This commissioned review article was subject to full peer-review.
Review article: cyclic vomiting syndrome in adults – rediscovering and redefining an old entity
Article first published online: 12 JUN 2011
© 2011 Blackwell Publishing Ltd
Alimentary Pharmacology & Therapeutics
Volume 34, Issue 3, pages 263–273, August 2011
How to Cite
Hejazi, R. A. and McCallum, R. W. (2011), Review article: cyclic vomiting syndrome in adults – rediscovering and redefining an old entity. Alimentary Pharmacology & Therapeutics, 34: 263–273. doi: 10.1111/j.1365-2036.2011.04721.x
- Issue published online: 4 JUL 2011
- Article first published online: 12 JUN 2011
- Publication data , Submitted 18 January 2011, First decision 3 February 2011, Resubmitted 10 May 2011, Accepted 12 May 2011, EV Pub Online 12 June 2011
Aliment Pharmacol Ther 2011; 34: 263–273
Background Cyclic vomiting syndrome is a disorder characterised by recurrent episodes of severe nausea and vomiting separated by symptom-free periods.
Aims To review the history, epidemiology, clinical aspects, pathophysiology, diagnosis and treatments of adult cyclic vomiting syndrome as well as to identify areas for further clinical research and the unanswered questions in this field.
Methods We conducted a PubMed search using such keywords as cyclic vomiting syndrome; nausea; vomiting; pathophysiology; diagnosis; treatment; trigger factors; gastric emptying test; autonomic nerve function test; gastrointestinal hormones; outcome and natural history and combined this information with the knowledge and extensive clinical research and publications from the authors.
Results Available data show that in adult cyclic vomiting syndrome, severe epigastric and sometimes diffuse abdominal pain accompanies most cycles of nausea and vomiting interspersed with periods of symptomatic remission. Psychological disorders, specifically anxiety and depression are common, and gastric emptying is actually rapid in approximately 60% of patients and normal in the remainder. There is an impressive and sustained response to high-dose tricyclic antidepressants. In up to 15% who are regarded as poor responders to tricyclic antidepressants, a predictable profile can be identified related to co-existing psychological disorders, marijuana use, poorly controlled migraine headache or chronic narcotic use.
Conclusions Cyclic vomiting syndrome in adults is an entity that is being increasingly recognised, but the need to educate Internists, Gastroenterologists and Emergency Department staff remains an ongoing challenge.