Objective: To analyze the clinical characteristics of children with cyclic vomiting syndrome (CVS), summarize the experience for twelve years, and improve awareness, diagnosis and treatment level of CVS.
Methods: The clinical data and results of long-term follow-up of the children with CVS seen from 1994 to 2007 in our department were analyzed.
Results: Forty-one children were enrolled in the study, 21 were male, and 20 female, mean age was 8 years, mean age of onset was 4 years, mean interval from onset to proper diagnosis was 4 years; 13/41 and 20/41 patients had family history of migraine and motion sickness, 20/41 patients had triggers, such as upper respiratory tract infection, diet, and mental/emotional factor. Vomiting lasted for days, during the periods between the episodes of vomiting the children were completely healthy. The intervals of most patients were 2 to 8 weeks, and in 12/41 patients the episodes started at early morning. The peak number of emesis per hour exceeded six in 23/41 children. The episodes were characterized by a pattern of sudden onset and sudden ending. All patients showed depressed, social withdrawal, intractable nausea and anorexia. Associated symptoms and signs include pallor, excess salivation, hypertension, headache, photophobia, and abdominal pain. Electroencephalogram of 13/33 patients were slightly abnormal. Electrogastrogram showed dysrhythmia and gastrointestinal motility were abnormal during the period of onset and normal during complete remission. Eleven of the 41 of patients were treated as epilepsy, and 9 patients were diagnosed as esophageal hiatal hernia and 4 superior mesenteric artery compression syndrome and had surgery before the diagnosis was made. Eight patients diagnosed from 1994 to 2000 were followed up for ten years in average, 3 patients were treated with doxepin and alprazolanic, and were cured after 2.2 (1.0 - 4.0) years; and five patients who did not use any medicine recovered 7.7 (4 - 10) years later. Fourteen children diagnosed from 2001 to 2007 were followed up for longer than one year, 9 patients were treated with valproate, doxepin, cyproheptadine, and recovered 2.3 (1 - 4) years later; 5 patients without treatment recovered 1.9 (1 - 3) years later.
Conclusions: The diagnosis must be based on the special manifestation of CVS, including intervals during which the patients are completely healthy, and the systemic diseases which can cause CV should be excluded. Most patients get better as they grow up. Therapeutic strategies may include combined use of neuroleptics, thymoleptics and anti-migraine when the episodes occur frequently and when there is growth retardation. Supportive care includes intravenous fluids and symptomatic treatment during an episode.