Autonomic nerve function in adults with cyclic vomiting syndrome: a prospective study
Article first published online: 4 NOV 2010
© 2010 Blackwell Publishing Ltd
Neurogastroenterology & Motility
Volume 22, Issue 12, pages 1303–e339, December 2010
How to Cite
Venkatesan, T., Prieto, T., Barboi, A., Li, B., Schroeder, A., Hogan, W., Ananthakrishnan, A. and Jaradeh, S. (2010), Autonomic nerve function in adults with cyclic vomiting syndrome: a prospective study. Neurogastroenterology & Motility, 22: 1303–e339. doi: 10.1111/j.1365-2982.2010.01577.x
- Issue published online: 4 NOV 2010
- Article first published online: 4 NOV 2010
- Received: 3 March 2010 Accepted for publication: 23 June 2010
- autonomic testing;
- postural tachycardia syndrome;
- sudomotor testing;
- sympathetic nervous system
Background Cyclic vomiting syndrome (CVS) is a functional gastrointestinal disorder that is characterized by recurrent episodes of intense vomiting. There are several postulated mechanisms involved in its pathogenesis and one potential explanation for this disorder may be linked to autonomic dysfunction. The aim of our study was to evaluate autonomic nerve function in patients with CVS prospectively.
Methods We tested the sympathetic nervous system through postural changes in heart rate (HR) and blood pressure and the thermoregulatory sweat test. The parasympathetic nervous system was tested through the HR response to deep breathing (R-R variability on EKG).
Key Results A total of 20 patients who met Rome III criteria for CVS, 14 (70%) women and 6 (30%) men, and 20 controls were enrolled in the study. A total of 17 (85%) CVS subjects and 2 (10%) controls had abnormalities on thermoregulatory sweat testing (P < 0.001). A total of 7 (35%) patients and one control subject had evidence of postural tachycardia (P = 0.04) with an increase in HR > 30 on standing. Of the subjects, 18 (90%) had either abnormal sudomotor function or postural tachycardia or both. The HR response to deep breathing was normal in 19 (95%) subjects with CVS and 18 (95%) controls.
Conclusions & Inferences The results of this study suggest that the majority of subjects (90%) with CVS have impairment of the sympathetic nervous system with postural tachycardia and/or sudomotor dysfunction while parasympathetic nerve function appears to be intact. These findings of dysautonomia in CVS have implications in both the diagnosis and treatment of these patients.