aprepitant in refractory patients. Abortive therapy consists of triptans, antiemetics (ondansetron), and sedation. Treatment of comorbid conditions is extremely important to improve overall patient outcomes. CVS has a significant negative impact on patients, families, and the healthcare system, and future research to understand its pathophysiology and develop targeted therapies is needed.
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Affiliation(s)
- Rosita Frazier
- Division of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - B U K Li
- Division of Gastroenterology, Hepatology & Nutrition, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Thangam Venkatesan
- Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University, Columbus, Ohio, USA
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Cardiac Vagal Regulation Is Impeded in Children With Cyclic Vomiting Syndrome. Am J Gastroenterol 2023:00000434-990000000-00668. [PMID: 36716443 DOI: 10.14309/ajg.0000000000002207] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 01/19/2023] [Indexed: 02/01/2023]
Abstract
INTRODUCTION The pathophysiology underlying cyclic vomiting syndrome (CVS) remains undefined. Scant data and distinct clinical features point to altered autonomic nervous system function. Autonomic signaling can be noninvasively assessed through cardiac indices of parasympathetic vagal regulation, which is reduced in children with disorders of gut-brain interaction. We aimed to examine dynamic cardiac vagal regulation in children with CVS compared with that in healthy controls (HC). METHODS A total of 31 children with CVS evaluated in a tertiary care CVS center and 66 HC (ages 8-18 years) underwent cardiac autonomic function assessment. Electrocardiogram recordings were conducted during 3-minute sit/stand/sit posture challenges. The electrocardiogram-derived variables heart period, respiratory sinus arrhythmia (RSA), and vagal efficiency (VE) were analyzed using linear regression and mixed-effects modeling. RESULTS After exclusion of medication confounders, 23 patients with CVS were included in analyses. Both groups were comparable in age, gender, and body mass index. Compared with HC, children with CVS had shorter heart period (standardized mean difference range: 1.15-1.22, all P values < 0.05) and lower RSA (SMD range: 0.66-0.88, all P values < 0.05). Patients with CVS had significantly lower VE during the entire course of posture shifts, compared with HC ( B = -19.87, SE = 6.95, t = -2.86, P = 0.005, SMD = 0.76). DISCUSSION Children with CVS have suboptimal parasympathetic autonomic regulation compared with HC, indexed by reduced RSA and VE, even during their interepisodic well phase. Abnormal vagal modulation may underlie CVS pathophysiology, comorbidities, and triggers. Assessing VE during posture stressors could inform therapeutic interventions.
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14
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Cheema S, Matharu M. Abdominal migraine and cyclical vomiting syndrome. HANDBOOK OF CLINICAL NEUROLOGY 2023; 198:209-219. [PMID: 38043963 DOI: 10.1016/b978-0-12-823356-6.00006-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Abdominal migraine and cyclical vomiting syndrome (CVS) are characteristic syndromes which have overlapping characteristics with migraine but lack the cardinal symptom of headache. Both abdominal migraine and CVS are characterized by recurrent attacks of nausea, vomiting, and/or abdominal pain lasting hours to a few days, with symptom freedom between attacks. Both abdominal migraine and CVS typically occur in children and adolescents, who often go on to develop more typical migraine headaches when older, but may also present for the first time in adults. Due to their shared characteristics and association with migraine headaches, abdominal migraine and CVS are sometimes called "migraine equivalents," and their pathophysiology is assumed to overlap with migraine headache. This chapter describes what is known about the clinical characteristics, epidemiology, pathophysiology, and prognosis of abdominal migraine and CVS, and explores their relationship to migraine. We also review the existing evidence for the nonpharmacological management, acute treatment of attacks, and preventive treatments for both abdominal migraine and CVS.
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Affiliation(s)
- Sanjay Cheema
- Headache and Facial Pain Group, University College London (UCL) Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - Manjit Matharu
- Headache and Facial Pain Group, University College London (UCL) Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom.
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Ailani J, Kaiser EA, Mathew PG, McAllister P, Russo AF, Vélez C, Ramajo AP, Abdrabboh A, Xu C, Rasmussen S, Tepper SJ. Role of Calcitonin Gene-Related Peptide on the Gastrointestinal Symptoms of Migraine-Clinical Considerations: A Narrative Review. Neurology 2022; 99:841-853. [PMID: 36127137 PMCID: PMC9651456 DOI: 10.1212/wnl.0000000000201332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 08/16/2022] [Indexed: 11/15/2022] Open
Abstract
Calcitonin gene-related peptide (CGRP) is involved in several of the pathophysiologic processes underpinning migraine attacks. Therapies that target CGRP or its receptor have shown efficacy as preventive or acute treatments for migraine. Two small-molecule CGRP receptor antagonists (rimegepant and ubrogepant) are approved for the acute treatment of migraine, and 4 monoclonal antibodies (eptinezumab, erenumab, fremanezumab, and galcanezumab) are approved for migraine prevention; erenumab targets the canonical CGRP receptor, the others CGRP ligand. CGRP plays a role in gastrointestinal nociception, inflammation, gastric acid secretion, and motility. Nausea and vomiting are among the gastrointestinal symptoms associated with migraine, but individuals with migraine may also experience functional upper and lower gastrointestinal comorbidities, such as gastroesophageal reflux disease, gastroparesis, functional diarrhea or constipation, and irritable bowel syndrome. Although gastrointestinal symptoms in migraine can be treatment-related, they may also be attributable to increased CGRP. In this review, we summarize the epidemiologic evidence for associations between migraine and gastrointestinal disorders, consider the possible physiologic role of CGRP in these associations, and review the clinical occurrence of gastrointestinal events in patients with migraine receiving CGRP-based therapies and other migraine treatments. Because patients with migraine are at an increased risk of comorbid and treatment-related gastrointestinal effects, we also propose a patient-management strategy to mitigate these effects.
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Affiliation(s)
- Jessica Ailani
- From the Department of Neurology (J.A.), Medstar Georgetown University Hospital, Washington, DC; Department of Neurology (E.A.K.), University of Pennsylvania, Philadelphia, PA; Harvard Medical School (P.G.M.), Boston, MA; Department of Neurology (P.G.M.), Brigham & Women's Hospital, Boston, MA; Department of Neurology (P.G.M.), Harvard Vanguard Medical Associates, Braintree, MA; New England Institute for Neurology and Headache (P.G.M., P.M.), Stamford, CT; Departments of Molecular Physiology and Biophysics (A.F.R.), Neurology, University of Iowa, Iowa City, IA; Center for the Prevention and Treatment of Visual Loss (A.F.R.), Iowa VA Health Care System, Iowa City, IA; Center for Neurointestinal Health (A.F.R., C.V.), Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, MA; Oxford PharmaGenesis (A.P.R.), Oxford, United Kingdom; Novartis Pharmaceuticals Corporation (A.A.), East Hanover, NJ; Amgen Neuroscience (C.X., S.R.), Thousand Oaks, CA; and Geisel School of Medicine at Dartmouth (S.J.T.), Hanover, NH.
| | - Eric A Kaiser
- From the Department of Neurology (J.A.), Medstar Georgetown University Hospital, Washington, DC; Department of Neurology (E.A.K.), University of Pennsylvania, Philadelphia, PA; Harvard Medical School (P.G.M.), Boston, MA; Department of Neurology (P.G.M.), Brigham & Women's Hospital, Boston, MA; Department of Neurology (P.G.M.), Harvard Vanguard Medical Associates, Braintree, MA; New England Institute for Neurology and Headache (P.G.M., P.M.), Stamford, CT; Departments of Molecular Physiology and Biophysics (A.F.R.), Neurology, University of Iowa, Iowa City, IA; Center for the Prevention and Treatment of Visual Loss (A.F.R.), Iowa VA Health Care System, Iowa City, IA; Center for Neurointestinal Health (A.F.R., C.V.), Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, MA; Oxford PharmaGenesis (A.P.R.), Oxford, United Kingdom; Novartis Pharmaceuticals Corporation (A.A.), East Hanover, NJ; Amgen Neuroscience (C.X., S.R.), Thousand Oaks, CA; and Geisel School of Medicine at Dartmouth (S.J.T.), Hanover, NH
| | - Paul G Mathew
- From the Department of Neurology (J.A.), Medstar Georgetown University Hospital, Washington, DC; Department of Neurology (E.A.K.), University of Pennsylvania, Philadelphia, PA; Harvard Medical School (P.G.M.), Boston, MA; Department of Neurology (P.G.M.), Brigham & Women's Hospital, Boston, MA; Department of Neurology (P.G.M.), Harvard Vanguard Medical Associates, Braintree, MA; New England Institute for Neurology and Headache (P.G.M., P.M.), Stamford, CT; Departments of Molecular Physiology and Biophysics (A.F.R.), Neurology, University of Iowa, Iowa City, IA; Center for the Prevention and Treatment of Visual Loss (A.F.R.), Iowa VA Health Care System, Iowa City, IA; Center for Neurointestinal Health (A.F.R., C.V.), Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, MA; Oxford PharmaGenesis (A.P.R.), Oxford, United Kingdom; Novartis Pharmaceuticals Corporation (A.A.), East Hanover, NJ; Amgen Neuroscience (C.X., S.R.), Thousand Oaks, CA; and Geisel School of Medicine at Dartmouth (S.J.T.), Hanover, NH
| | - Peter McAllister
- From the Department of Neurology (J.A.), Medstar Georgetown University Hospital, Washington, DC; Department of Neurology (E.A.K.), University of Pennsylvania, Philadelphia, PA; Harvard Medical School (P.G.M.), Boston, MA; Department of Neurology (P.G.M.), Brigham & Women's Hospital, Boston, MA; Department of Neurology (P.G.M.), Harvard Vanguard Medical Associates, Braintree, MA; New England Institute for Neurology and Headache (P.G.M., P.M.), Stamford, CT; Departments of Molecular Physiology and Biophysics (A.F.R.), Neurology, University of Iowa, Iowa City, IA; Center for the Prevention and Treatment of Visual Loss (A.F.R.), Iowa VA Health Care System, Iowa City, IA; Center for Neurointestinal Health (A.F.R., C.V.), Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, MA; Oxford PharmaGenesis (A.P.R.), Oxford, United Kingdom; Novartis Pharmaceuticals Corporation (A.A.), East Hanover, NJ; Amgen Neuroscience (C.X., S.R.), Thousand Oaks, CA; and Geisel School of Medicine at Dartmouth (S.J.T.), Hanover, NH
| | - Andrew F Russo
- From the Department of Neurology (J.A.), Medstar Georgetown University Hospital, Washington, DC; Department of Neurology (E.A.K.), University of Pennsylvania, Philadelphia, PA; Harvard Medical School (P.G.M.), Boston, MA; Department of Neurology (P.G.M.), Brigham & Women's Hospital, Boston, MA; Department of Neurology (P.G.M.), Harvard Vanguard Medical Associates, Braintree, MA; New England Institute for Neurology and Headache (P.G.M., P.M.), Stamford, CT; Departments of Molecular Physiology and Biophysics (A.F.R.), Neurology, University of Iowa, Iowa City, IA; Center for the Prevention and Treatment of Visual Loss (A.F.R.), Iowa VA Health Care System, Iowa City, IA; Center for Neurointestinal Health (A.F.R., C.V.), Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, MA; Oxford PharmaGenesis (A.P.R.), Oxford, United Kingdom; Novartis Pharmaceuticals Corporation (A.A.), East Hanover, NJ; Amgen Neuroscience (C.X., S.R.), Thousand Oaks, CA; and Geisel School of Medicine at Dartmouth (S.J.T.), Hanover, NH
| | - Christopher Vélez
- From the Department of Neurology (J.A.), Medstar Georgetown University Hospital, Washington, DC; Department of Neurology (E.A.K.), University of Pennsylvania, Philadelphia, PA; Harvard Medical School (P.G.M.), Boston, MA; Department of Neurology (P.G.M.), Brigham & Women's Hospital, Boston, MA; Department of Neurology (P.G.M.), Harvard Vanguard Medical Associates, Braintree, MA; New England Institute for Neurology and Headache (P.G.M., P.M.), Stamford, CT; Departments of Molecular Physiology and Biophysics (A.F.R.), Neurology, University of Iowa, Iowa City, IA; Center for the Prevention and Treatment of Visual Loss (A.F.R.), Iowa VA Health Care System, Iowa City, IA; Center for Neurointestinal Health (A.F.R., C.V.), Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, MA; Oxford PharmaGenesis (A.P.R.), Oxford, United Kingdom; Novartis Pharmaceuticals Corporation (A.A.), East Hanover, NJ; Amgen Neuroscience (C.X., S.R.), Thousand Oaks, CA; and Geisel School of Medicine at Dartmouth (S.J.T.), Hanover, NH
| | - Angela Pozo Ramajo
- From the Department of Neurology (J.A.), Medstar Georgetown University Hospital, Washington, DC; Department of Neurology (E.A.K.), University of Pennsylvania, Philadelphia, PA; Harvard Medical School (P.G.M.), Boston, MA; Department of Neurology (P.G.M.), Brigham & Women's Hospital, Boston, MA; Department of Neurology (P.G.M.), Harvard Vanguard Medical Associates, Braintree, MA; New England Institute for Neurology and Headache (P.G.M., P.M.), Stamford, CT; Departments of Molecular Physiology and Biophysics (A.F.R.), Neurology, University of Iowa, Iowa City, IA; Center for the Prevention and Treatment of Visual Loss (A.F.R.), Iowa VA Health Care System, Iowa City, IA; Center for Neurointestinal Health (A.F.R., C.V.), Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, MA; Oxford PharmaGenesis (A.P.R.), Oxford, United Kingdom; Novartis Pharmaceuticals Corporation (A.A.), East Hanover, NJ; Amgen Neuroscience (C.X., S.R.), Thousand Oaks, CA; and Geisel School of Medicine at Dartmouth (S.J.T.), Hanover, NH
| | - Ahmad Abdrabboh
- From the Department of Neurology (J.A.), Medstar Georgetown University Hospital, Washington, DC; Department of Neurology (E.A.K.), University of Pennsylvania, Philadelphia, PA; Harvard Medical School (P.G.M.), Boston, MA; Department of Neurology (P.G.M.), Brigham & Women's Hospital, Boston, MA; Department of Neurology (P.G.M.), Harvard Vanguard Medical Associates, Braintree, MA; New England Institute for Neurology and Headache (P.G.M., P.M.), Stamford, CT; Departments of Molecular Physiology and Biophysics (A.F.R.), Neurology, University of Iowa, Iowa City, IA; Center for the Prevention and Treatment of Visual Loss (A.F.R.), Iowa VA Health Care System, Iowa City, IA; Center for Neurointestinal Health (A.F.R., C.V.), Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, MA; Oxford PharmaGenesis (A.P.R.), Oxford, United Kingdom; Novartis Pharmaceuticals Corporation (A.A.), East Hanover, NJ; Amgen Neuroscience (C.X., S.R.), Thousand Oaks, CA; and Geisel School of Medicine at Dartmouth (S.J.T.), Hanover, NH
| | - Cen Xu
- From the Department of Neurology (J.A.), Medstar Georgetown University Hospital, Washington, DC; Department of Neurology (E.A.K.), University of Pennsylvania, Philadelphia, PA; Harvard Medical School (P.G.M.), Boston, MA; Department of Neurology (P.G.M.), Brigham & Women's Hospital, Boston, MA; Department of Neurology (P.G.M.), Harvard Vanguard Medical Associates, Braintree, MA; New England Institute for Neurology and Headache (P.G.M., P.M.), Stamford, CT; Departments of Molecular Physiology and Biophysics (A.F.R.), Neurology, University of Iowa, Iowa City, IA; Center for the Prevention and Treatment of Visual Loss (A.F.R.), Iowa VA Health Care System, Iowa City, IA; Center for Neurointestinal Health (A.F.R., C.V.), Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, MA; Oxford PharmaGenesis (A.P.R.), Oxford, United Kingdom; Novartis Pharmaceuticals Corporation (A.A.), East Hanover, NJ; Amgen Neuroscience (C.X., S.R.), Thousand Oaks, CA; and Geisel School of Medicine at Dartmouth (S.J.T.), Hanover, NH
| | - Soeren Rasmussen
- From the Department of Neurology (J.A.), Medstar Georgetown University Hospital, Washington, DC; Department of Neurology (E.A.K.), University of Pennsylvania, Philadelphia, PA; Harvard Medical School (P.G.M.), Boston, MA; Department of Neurology (P.G.M.), Brigham & Women's Hospital, Boston, MA; Department of Neurology (P.G.M.), Harvard Vanguard Medical Associates, Braintree, MA; New England Institute for Neurology and Headache (P.G.M., P.M.), Stamford, CT; Departments of Molecular Physiology and Biophysics (A.F.R.), Neurology, University of Iowa, Iowa City, IA; Center for the Prevention and Treatment of Visual Loss (A.F.R.), Iowa VA Health Care System, Iowa City, IA; Center for Neurointestinal Health (A.F.R., C.V.), Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, MA; Oxford PharmaGenesis (A.P.R.), Oxford, United Kingdom; Novartis Pharmaceuticals Corporation (A.A.), East Hanover, NJ; Amgen Neuroscience (C.X., S.R.), Thousand Oaks, CA; and Geisel School of Medicine at Dartmouth (S.J.T.), Hanover, NH
| | - Stewart J Tepper
- From the Department of Neurology (J.A.), Medstar Georgetown University Hospital, Washington, DC; Department of Neurology (E.A.K.), University of Pennsylvania, Philadelphia, PA; Harvard Medical School (P.G.M.), Boston, MA; Department of Neurology (P.G.M.), Brigham & Women's Hospital, Boston, MA; Department of Neurology (P.G.M.), Harvard Vanguard Medical Associates, Braintree, MA; New England Institute for Neurology and Headache (P.G.M., P.M.), Stamford, CT; Departments of Molecular Physiology and Biophysics (A.F.R.), Neurology, University of Iowa, Iowa City, IA; Center for the Prevention and Treatment of Visual Loss (A.F.R.), Iowa VA Health Care System, Iowa City, IA; Center for Neurointestinal Health (A.F.R., C.V.), Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, MA; Oxford PharmaGenesis (A.P.R.), Oxford, United Kingdom; Novartis Pharmaceuticals Corporation (A.A.), East Hanover, NJ; Amgen Neuroscience (C.X., S.R.), Thousand Oaks, CA; and Geisel School of Medicine at Dartmouth (S.J.T.), Hanover, NH
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Frazier R, Venkatesan T. Current understanding of the etiology of cyclic vomiting syndrome and therapeutic strategies in its management. Expert Rev Clin Pharmacol 2022; 15:1305-1316. [PMID: 36259482 DOI: 10.1080/17512433.2022.2138341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Cyclic vomiting syndrome is a chronic debilitating disorder of the gut-brain interaction and is characterized by recurrent episodes of nausea and vomiting.Recent studies indicate that it is common and affects 2% of the US population. Unfortunately, there is significant heterogeneity in the management of these patients in the medical community. This review article aims to bridge this gap and will review the epidemiology and etiology with a focus on management of CVS. AREAS COVERED This article reviews the epidemiology, and pathophysiology of CVS and impact on patients. It also discusses management based on recent guidelines based on which is intended for the busy clinician. A literature search was done using PubMed and key words "cyclic vomiting", "management", "etiology", and pathophysiology were used to identify articles of importance. EXPERT OPINION CVS is a complex, poorly understood disorder of gut-brain interaction (DGBI) and has a significant negative impact on patients, families and the healthcare system. Recent guidelines recommend a multidisciplinary approach to management using prophylactic therapy in moderate-severe CVS and abortive medication for acute flares. However more research is needed to better understand the pathophysiology and develop targeted therapies for CVS.
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Affiliation(s)
- Rosita Frazier
- Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona
| | - Thangam Venkatesan
- Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University, Columbus, OH
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17
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Ailani J, Kaiser EA, Mathew PG, McAllister P, Russo AF, Vélez C, Ramajo AP, Abdrabboh A, Xu C, Rasmussen S, Tepper SJ. Role of Calcitonin Gene-Related Peptide on the Gastrointestinal Symptoms of Migraine-Clinical Considerations: A Narrative Review. Neurology 2022. [PMID: 36127137 DOI: 10.1212/wnl.0000000000201332.10.1212/wnl.0000000000201332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023] Open
Abstract
Calcitonin gene-related peptide (CGRP) is involved in several of the pathophysiological processes underpinning migraine attacks. Therapies that target CGRP or its receptor have shown efficacy as preventive or acute treatments for migraine. Two small-molecule CGRP receptor antagonists (rimegepant and ubrogepant) are approved for the acute treatment of migraine, and four monoclonal antibodies (eptinezumab, erenumab, fremanezumab, and galcanezumab) are approved for migraine prevention; erenumab targets the canonical CGRP receptor, the others CGRP ligand. CGRP plays a role in gastrointestinal nociception, inflammation, gastric acid secretion, and motility. Nausea and vomiting are among the gastrointestinal symptoms associated with migraine, but individuals with migraine may also experience functional upper and lower gastrointestinal comorbidities, such as gastroesophageal reflux disease, gastroparesis, functional diarrhea or constipation, and irritable bowel syndrome. Although gastrointestinal symptoms in migraine can be treatment-related, they may also be attributable to increased CGRP. In this review, we summarize the epidemiological evidence for associations between migraine and gastrointestinal disorders, consider the possible physiological role of CGRP in these associations, and review the clinical occurrence of gastrointestinal events in patients with migraine receiving CGRP-based therapies and other migraine treatments. Because patients with migraine are at an increased risk of comorbid and treatment-related gastrointestinal effects, we also propose a patient-management strategy to mitigate these effects.
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Affiliation(s)
- Jessica Ailani
- Department of Neurology, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Eric A Kaiser
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - Paul G Mathew
- Harvard Medical School, Boston, MA, USA.,Department of Neurology, Brigham & Women's Hospital, Boston, MA, USA.,Department of Neurology, Harvard Vanguard Medical Associates, Braintree, MA, USA
| | - Peter McAllister
- New England Institute for Neurology and Headache, Stamford, CT, USA
| | - Andrew F Russo
- Departments of Molecular Physiology and Biophysics, Neurology, University of Iowa, Iowa City, IA, USA.,Center for the Prevention and Treatment of Visual Loss, Iowa VA Health Care System, Iowa City, IA, USA
| | - Christopher Vélez
- Center for Neurointestinal Health, Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | | | | | - Cen Xu
- Amgen Neuroscience, Thousand Oaks, CA, USA
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18
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Isoldi S, Di Nardo G, Mallardo S, Parisi P, Raucci U, Tambucci R, Quitadamo P, Salvatore S, Felici E, Cisarò F, Pensabene L, Banzato C, Strisciuglio C, Romano C, Fusco P, Rigotti F, Sansotta N, Caimmi S, Savasta S, Zuin G, Di Stefano M, Provera S, Campanozzi A, Rossi P, Gatti S, Corpino M, Alvisi P, Martelossi S, Suppiej A, Gandullia P, Verrotti A, Terrin G, Pacenza C, Fornaroli F, Comito D, D'Arrigo S, Striano P, Raviglione F, Carotenuto M, Orsini A, Belcastro V, Di Corcia G, Raieli V, Ferilli MAN, Ruscitto C, Spadoni E, Grosso S, D'Alonzo R, Papa A, Pavone P, Meli M, Velardita M, Mainetti M, Vanacore N, Borrelli O. Cyclic vomiting syndrome in children: a nationwide survey of current practice on behalf of the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition (SIGENP) and Italian Society of Pediatric Neurology (SINP). Ital J Pediatr 2022; 48:156. [PMID: 36042474 PMCID: PMC9429644 DOI: 10.1186/s13052-022-01346-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 08/10/2022] [Indexed: 11/23/2022] Open
Abstract
Background Cyclic Vomiting Syndrome (CVS) is a rare functional gastrointestinal disorder, which has a considerable burden on quality of life of both children and their family. Aim of the study was to evaluate the diagnostic modalities and therapeutic approach to CVS among Italian tertiary care centers and the differences according to subspecialties, as well as to explore whether potential predictive factors associated with either a poor outcome or a response to a specific treatment. Methods Cross-sectional multicenter web-based survey involving members of the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition (SIGENP) and Italian Society of Pediatric Neurology (SINP). Results A total of 67 responses were received and analyzed. Most of the respondent units cared for less than 20 patients. More than half of the patients were referred after 3 to 5 episodes, and a quarter after 5 attacks. We report different diagnostic approaches among Italian clinicians, which was particularly evident when comparing gastroenterologists and neurologists. Moreover, our survey demonstrated a predilection of certain drugs during emetic phase according to specific clinic, which reflects the cultural background of physicians. Conclusion In conclusion, our survey highlights poor consensus amongst clinicians in our country in the diagnosis and the management of children with CVS, raising the need for a national consensus guideline in order to standardize the practice. Supplementary Information The online version contains supplementary material available at 10.1186/s13052-022-01346-y.
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Affiliation(s)
- Sara Isoldi
- Maternal and Child Health Department, Santa Maria Goretti Hospital, Sapienza-University of Rome, Latina, Italy
| | - Giovanni Di Nardo
- Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Faculty of Medicine & Psychology, Sant'Andrea Hospital, Sapienza University of Rome, 00189, Rome, Lazio, Italy
| | - Saverio Mallardo
- Maternal and Child Health Department, Santa Maria Goretti Hospital, Sapienza-University of Rome, Latina, Italy
| | - Pasquale Parisi
- Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Faculty of Medicine & Psychology, Sant'Andrea Hospital, Sapienza University of Rome, 00189, Rome, Lazio, Italy.
| | - Umberto Raucci
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, Institute for Research, Hospitalization and Health Care (IRCCS), Rome, Italy
| | - Renato Tambucci
- Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital, Institute for Research, Hospitalization and Health Care (IRCCS), Rome, Italy
| | - Paolo Quitadamo
- Department of Pediatrics, A.O.R.N. Santobono-Pausilipon, Naples, Italy
| | - Silvia Salvatore
- Pediatric Department, Ospedale "F. Del Ponte", University of Insubria, Varese, Italy
| | - Enrico Felici
- Unit of Pediatrics, The Children Hospital, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Fabio Cisarò
- Pediatric Gastroenterology Unit, Regina Margherita Children's Hospital, Azienda Ospedaliera-Universitaria, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Licia Pensabene
- Pediatric Unit, Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Claudia Banzato
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Division, University of Verona, Verona, Italy
| | - Caterina Strisciuglio
- Department of Woman, Child, General and Specialistic Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Claudio Romano
- Pediatric Gastroenterology Unit, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy
| | - Patrizia Fusco
- Pediatric Unit, Montis Regalis Hospital, Mondovì, Cuneo, Italy
| | | | - Naire Sansotta
- Paediatric Hepatology, Gastroenterology and Transplantation, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Silvia Caimmi
- Pediatric Clinic, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Salvatore Savasta
- Pediatric Clinic, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Giovanna Zuin
- Pediatric Department, University of Milano Bicocca, FMBBM, San Gerardo Hospital, Monza, Italy
| | - Marina Di Stefano
- Department of Pediatrics, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Silvia Provera
- Department of Pediatrics, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Angelo Campanozzi
- Department of Medical and Surgical Sciences, Pediatric Unit, University of Foggia, Foggia, Italy
| | - Paolo Rossi
- Department of Pediatrics, Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Rome, Italy
| | - Simona Gatti
- Department of Pediatrics, Università Politecnica delle Marche, Ancona, Italy
| | - Mara Corpino
- Gastroenterologia Pediatrica, Clinica Pediatrica e Malattie Rare, Ospedale Pediatrico Microcitemico A. Cao, ARNAS Brotzu, Cagliari, Italy
| | - Patrizia Alvisi
- Department of Paediatrics, Ospedale Maggiore, Azienda USL, Bologna, Italy
| | | | - Agnese Suppiej
- Pediatric Section, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Paolo Gandullia
- UOC Gastroenterologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - Gianluca Terrin
- Department of Maternal and Child Health, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Caterina Pacenza
- Department of Pediatrics, San Giovanni di Dio Hospital, Crotone, Italy
| | - Fabiola Fornaroli
- Gastroenterology and Endoscopy Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | - Stefano D'Arrigo
- Developmental Neurology Division, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Pasquale Striano
- Pediatric Neurology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - Marco Carotenuto
- Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health and Physical and Preventive Medicine, Università degli Studi della Campania "Luigi Vanvitelli", Caserta, Italy
| | - Alessandro Orsini
- Paediatric Neurology Section, Paediatric Department, Pisa University Hospital, University of Pisa, Pisa, Italy
| | | | | | - Vincenzo Raieli
- Child Neuropsychiatry Unit - ISMEP- ARNAS CIVICO, Palermo, Italy
| | - Michela Ada Noris Ferilli
- Department of Neuroscience, Paediatric Headache Center, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Claudia Ruscitto
- Child Neurology and Psychiatry Unit, Systems Medicine Department, Tor Vergata University Hospital of Rome, Rome, Italy
| | - Elisabetta Spadoni
- Pediatric Department, Azienda Ospedaliera Nord-Ovest of Tuscany, San Luca Hospital of Lucca, Lucca, Italy
| | - Salvatore Grosso
- Molecular Medicine and Development, University of Siena, Siena, Italy
| | - Renato D'Alonzo
- Pediatric and Neonatological Unit, Maternal and Child Department, Nuovo Ospedale San Giovanni Battista, Foligno, Italy
| | - Amanda Papa
- Infantile Neuropsychiatry Departement Maggiore della Carità University Hospital, Novara, Italy
| | - Piero Pavone
- Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Mariaclaudia Meli
- Azienda Policlinico, "Rodolico-San Marco Hospital", University of Catania, Catania, Italy
| | - Mario Velardita
- Department of Pediatrics, Hospital "Salvatore e Saverio Gravina", Caltagirone, Italy
| | - Martina Mainetti
- Department of Pediatrics, Santa Maria delle Croci Hospital, Ravenna, Italy
| | - Nicola Vanacore
- National Centre for Epidemiology, Surveillance and Health Promotion, National Institute of Health, Rome, Italy
| | - Osvaldo Borrelli
- Division of Neurogastroenterology and Motility, Department of Pediatric Gastroenterology, University College London (UCL) Institute of Child Health and Great Ormond Street Hospital, London, UK
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Song X, Chen YJ, Perry A, Kagan J, Bhandari S, Almansa C, Richmond C, Levinthal DJ, Venkatesan T. Productivity Loss and Indirect Burden of Cyclic Vomiting Syndrome in the United States. GASTRO HEP ADVANCES 2022; 1:954-962. [PMID: 39131254 PMCID: PMC11307938 DOI: 10.1016/j.gastha.2022.06.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 06/30/2022] [Indexed: 08/13/2024]
Abstract
Background and Aims To quantify the indirect burden of cyclic vomiting syndrome (CVS), we assessed work-related productivity loss in patients with CVS and caregivers using large-sized databases in the United States. Methods Patients aged 18-64 years with full-time employment in MarketScan Commercial and Health and Productivity Management Databases were selected if they had ≥1 inpatient or ≥2 outpatient claims for CVS between 2008 and 2018 and continuous enrollment of ≥6 months before and ≥3 months after the initial CVS diagnosis. CVS caregivers were adults with full-time employment and also having dependent(s) with CVS. Propensity scores via multivariable regressions were used to match patients with CVS and their caregivers to non-CVS controls. Productivity loss was assessed by short-term disability (STD) and absenteeism (ABS) days, and the associated costs were also calculated. Differences between the matched cohorts were regarded as the burden attributable to CVS. Results Patients with CVS had longer annualized STD (21.1 vs 7.0, P < .001) and ABS days (26.4 vs 22.8, P < .05) than their matched controls. CVS caregivers had more annualized STD (3.9 vs 2.6, P < .001) and ABS days (20.9 vs 19.5, P < .05) than controls. Productivity loss costs for STD or ABS days were greater for patients with CVS and caregivers. Annualized health-care resource utilization (inpatient, emergency room, outpatient) was 5.2-6.0 times higher in patients with CVS (P < .001). Conclusion CVS is associated with higher productivity loss due to STD/ABS and, therefore, greater indirect costs for patients and caregivers. Further research is needed to assess the full societal burden of CVS. More effective interventions may reduce the disease burden.
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Affiliation(s)
- Xue Song
- IBM Watson Health, Cambridge, Massachusetts
| | - Yaozhu J. Chen
- Takeda Development Center Americas, Inc., Cambridge, Massachusetts
| | | | | | - Sanjay Bhandari
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Cristina Almansa
- Takeda Development Center Americas, Inc., Cambridge, Massachusetts
| | - Camilla Richmond
- Takeda Development Center Americas, Inc., Cambridge, Massachusetts
| | - David J. Levinthal
- Division of Gastroenterology and Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Thangam Venkatesan
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin
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20
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Guo Z, Chen P, Liu L, Song H. Compatibility and stability of methylprednisolone sodium succinate and granisetron hydrochloride in 0.9% sodium chloride solution. Medicine (Baltimore) 2022; 101:e29674. [PMID: 35839031 PMCID: PMC11132371 DOI: 10.1097/md.0000000000029674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 05/11/2022] [Indexed: 11/26/2022] Open
Abstract
A combination of methylprednisolone sodium succinate (MSS) and granisetron hydrochloride (GH) is generally devoted to treating the chemotherapy-induced nausea and vomiting. To date, none of these novel mixtures have been commercially available. The present study was aimed at investigating physical and chemical compatibility and stability of a combination of MSS with GH in 0.9% sodium chloride injection for 72 hours at 4°C and 25°C. A mixture of MSS (0.4-0.8 mg/mL) with GH (0.03 mg/mL) was prepared and stored in both polyvinyl chloride bags and glass bottles using 0.9% sodium chloride injection as a diluent. The study was performed using a validated and stability-indicating high-performance liquid chromatography method. The physical compatibility was assessed by a spectrometer. Furthermore, the pH measurement of each sample was measured electronically. All test solutions stored at 4°C or 25°C had a no >2% loss of the initial concentration throughout the 72-hour study period. All solutions remained clear and colorless throughout the study and were without precipitation or turbidity in any of the batches. The drug mixtures of MSS (0.4-0.8 mg/mL) and GH (0.03 mg/mL) in 0.9% sodium chloride injections were physically and chemically stable for at least 72 hours when stored at 4°C or 25°C in polyvinyl chloride bags or glass bottles.
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Affiliation(s)
- Zhilei Guo
- Department of Pharmacy, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Peng Chen
- Department of Pharmacy, Renmin Hospital of Wuhan University, Wuhan, China
| | - Li Liu
- Department of Pharmacy, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hongping Song
- Department of Pharmacy, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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21
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Kumagai N, Kondoh T, Matsumoto Y, Ikezumi Y. Transient Type 3 Renal Tubular Acidosis during Cyclic Vomiting Syndrome. TOHOKU J EXP MED 2022; 257:73-76. [PMID: 35354692 DOI: 10.1620/tjem.2022.j015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Naonori Kumagai
- Department of Pediatrics, Fujita Health University School of Medicine
| | - Tomomi Kondoh
- Department of Pediatrics, Fujita Health University School of Medicine
| | - Yuji Matsumoto
- Department of Pediatrics, Fujita Health University School of Medicine
| | - Yohei Ikezumi
- Department of Pediatrics, Fujita Health University School of Medicine
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22
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Mauritz MD, Hasan C, Schreiber L, Wegener-Panzer A, Barth S, Zernikow B. Differential Diagnosis of Cyclic Vomiting and Periodic Headaches in a Child with Ventriculoperitoneal Shunt: Case Report of Chronic Shunt Overdrainage. CHILDREN (BASEL, SWITZERLAND) 2022; 9:432. [PMID: 35327804 PMCID: PMC8946983 DOI: 10.3390/children9030432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/10/2022] [Accepted: 03/16/2022] [Indexed: 11/17/2022]
Abstract
Fourteen months after the implantation of a ventriculoperitoneal shunt catheter, a six-year-old boy developed recurrent, severe headaches and vomiting every three weeks. The attacks were of such severity that hospitalizations for analgesic and antiemetic therapies and intravenous rehydration and electrolyte substitution were repeatedly required. The patient was asymptomatic between the attacks. After an extensive diagnostic workup-including repeated magnetic resonance imaging (MRI) and neurosurgical examinations-common differential diagnoses, including shunt overdrainage, were ruled out. The patient was transferred to a specialized pediatric pain clinic with suspected cyclic vomiting syndrome (CVS). Despite intensive and in part experimental prophylactic and abortive pharmacological treatment, there was no improvement in his symptoms. Consecutive MRI studies reinvestigating the initially excluded shunt overdrainage indicated an overdrainage syndrome. Subsequently, the symptoms disappeared after disconnecting the shunt catheter. This case report shows that even if a patient meets CVS case definitions, other differential diagnoses must be carefully reconsidered to avoid fixation error.
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Affiliation(s)
- Maximilian David Mauritz
- Paediatric Palliative Care Centre, Children’s and Adolescents’ Hospital, Witten/Herdecke University, 45711 Datteln, Germany; (C.H.); (B.Z.)
| | - Carola Hasan
- Paediatric Palliative Care Centre, Children’s and Adolescents’ Hospital, Witten/Herdecke University, 45711 Datteln, Germany; (C.H.); (B.Z.)
- Department of Children’s Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, 58448 Witten, Germany
| | - Lutz Schreiber
- Department of Pediatric Neurosurgery, Klinikum Vest, Academic Teaching Hospital, Ruhr University Bochum, 45657 Recklinghausen, Germany;
| | - Andreas Wegener-Panzer
- Department of Radiology, Children’s and Adolescents’ Hospital, Witten/Herdecke University, 45711 Datteln, Germany;
| | - Sylvia Barth
- Department of Pediatrics, Ostalb Klinikum Aalen, 73430 Aalen, Germany;
| | - Boris Zernikow
- Paediatric Palliative Care Centre, Children’s and Adolescents’ Hospital, Witten/Herdecke University, 45711 Datteln, Germany; (C.H.); (B.Z.)
- Department of Children’s Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, 58448 Witten, Germany
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23
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Reeves PT, Kovacic K, Rogers PL, Sanghavi R, Levinthal DJ, Echelmeyer S, Li BUK. Development and Assessment of a Low Literacy, Pictographic Cyclic Vomiting Syndrome Action Plan. J Pediatr 2022; 242:174-183.e1. [PMID: 34740589 DOI: 10.1016/j.jpeds.2021.10.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/04/2021] [Accepted: 10/26/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To develop and assess an evidence-based, individualized Cyclic Vomiting Syndrome Action Plan (CVSAP) to optimize both preventative and acute care. STUDY DESIGN This implementation science project synthesized a combination of clinical practice guidelines, published literature, and clinical experience by a team of CVS clinicians to develop the CVSAP. The tool was developed to include validated pictograms and an automatic, embedded, weight-based dosing calculator to output acute management recommendations. The final version of the CVSAP was tested by patients/caregivers, readability calculators, medical librarians, and clinicians using validated metrics. RESULTS All pictograms met the criteria for inclusion in the CVSAP. A composite readability score of 5.32 was consistent with a fifth-grade level. Patients/caregivers (n = 70) judged the CVSAP to be of high quality with consumer information rating form rating of 84.2%. Six medical librarians rated the CVSAP to have 93% understandability and 100% actionability, and 33 clinicians completing the SAM generated a suitability rating of 87.5%. CONCLUSIONS The CVSAP visually highlights individualized care plan components to facilitate optimized preventative and acute CVS care. Further investigation will determine if CVSAP increases caregiver confidence and compliance in home management and improves quality of life and clinical outcomes for patients with CVS.
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Affiliation(s)
- Patrick T Reeves
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Walter Reed National Military Medical Center, Bethesda, MD; Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD.
| | - Katja Kovacic
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Medical College of Wisconsin, Milwaukee, WI
| | - Philip L Rogers
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Walter Reed National Military Medical Center, Bethesda, MD; Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Rinarani Sanghavi
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, U T Southwestern Medical Center, Dallas, TX
| | - David J Levinthal
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Sofia Echelmeyer
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - B U K Li
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Medical College of Wisconsin, Milwaukee, WI
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24
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LenglarT L, Caula C, Moulding T, Lyles A, Wohrer D, Titomanlio L. Brain to Belly: Abdominal Variants of Migraine and Functional Abdominal Pain Disorders Associated With Migraine. J Neurogastroenterol Motil 2021; 27:482-494. [PMID: 34642268 PMCID: PMC8521460 DOI: 10.5056/jnm20290] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/22/2021] [Accepted: 04/08/2021] [Indexed: 12/13/2022] Open
Abstract
Migraine is one of the most frequent causes of primary headache and 9% of children suffer from migraines. Most children will continue to experience migraine attacks as adults, therefore it is imperative that we have a thorough understanding of this major health issue. This article considers the so-called abdominal variants of migraine, which are more commonly seen in children rather than adults: abdominal migraine, cyclic vomiting syndrome, and infantile colic. Other functional abdominal pain disorders such as irritable bowel syndrome and functional dyspepsia have also been linked to migraine in clinical studies. The common pathophysiological root of these diseases seems to be the gut-brain axis mechanism. Abdominal variants of migraine are considered pediatric precursors of migraine whereas the functional abdominal pain disorders related to migraine seem to share a pathophysiological root with no temporarily link as for today. In this review we aim to describe the epidemiological background, the current pathophysiological theories and the relationship of each disease to migraine. This review is the first to compile abdominal variants of migraine and functional abdominal pain disorders associated with migraine and we endeavor to elucidate the broad spectrum of migraine-related episodes in children.
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Affiliation(s)
- Léa LenglarT
- Department of Pediatric Emergency Care, APHP - Hopital Robert Debré, Paris, France
| | - Caroline Caula
- Department of Pediatric Emergency Care, APHP - Hopital Robert Debré, Paris, France
| | - Thomas Moulding
- Department of Specialty and Integrated Medicine, The Leeds Teaching Hospitals, NHS Trust, Leeds, UK
| | - Annabel Lyles
- Department of Oncology, The Leeds Teaching Hospitals, NHS Trust, Leeds, UK
| | - Delphine Wohrer
- Department of Pediatric Emergency Care, APHP - Hopital Robert Debré, Paris, France
| | - Luigi Titomanlio
- Department of Pediatric Emergency Care, APHP - Hopital Robert Debré, Paris, France.,Pediatric Migraine and Neurovascular Diseases Unit, APHP - Hopital Robert Debré, Paris, France.,Paris University, INSERM U1141, DHU Protect, Paris, France
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25
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Arafat SY, Mondal F, Ghimire S, Perveen I. Cyclic vomiting syndrome in a 27-year-old male: A case report. Clin Case Rep 2021; 9:e04488. [PMID: 34267919 PMCID: PMC8271246 DOI: 10.1002/ccr3.4488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/07/2021] [Accepted: 05/17/2021] [Indexed: 11/26/2022] Open
Abstract
A 27-year-old man presented with post-meal chest tightness followed by vomiting for 3 years. With a multidisciplinary approach, he was labeled as cyclical vomiting syndrome and treated with pharmacotherapy, psychotherapy, and lifestyle modifications.
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Affiliation(s)
- S.M. Yasir Arafat
- Department of PsychiatryEnam Medical College and HospitalDhakaBangladesh
| | - Firoj Mondal
- Department of PsychiatryEnam Medical College and HospitalDhakaBangladesh
| | - Sabina Ghimire
- Department of PsychiatryEnam Medical College and HospitalDhakaBangladesh
| | - Irin Perveen
- Department of GastroenterologyEnam Medical College and HospitalDhakaBangladesh
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26
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Abdulkader ZM, Bali N, Vaz K, Yacob D, Di Lorenzo C, Lu PL. Predictors of Hospital Admission for Pediatric Cyclic Vomiting Syndrome. J Pediatr 2021; 232:154-158. [PMID: 33259858 DOI: 10.1016/j.jpeds.2020.11.055] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 11/09/2020] [Accepted: 11/24/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To identify predictors of hospitalization in pediatric patients presenting to an emergency department (ED) for a cyclic vomiting syndrome (CVS) attack. STUDY DESIGN We retrospectively reviewed patients with CVS seen at our institution between 2015 and 2018 and included those who met the Rome IV criteria for CVS. We identified all CVS-related ED visits and subsequently performed a case-control analysis, utilizing multivariate logistic regression, to identify clinical and demographic factors that may predict hospitalization. RESULTS In total, 219 patients with CVS (using International Statistical Classification of Diseases and Related Health Problems, 10th Revision) were identified, of which 65% met the inclusion criteria (median age 11 years). We identified 152 CVS-related ED visits, of which 62% resulted in hospitalization. Factors found to predict hospitalization using multivariate analyses included male sex (P = .04), younger age (P = .027), delayed presentation (>24 hours) to the ED (P < .001), and longer wait time prior treatment with antiemetics (P = .029). CONCLUSION One-quarter of all patients with CVS had presented to the ED and nearly two-thirds of these ED visits resulted in hospitalization. A delayed presentation to the ED following the onset of symptoms was the strongest independent predictor of hospital admission, alongside male sex, younger age, and longer ED wait times before treatment with antiemetics. These findings suggest that early intervention may be key to successfully mitigating the risk of hospitalization for a CVS attack.
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Affiliation(s)
- Zeyad M Abdulkader
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, OH.
| | - Neetu Bali
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, OH
| | - Karla Vaz
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, OH
| | - Desalegn Yacob
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, OH
| | - Carlo Di Lorenzo
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, OH
| | - Peter L Lu
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, OH
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27
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Li BUK. Treating Cyclic Vomiting Syndrome in the Emergency Department: Sooner Appears Better. J Pediatr 2021; 232:12-14. [PMID: 33373673 DOI: 10.1016/j.jpeds.2020.12.066] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 12/23/2020] [Indexed: 02/07/2023]
Affiliation(s)
- B U K Li
- Department of Pediatrics, Medical College of Wisconsin, Middleton, Wisconsin.
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28
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Nivatsi M, Aslanidou I, Mantadakis E. Highly effective use of aprepitant in an adolescent girl with severe cyclic vomiting syndrome. BMJ Case Rep 2021; 14:e241132. [PMID: 33664041 PMCID: PMC7934711 DOI: 10.1136/bcr-2020-241132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2021] [Indexed: 01/16/2023] Open
Abstract
Cyclic vomiting syndrome (CVS) is a debilitating functional gastrointestinal disorder. Diagnosis is based on the Rome III criteria. There are no evidence-based guidelines for the management of paediatric CVS, although ondansetron and antimigraine medications are frequently tried. We describe a 13-year-old adolescent girl with severe CVS and numerous hospital admissions for dehydration because of cyclic vomiting. She had failed oral ondansetron therapy. Oral aprepitant (125 mg in the first, and 85 mg on the second and third days), a neurokinin 1 receptor antagonist that has been approved for preventing chemotherapy-induced vomiting or postoperative emesis, was tried in our patient at home during the first prodromal signs of an upset stomach. She had a dramatic response to it, with no further episodes of vomiting since its start. There is an urgent need for randomised clinical studies to assess the efficacy of available treatment options, including aprepitant in patients with severe CVS.
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Affiliation(s)
- Maria Nivatsi
- Department of Paediatrics, University General Hospital of Alexandroupolis, Alexandroupolis, Thrace, Greece
| | - Ilona Aslanidou
- Department of Paediatrics, University General Hospital of Alexandroupolis, Alexandroupolis, Thrace, Greece
| | - Elpis Mantadakis
- Department of Paediatrics, Democritus University of Thrace Faculty of Medicine, Alexandroupolis, Thrace, Greece
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29
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Kovacic K, Li BUK. Cyclic vomiting syndrome: A narrative review and guide to management. Headache 2021; 61:231-243. [PMID: 33619730 DOI: 10.1111/head.14073] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/03/2021] [Accepted: 01/06/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVES/BACKGROUND Cyclic vomiting syndrome (CVS) is a disabling disorder of gut-brain interaction manifested by stereotypical and severe episodes of nausea and vomiting. Prevalence data indicate that CVS affects 1-2% of children and there has been a recent dramatic rise in diagnosed adults. METHODS This narrative review summarizes relevant literature pertaining to pediatric and adult CVS and provides a guide to management based on extensive clinical experience. RESULTS More timely diagnosis is facilitated by an expert consensus diagnostic approach and limited testing. Some diagnostic tests of exclusion remain essential. These include an upper gastrointestinal (GI) contrast study to exclude intestinal malrotation and basic laboratory screening. An abdominal ultrasound is recommended to exclude renal hydronephrosis in children and biliary disease in adults. Exclusion of metabolic/genetic conditions is warranted in those with specific warning signs, presentation in infants/toddler age, and in those with refractory disease. In the absence of chronic GI symptoms, referral to a GI specialist for upper endoscopy is generally not necessary in children but recommended in adults. A large subset termed migraine-equivalent CVS display strong clinical and genetic features of migraine. A unifying pathophysiologic core concept involves neuronal hyperexcitability and aberrant central modulation of autonomic signals. This is coupled with multiple susceptibility factors including mitochondrial dysfunction/cellular energy deficits, a hyper-responsive hypothalamic-pituitary-adrenal axis and many comorbidities that increase vulnerability to triggering events. CVS episodes are frequently triggered by stressors and intercurrent illnesses. Lifestyle and non-pharmacological interventions thus play a pivotal role in successful management. Pharmacological therapies are categorized into abortive, supportive/rescue, and prophylactic treatments. The majority respond particularly well to migraine-focused treatment strategies. CONCLUSION Despite improved characterization and understanding, CVS remains classified as a functional disorder of brain-gut interaction that is often disjointly managed by generalists and subspecialists. Early recognition, evaluation, and management will facilitate care and improve outcomes. Further research into its natural history with common progression to migraine headaches, neuroendocrine mechanisms, and the pathophysiologic relation to migraine diathesis is much needed.
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Affiliation(s)
- Katja Kovacic
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Medical College of Wisconsin, Milwaukee, WI, USA
| | - B U K Li
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Medical College of Wisconsin, Milwaukee, WI, USA
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30
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Abstract
Paediatric functional abdominal pain disorders, currently referred to as disorders of gut-brain interaction, comprise irritable bowel syndrome, functional dyspepsia, abdominal migraine and functional abdominal pain not otherwise specified, as defined by the Rome IV diagnostic criteria. Functional abdominal pain disorders are common disorders with a prevalence of 3-16% depending on country, age and sex. A greater understanding of aetiopathogenesis and pathophysiology is emerging and includes intestinal components (inflammation, motility and the microbiota), central factors (psychological aspects, sensitization and/or differences in connectivity or activity of certain brain regions) as well as extrinsic factors (infections). In particular, the timing of disruption of the microbiota-gut-brain axis seems to be important. Diagnosis is challenging but is primarily based on clinical symptoms and exclusion of other organic causes, with an emphasis on avoiding unnecessary invasive diagnostic procedures. The available pharmacological interventions are limited in children and, therefore, management has focused on combined approaches, including mind-targeted interventions (hypnotherapy and cognitive behavioural therapy), diet (probiotics) and percutaneous electrical nerve field stimulation. The evidence for their clinical efficacy, although limited, is favourable, with positive impacts on symptoms and overall quality of life. The coming decades hold promise for improved understanding and management of these enigmatic disorders.
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31
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Raucci U, Borrelli O, Di Nardo G, Tambucci R, Pavone P, Salvatore S, Baldassarre ME, Cordelli DM, Falsaperla R, Felici E, Ferilli MAN, Grosso S, Mallardo S, Martinelli D, Quitadamo P, Pensabene L, Romano C, Savasta S, Spalice A, Strisciuglio C, Suppiej A, Valeriani M, Zenzeri L, Verrotti A, Staiano A, Villa MP, Ruggieri M, Striano P, Parisi P. Cyclic Vomiting Syndrome in Children. Front Neurol 2020; 11:583425. [PMID: 33224097 PMCID: PMC7667239 DOI: 10.3389/fneur.2020.583425] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 09/14/2020] [Indexed: 12/13/2022] Open
Abstract
Cyclic Vomiting Syndrome (CVS) is an underdiagnosed episodic syndrome characterized by frequent hospitalizations, multiple comorbidities, and poor quality of life. It is often misdiagnosed due to the unappreciated pattern of recurrence and lack of confirmatory testing. CVS mainly occurs in pre-school or early school-age, but infants and elderly onset have been also described. The etiopathogenesis is largely unknown, but it is likely to be multifactorial. Recent evidence suggests that aberrant brain-gut pathways, mitochondrial enzymopathies, gastrointestinal motility disorders, calcium channel abnormalities, and hyperactivity of the hypothalamic-pituitary-adrenal axis in response to a triggering environmental stimulus are involved. CVS is characterized by acute, stereotyped and recurrent episodes of intense nausea and incoercible vomiting with predictable periodicity and return to baseline health between episodes. A distinction with other differential diagnoses is a challenge for clinicians. Although extensive and invasive investigations should be avoided, baseline testing toward identifying organic causes is recommended in all children with CVS. The management of CVS requires an individually tailored therapy. Management of acute phase is mainly based on supportive and symptomatic care. Early intervention with abortive agents during the brief prodromal phase can be used to attempt to terminate the attack. During the interictal period, non-pharmacologic measures as lifestyle changes and the use of reassurance and anticipatory guidance seem to be effective as a preventive treatment. The indication for prophylactic pharmacotherapy depends on attack intensity and severity, the impairment of the QoL and if attack treatments are ineffective or cause side effects. When children remain refractory to acute or prophylactic treatment, or the episode differs from previous ones, the clinician should consider the possibility of an underlying disease and further mono- or combination therapy and psychotherapy can be guided by accompanying comorbidities and specific sub-phenotype. This review was developed by a joint task force of the Italian Society of Pediatric Gastroenterology Hepatology and Nutrition (SIGENP) and Italian Society of Pediatric Neurology (SINP) to identify relevant current issues and to propose future research directions on pediatric CVS.
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Affiliation(s)
- Umberto Raucci
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, Institute for Research, Hospitalization and Health Care (IRCCS), Rome, Italy
| | - Osvaldo Borrelli
- Division of Neurogastroenterology and Motility, Department of Pediatric Gastroenterology, University College London (UCL) Institute of Child Health and Great Ormond Street Hospital, London, United Kingdom
| | - Giovanni Di Nardo
- Chair of Pediatrics, Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Faculty of Medicine & Psychology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Renato Tambucci
- Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital, Institute for Research, Hospitalization and Health Care (IRCCS), Rome, Italy
| | - Piero Pavone
- Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Silvia Salvatore
- Pediatric Department, Ospedale “F. Del Ponte,” University of Insubria, Varese, Italy
| | | | | | - Raffaele Falsaperla
- Neonatal Intensive Care and Pediatric Units, S. Marco Hospital, Vittorio Emanuele Hospital, Catania, Italy
| | - Enrico Felici
- Unit of Pediatrics, The Children Hospital, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Michela Ada Noris Ferilli
- Division of Neurology, Bambino Gesù Children's Hospital, Institute for Research, Hospitalization and Health Care (IRCCS), Rome, Italy
| | - Salvatore Grosso
- Clinical Pediatrics, Department of Molecular Medicine and Development, University of Siena, Siena, Italy
| | - Saverio Mallardo
- Pediatric Department, Santa Maria Goretti Hospital, Sapienza University of Rome, Latina, Italy
| | - Diego Martinelli
- Division of Metabolism, Department of Pediatric Specialties, Bambino Gesù Children's Hospital, Institute for Research, Hospitalization and Health Care (IRCCS), Rome, Italy
| | - Paolo Quitadamo
- Department of Pediatrics, A.O.R.N. Santobono-Pausilipon, Naples, Italy
| | - Licia Pensabene
- Pediatric Unit, Department of Medical and Surgical Sciences, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
| | - Claudio Romano
- Pediatric Gastroenterology Unit, Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University of Messina, Messina, Italy
| | | | - Alberto Spalice
- Child Neurology Division, Department of Pediatrics, “Sapienza,” University of Rome, Rome, Italy
| | - Caterina Strisciuglio
- Department of Woman, Child, General and Specialistic Surgery, University of Campania “Luigi Vanvitelli,” Naples, Italy
| | - Agnese Suppiej
- Pediatric Section, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Massimiliano Valeriani
- Division of Neurology, Bambino Gesù Children's Hospital, Institute for Research, Hospitalization and Health Care (IRCCS), Rome, Italy
| | - Letizia Zenzeri
- Emergency Pediatric Department, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Alberto Verrotti
- Department of Pediatrics, University of L'Aquila, L'Aquila, Italy
| | - Annamaria Staiano
- Section of Pediatrics, Department of Translational Medical Science, “Federico II” University of Naples, Naples, Italy
| | - Maria Pia Villa
- Chair of Pediatrics, Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Faculty of Medicine & Psychology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Martino Ruggieri
- Unit of Rare Diseases of the Nervous System in Childhood, Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Pasquale Striano
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genova, Italy
- Institute for Research, Hospitalization and Health Care (IRCCS) “G. Gaslini” Institute, Genova, Italy
| | - Pasquale Parisi
- Chair of Pediatrics, Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Faculty of Medicine & Psychology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
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Ambartsumyan L, Khlevner J, Nurko S, Rosen R, Kaul A, Pandolfino JE, Ratcliffe E, Yacob D, Li BU, Punati J, Sood M, Rao SSC, Levitt MA, Cocjin J, Rodriguez L, Flores A, Rosen JM, Belkind-Gerson J, Saps M, Garza JM, Fortunato J, Schroedl RL, Keefer L, Friedlander J, Heuckeroth RO, Rao M, El-Chammas K, Vaz K, Chumpitazi BP, Sanghavi R, Matta S, Danialifar T, Di Lorenzo C, Darbari A. Proceedings of the 2018 Advances In Motility and In NeuroGastroenterology: AIMING for the Future Single Topic Symposium. J Pediatr Gastroenterol Nutr 2020; 71:e59-e67. [PMID: 32287151 PMCID: PMC8451965 DOI: 10.1097/mpg.0000000000002720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Motility and functional disorders are common in children and often debilitating, yet these disorders remain challenging to treat effectively. At the 2018 Annual North American Society for Pediatric Gastroenterology, Hepatology and Nutrition meeting, the Neurogastroenterology and Motility Committee held a full day symposium entitled, 2018 Advances In Motility and In NeuroGastroenterology - AIMING for the future. The symposium aimed to explore clinical paradigms in pediatric gastrointestinal motility disorders and provided a foundation for advancing new scientific and therapeutic research strategies. METHODS The symposium brought together leading experts throughout North America to review the state of the art in the diagnosis and management of motility and functional disorders in children. Presentations were divided into esophageal, antral duodenal, and colorectal modules. Each module included oral presentations by experts in the respective fields, leading to thought-provoking discussions. There were 2 breakout sessions with small group discussions on select topics, focusing on defining scientific insights into the diagnosis and management of pediatric functional gastrointestinal and motility disorders in a systematic, segment-based approach. CONCLUSIONS The field of neurogastroenterology has made remarkable progress in the last decade. The current report summarizes the major learning points from the symposium highlighting the diagnosis and promising therapies on the horizon for pediatric neurogastrointestinal and motility disorders.
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Affiliation(s)
| | - Julie Khlevner
- Division of Gastroenterology, Hepatology and Nutrition, Columbia University College of Physicians and Surgeons, New York, NY
| | - Samuel Nurko
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, MA
| | - Rachel Rosen
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, MA
| | - Ajay Kaul
- Division of Gastroenterology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229
| | - John E. Pandolfino
- Division of Gastroenterology and Hepatology, Northwestern University, Chicago, IL
| | | | - Desale Yacob
- Division of Gastroenterology, Nationwide Children’s Hospital, Columbus, OH
| | - B U.K. Li
- Division of Pediatric Gastroenterology and Nutrition, Medical College of Wisconsin, Milwaukee, WI
| | - Jaya Punati
- Division of Gastroenterology, Children’s Hospital of Los Angeles, Los Angeles, CA
| | - Manu Sood
- Division of Pediatric Gastroenterology and Nutrition, Medical College of Wisconsin, Milwaukee, WI
| | - Satish SC Rao
- Division of Gastroenterology, Department of Medicine, Augusta University Medical Center, Augusta, GA
| | - Marc A Levitt
- Division of Colorectal Surgery, Children’s National Hospital, Washington, DC
| | - Jose Cocjin
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children’s Mercy Kansas City, Kansas City, MO
| | - Leonel Rodriguez
- Section of Pediatric Gastroenterology, Hepatology and Nutrition, Yale School of Medicine, New Haven, CT
| | - Alejandro Flores
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, MA
| | - John M Rosen
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children’s Mercy Kansas City, Kansas City, MO
| | - Jaime Belkind-Gerson
- Division of Gastroenterology, Hepatology and Nutrition, Children’s Hospital of Colorado, Aurora, CO
| | - Miguel Saps
- Division of Pediatric Gastroenterology and Nutrition, University of Miami, Miami, FL
| | - Jose M Garza
- Children’s Center for Digestive Health Care, Atlanta, GA
| | - John Fortunato
- Division of Gastroenterology, Ann & Robert H Lurie Children’s Hospital, Chicago, IL
| | - Rose L Schroedl
- Division of Gastroenterology, Nationwide Children’s Hospital, Columbus, OH
| | - Laurie Keefer
- Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Joel Friedlander
- Section of Pediatric Gastroenterology, Hepatology and Nutrition, Yale School of Medicine, New Haven, CT
| | - Robert O. Heuckeroth
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania and The Children's Hospital of Philadelphia - Research Institute, Philadelphia, PA
| | - Meenakshi Rao
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, MA
| | - Khalil El-Chammas
- Division of Gastroenterology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229
| | - Karla Vaz
- Division of Gastroenterology, Nationwide Children’s Hospital, Columbus, OH
| | | | - Rina Sanghavi
- Division of Pediatric Gastroenterology, University of Texas Southwestern Medical Center Dallas, TX
| | - Sravan Matta
- Pediatric Gastroenterology and Nutrition, Kaiser Permanente Sacramento Medical Center, Sacramento, CA
| | - Tanaz Danialifar
- Division of Gastroenterology, Children’s Hospital of Los Angeles, Los Angeles, CA
| | - Carlo Di Lorenzo
- Division of Gastroenterology, Nationwide Children’s Hospital, Columbus, OH
| | - Anil Darbari
- Division of Pediatric Gastroenterology and Nutrition, Children’s National Hospital, Washington, DC
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McAbee GN, Morse AM, Cook W, Tang V, Brosgol Y. Neurological Etiologies and Pathophysiology of Cyclic Vomiting Syndrome. Pediatr Neurol 2020; 106:4-9. [PMID: 32107138 DOI: 10.1016/j.pediatrneurol.2019.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 12/05/2019] [Accepted: 12/06/2019] [Indexed: 12/28/2022]
Abstract
Cyclic vomiting syndrome is an idiopathic chronic periodic disorder of childhood which may persist into the adult years. Although cyclic vomiting syndrome is considered a central nervous system disorder, it is often managed by a pediatric gastroenterologist. The practitioner should not assume a gastrointestinal or non-neurological cause of symptoms especially if there are coexisting neurological symptoms and signs or if vomiting does not bring relief; this suggests a possible central nervous system cause, which may necessitate a pediatric neurology consultation. Examples of central nervous system causes of cyclic vomiting syndrome that can have subjective and objective neurological findings include abdominal migraine, certain types of epilepsy, structural lesions (tumors, Chiari malformation, demyelinating disease), mitochondrial disease, autonomic disorders, fatty acid/organic acid disorders, urea cycle defects, and cannabinoid hyperemesis syndrome. Improved familiarity with cyclic vomiting syndrome and its mimics may improve the time to appropriate diagnosis and may reduce morbidity related to cyclic vomiting syndrome.
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Affiliation(s)
- Gary N McAbee
- Division of Child Neurology, Department of Pediatrics, Maimonides Children's Hospital, Brooklyn, New York.
| | - Anne Marie Morse
- Division of Child Neurology, Department of Pediatrics, Janet Weis Children's Hospital, Geisinger Medical Center, Danville, Pennsylvania
| | - Ward Cook
- Division of Child Neurology, Department of Pediatrics, Janet Weis Children's Hospital, Geisinger Medical Center, Danville, Pennsylvania
| | - Vivian Tang
- Division of Pediatric Gastroenterology, Department of Pediatrics, Maimonides Children's Hospital, Brooklyn, New York
| | - Yuri Brosgol
- Division of Child Neurology, Department of Pediatrics, Maimonides Children's Hospital, Brooklyn, New York
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Cyclic Vomiting Syndrome in a Medically Complex Patient: A Case Report. J Pediatr Health Care 2019; 33:711-717. [PMID: 31395300 DOI: 10.1016/j.pedhc.2019.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 05/24/2019] [Accepted: 06/08/2019] [Indexed: 01/03/2023]
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Hasler WL, Levinthal DJ, Tarbell SE, Adams KA, Li BUK, Issenman RM, Sarosiek I, Jaradeh SS, Sharaf RN, Sultan S, Venkatesan T. Cyclic vomiting syndrome: Pathophysiology, comorbidities, and future research directions. Neurogastroenterol Motil 2019; 31 Suppl 2:e13607. [PMID: 31241816 PMCID: PMC6899706 DOI: 10.1111/nmo.13607] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 03/18/2019] [Indexed: 12/14/2022]
Abstract
Cyclic vomiting syndrome (CVS) is characterized by severe episodic emesis in adults and children. Cannabinoid hyperemesis syndrome is an increasingly recognized CVS-like illness that has been associated with chronic cannabis use. There are significant gaps in our understanding of the pathophysiology, clinical features, comorbidities, and effective management options of CVS. Recommendations for treating CVS are based on limited clinical data, as no placebo-controlled, randomized trials have yet been conducted. Diseases associated with CVS, including migraine, mitochondrial disorders, autonomic dysfunction, and psychiatric comorbidities, provide clues about pathophysiologic mechanisms and suggest potential therapies. We review our current understanding of CVS and propose future research directions with the aim of developing effective therapy. Establishing a multicenter, standardized registry of CVS patients could drive research on multiple fronts including developing CVS-specific outcome measures to broaden our understanding of clinical profiles, to serve as treatment end points in clinical trials, and to provide a platform for patient recruitment for randomized clinical trials. Such a robust database would also facilitate conduct of research that aims to determine the underlying pathophysiological mechanisms and genetic basis for CVS, as well as identifying potential biomarkers for the disorder. Soliciting government and industry support is crucial to establishing the necessary infrastructure and achieving these goals. Patient advocacy groups such as the Cyclic Vomiting Syndrome Association (CVSA), which partner with clinicians and researchers to disseminate new information, to promote ongoing interactions between patients, their families, clinicians, investigators, to support ongoing CVS research and education, must be an integral part of this endeavor.
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Affiliation(s)
- William L. Hasler
- Division of GastroenterologyUniversity of Michigan Health SystemAnn ArborMichigan
| | - David J. Levinthal
- Division of Gastroenterology, Hepatology and NutritionUniversity of Pittsburgh Medical CenterPittsburghPennsylvania
| | - Sally E. Tarbell
- Department of Psychiatry and Behavioral SciencesNorthwestern Feinberg School of MedicineChicagoIllinois
| | | | - B U. K. Li
- Department of PediatricsMedical College of WisconsinMilwaukeeWisconsin
| | - Robert M. Issenman
- Division of Pediatric GastroenterologyMcMaster UniversityHamiltonOntarioCanada
| | - Irene Sarosiek
- Division of GastroenterologyTexas Tech University Health Sciences CenterEl PasoTexas
| | | | - Ravi N. Sharaf
- Division of GastroenterologyDepartment of Healthcare Policy and ResearchWeill Cornell Medical CenterNew YorkNew York,Department of MedicineWeill Cornell Medical CenterNew YorkNew York
| | | | - Thangam Venkatesan
- Division of Gastroenterology and HepatologyMedical College of WisconsinMilwaukeeWisconsin
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