Introduction Cyclic Vomiting syndrome (CVS) is characterised by recurrent attacks of intractable vomiting with no identifiable organic cause. It can take years before CVS is diagnosed, furthermore there have only been a handful of case studies looking at management strategies to reduce the duration/frequency or intensity of cyclic vomiting attacks. The objectives of this review were to identify associated clinical features that would help suggest a diagnosis of CVS and to review the literature to identify management strategies with the highest efficacy.
Methods A literature search was performed using the databases MEDLINE via Ovid (1948 to October 2011) and EMBASE (1980 to October 2011). The search terms included “Cyclic” and “Vomiting”. Data from adult-onset to paediatric-onset CVS were included. Data were extracted into a standardised form.
Results The systematic search yielded 33 papers with 1141 cases of cyclic vomiting syndrome. All but one paper were retrospective studies. Both adult-onset and paediatric-onset CVS had a high association with headaches/migraines and psychiatric conditions such as anxiety/depression. Furthermore, in children travel sickness was noted in 28.3%. The mean duration and frequency of attacks were higher in adult-onset CVS compared to paediatric-CVS. Overall remission was achieved in 73.2% of cases. When tricyclic antidepressants were used, 75.5% of adult-onset CVS patients had a response (n=237) and 67.6% of paediatric onset-CVS patients (n=244). In adult-onset CVS, 37 patients had been treated with sumatriptan with a response rate of 56.8%. In paediatric-onset CVS, 91 patients had been treated with propranolol and amitriptyline resulting in a response rate of 86.8%. There were no studies focusing on the acute management of CVS.
Conclusion CVS is an intractable illness with a major impact on patient's quality of life. There is a long duration between symptom onset and diagnosis of the condition. There is a high association with headaches/migraines and anxiety/depression. Symptoms are more severe in adult-onset CVS. Tricyclic antidepressants have the most evidence and have high efficacy at reducing the frequency/duration or intensity of attacks. There is limited evidence on the acute management of CVS.
Competing interests None declared.
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