A part of this study was presented in poster form at the American College of Gastroenterology (ACG) Meeting, Orlando, FL, USA. Oct 2008.
Spectrum of gastric emptying patterns in adult patients with cyclic vomiting syndrome
Article first published online: 19 AUG 2010
© 2010 Blackwell Publishing Ltd
Neurogastroenterology & Motility
Volume 22, Issue 12, pages 1298–e338, December 2010
How to Cite
Hejazi, R. A., Lavenbarg, T. H. and Mccallum, R. W. (2010), Spectrum of gastric emptying patterns in adult patients with cyclic vomiting syndrome. Neurogastroenterology & Motility, 22: 1298–e338. doi: 10.1111/j.1365-2982.2010.01584.x
- Issue published online: 4 NOV 2010
- Article first published online: 19 AUG 2010
- Received: 9 April 2010 Accepted for publication: 30 June 2010
- cyclic vomiting syndrome;
- gastric emptying test
Background Cyclic vomiting syndrome (CVS) in adults is a disorder characterized by recurrent and stereotypic episodes of severe nausea, vomiting and abdominal pain separated by symptom-free intervals. Both rapid and delayed gastric emptying (GE) have been observed but the reports involved small numbers of CVS patients.
Methods We performed a retrospective study of 92 adult patients who met Rome Ш diagnostic criteria for CVS between 2003 and 2009 at the Kansas University Medical Center. Gastric emptying was measured by a standardized scintigraphic method involving a low fat (2%) isotope labeled egg white meal of 250 Kcal, with anterior and posterior gastric imaging in the standing position obtained at 0, 1, 2, 4 h after meal ingestion. Rapid GE was defined as <50% isotope retention at 1st h and/or <30% at 2nd h and delayed GE as >10% at 4 h.
Key Results Ninety two patients were analyzed: 47 males and 45 females mean of age 37 ± 12 years (range: 20–68 years). There were 27 patients with a personal history of migraine headache, 30 with history of marijuana use, 12 had diabetes mellitus (DM) and 10 had irritable bowel syndrome (IBS) as an accompanying diagnosis. Fifty four patients (59%) met criteria for rapid GE, 25 (27%) had normal GE and 13 (14%) had slow GE. Eighty percent of patients with co-existing IBS symptoms were identified as rapid. The subset with delayed emptying was often associated with narcotics use, DM and marijuana use (P < 0.05).
Conclusions & Inferences (i) In adult CVS patients, GE is generally either rapid or normal. (ii) Cyclic vomiting syndrome is an important new etiology to explain the finding of rapid GE on a radionuclide test. (iii) The small subset of CVS patients (14%) whose GE was slow were explained by the role of narcotics and/or marijuana.