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World J Clin Pediatr. Aug 8, 2014; 3(3): 54-58
Published online Aug 8, 2014. doi: 10.5409/wjcp.v3.i3.54
Cyclical vomiting syndrome: Recognition, assessment and management
Michelle LN Tan, Maria Janelle Liwanag, Seng Hock Quak
Michelle LN Tan, Maria Janelle Liwanag, Seng Hock Quak, Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
Michelle LN Tan, Maria Janelle Liwanag, Seng Hock Quak, Khoo Teck Puat-National University Children’s Medical Institute, National University Health System, Singapore 119228, Singapore
Author contributions: Tan MLN and Liwang MJ wrote the first draft; Quak SH reviewed, provided critical input and comments.
Correspondence to: Michelle LN Tan, Senior Registrar, Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Paediatrics 1E Kent Ridge Road, NUHS Tower Block Level 12, Singapore 119228, Singapore. michelle_ln_tan@nuhs.edu.sg
Telephone: +65-97317694 Fax: +65-67797486
Received: February 28, 2014
Revised: June 16, 2014
Accepted: July 12, 2014
Published online: August 8, 2014
Abstract

Cyclical vomiting syndrome (CVS) is a functional, debilitating disorder of childhood frequently leading to hospitalization. Affected children usually experience a stereotypical pattern of vomiting though it may vary between different individuals. The vomiting is intense often bilious, and accompanied by disabling nausea. Identifiable precipitating factors for CVS include psychosocial stressors, infections, lack of sleep and occasionally even food triggers. Often, it may be difficult to distinguish episodes of CVS from other causes of acute abdomen and altered consciousness. Thus, the diagnosis of CVS remains largely one of exclusion. Investigations routinely done during the work-up of a child with suspected CVS include both blood and imaging modalities. Plasma lactate, ammonia, amino acid and acylcarnitine profiles as well as urine organic acid profile are indicated to exclude inborn errors of metabolism. The treatment remains challenging and targeted at prevention or shortening of the attacks and can be considered as abortive, supportive and prophylactic. Use of non-pharmacological therapy is also part of the management of CVS. The prognosis of CVS is variable. More insight into the pathogenesis of this disorder as well as role of non-pharmacological therapy is needed.

Keywords: Cyclical vomiting syndrome, Childhood, Pathogenesis, Investigations, Treatment

Core tip: Cyclical vomiting syndrome (CVS) is a functional childhood disorder which has been increasingly reported in recent years. Much of its pathogenesis remains unknown. Diagnosis may be delayed if not considered by paediatricians. Management of CVS still remains a challenge.