Advertisement

Current Treatment Options in Gastroenterology

, Volume 10, Issue 4, pp 273–282 | Cite as

Treatment of cyclic vomiting syndrome

  • Pavan Chepyala
  • R. Paul Svoboda
  • Kevin W. OldenEmail author
Article

Opinion statement

Cyclic vomiting syndrome (CVS) is a relatively rare but highly incapacitating disorder. It is seen both in children and adults, although classically it has been perceived as a pediatric gastrointestinal disorder. Recent studies have demonstrated that this disorder indeed can be seen in adults and is highly disabling. Although classically associated with migraine headaches in the pediatric form, this relationship is less well established in adults. This has major implications for management in that traditionally, one of the major avenues for treatment of pediatric CVS has been antimigraine drugs. An additional factor that obscures a review of CVS treatment is the fact that because of its relative rarity, no randomized controlled trials (RCTs) have been performed. In the absence of RCTs, it is difficult to make definitive recommendations regarding treatment. The literature to date consists of case reports and open-ended case series. However, despite these limitations, it is the goal of this article to present in a comprehensive manner the options available for the treatment of CVS. Recognizing the limitations in the literature, it is clear that a number of treatment strategies that can often prove effective for the treatment of these complicated and often-challenging patients are available. Treatment is divided between acute intervention, when a patient is actively and severely vomiting, and prophylactic treatment for patients in their “interictal” phase, the goal of which is reducing frequency and intensity of subsequent episodes. Finally, we are beginning to identify possible mechanisms of the cause of CVS. Once these are better understood, this will provide the basis for further improvement in treatment.

Keywords

Migraine Topiramate Sumatriptan Dexmedetomidine CoQ10 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Li BU, Balint JP: Cyclic vomiting syndrome: evolution in our understanding of a brain-gut disorder. Adv Pediatr 2000, 47:117–160.PubMedGoogle Scholar
  2. 2.
    Prakash C, Clouse RE: Cyclic vomiting in adults: response to tricyclic antidepressants. Am J Gastroenterol 1999, 10:2855–2860.CrossRefGoogle Scholar
  3. 3.
    Cullen KJ, MacDonald WB: The periodic syndrome: its nature and prevalence. Med J Aust 1963, 50:167–173.PubMedGoogle Scholar
  4. 4.
    Abu-Arafeh I, Russell G: Cyclical vomiting syndrome in children: a population-based study. J Pediatr Gastroenterol Nutr 1995, 21:454–458.PubMedGoogle Scholar
  5. 5.
    Fleisher DR, Gornowicz B, Adams K, et al.: Cyclic vomiting syndrome in 41 adults: the illness, the patients, and problems with management. BMC Med 2005, 3:20.PubMedCrossRefGoogle Scholar
  6. 6.
    Lindley KJ: Pathogenesis and treatment of cyclical vomiting. J Pediatr Gastroenterol Nutr 2005, 41(Suppl 1):S38–S40.PubMedGoogle Scholar
  7. 7.
    Fleisher DR: Management of cyclic vomiting syndrome. J Pediatr Gastroenterol Nutr 1995, 21(Suppl 1):S52–S56.PubMedGoogle Scholar
  8. 8.
    Prakash C, Clouse RE: Cyclic vomiting syndrome in adults: clinical features and response to tricyclic antidepressants. Am J Gastroenterol 1999, 94:2855–2860.PubMedCrossRefGoogle Scholar
  9. 9.
    Forbes D, Withers G: Prophylactic therapy in cyclic vomiting syndrome. J Pediatr Gastroenterol Nutr 1995, 21(Suppl 1):S57–S59.PubMedGoogle Scholar
  10. 10.
    Andersen JM, Sugerman KS, Lockhart JR, Weinberg WA: Effective prophylactic therapy for cyclic vomiting in children using amitriptyline or cyproheptadine. Pediatrics 1997, 100:977–981.PubMedCrossRefGoogle Scholar
  11. 11.
    Clouse RE, Sauk GS, Shah R, et al.: Newer antiepileptic drugs for adults with cyclic vomiting syndrome (CVS): a novel approach to maintenance therapy [abstract]. Gastroenterology 2006, 130:A–598.CrossRefGoogle Scholar
  12. 12.
    Palmer GM, Cameron DJ: Use of intravenous midazolam and clonidine in cyclical vomiting syndrome: a case report. Paediatr Anaesth 2005, 15:68–72.PubMedCrossRefGoogle Scholar
  13. 13.
    Khasawinah TA, Ramirez A, Berkenbosch JW, et al.: Preliminary experience with dexmedetomidine in the treatment of cyclic vomiting syndrome. Am J Ther 2003, 10:303–307.PubMedCrossRefGoogle Scholar
  14. 14.
    Calcar SC, Harding CO, Wolff JA: L-carnitine administration reduces number of episodes in cyclic vomiting syndrome. Clin Pediatr (Phila) 2002, 41:171–174.CrossRefGoogle Scholar
  15. 15.
    CVSA resources page. Cyclic Vomiting Syndrome Association website. Available at: http://www.cvsaonline.org/announcesofCoQ10L-carnitine.htm. Accessed July 11, 2006.
  16. 16.
    Benson JM, Zorn SL, Book LS: Sumatriptan in the treatment of cyclic vomiting. Ann Pharmacother 1995, 29:997–999.PubMedGoogle Scholar
  17. 17.
    Murphy C, Shah N, Mila P, et al.: Proceedings of the 39th Annual Meeting of the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. Dresden, Germany; June 7–10, 2006. Abstract OP3-05.Google Scholar
  18. 18.
    Li BU: Cyclic vomiting: new understanding of an old disorder. Contemp Pediatr 1996, 13:48–62.Google Scholar
  19. 19.
    Peroutka SJ: Drugs effective in the therapy of migraine. In Goodman and Gilman’s Pharmacological Basis of Therapeutics, edn 9. Edited by Hardman JG, Limbird LE, Gilman AG. New York: McGraw-Hill; 1996:487–502.Google Scholar
  20. 20.
    Crouch JR, Ziegler DK, Hassanein R: Amitriptyline in the prophylaxis of migraine [abstract]. Neurology 1976, 26:121–127.Google Scholar
  21. 21.
    Weitz R: Prophylaxis of cyclic vomiting with propranolol. Drug Intell Clin Pharm 1982, 16:161–162.PubMedGoogle Scholar
  22. 22.
    Pfau BT, Li BU, Murray RD, et al.: Differentiating cyclic from chronic vomiting patterns in children: quantitative criteria and diagnostic implications. Pediatrics 1996, 97:364–368.PubMedGoogle Scholar
  23. 23.
    Di Lorenzo C, Black C, Saps M. Children. In Special Considerations in Dosing/Considerations in Special Populations. www.elsevier-international.com/e-books/pdf/1270.pdf. Accessed August 6, 2006.
  24. 24.
    Study NCT002869.88. Available at: www.clinicaltrials.gov/ct/show/NCT002869.88. Accessed August 7, 2006.
  25. 25.
    Silberstein SD, Neto W, Schmitt J, et al.: Topiramate in migraine prevention: results of a large controlled trial. Arch Neurol 2004, 61:490–495.PubMedCrossRefGoogle Scholar
  26. 26.
    Vanderhoof JA, Young R, Kaufman SS, Ernst L: Treatment of cyclic vomiting in childhood with erythromycin. J Pediatr Gastroenterol Nutr 1993, 17:387–391.PubMedCrossRefGoogle Scholar
  27. 27.
    Vanderhoof JA, Young R, Kaufman SS, Ernst L: Treatment of cyclic vomiting in childhood with erythromycin. J Pediatr Gastroenterol Nutr 1995, 21(Suppl 1):S60–S62.PubMedGoogle Scholar
  28. 28.
    Hesketh PJ: Potential role of the NK1 receptor antagonists in chemotherapy-induced nausea and vomiting. Support Care Cancer 2001, 9:350–354.PubMedCrossRefGoogle Scholar
  29. 29.
    Chawla SP, Grunberg SM, Gralla RJ, et al.: Establishing the dose of the oral NK1 antagonist aprepitant for the prevention of chemotherapy-induced nausea and vomiting. Cancer 2003, 97:2290–2300.PubMedCrossRefGoogle Scholar
  30. 30.
    McRonald FE, Fleisher DR: Anticipatory nausea in cyclical vomiting. BMC Pediatr 2005, 5:3.PubMedCrossRefGoogle Scholar
  31. 31.
    Withers GD, Silburn SR, Forbes DA: Precipitants and aetiology of cyclic vomiting syndrome. Acta Paediatr 1998, 87:272–277.PubMedCrossRefGoogle Scholar
  32. 32.
    Rozen TD, Oshinsky ML, Gebeline CA, et al.: Open label trial of coenzyme Q10 as a migraine preventive. Cephalalgia 2002, 22:137–141.PubMedCrossRefGoogle Scholar
  33. 33.
    Sandor PS, DiClemente L, Coppola G, et al.: Efficacy of coenzyme Q10 in migraine prophylaxis: a randomized controlled trial. Neurology 2005, 64:713–715.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Pavan Chepyala
  • R. Paul Svoboda
  • Kevin W. Olden
    • 1
    Email author
  1. 1.Division of Gastroenterology and HepatologyUniversity of Arkansas for Medical SciencesLittle RockUSA

Personalised recommendations