A recent article published in Frontiers in Neurology presented a review from a collaboration between the Italian Society of Pediatric Gastroenterology Hepatology and Nutrition (SIGENP) and Italian Society of Pediatric Neurology (SINP) – to identify relevant current issues, and to propose future research directions on pediatric Cyclic Vomiting Syndrome (CVS).

It was stated that CVS – an underdiagnosed episodic syndrome, is characterized by frequent hospitalizations, multiple comorbidities and poor quality of life (QoL). It is often misdiagnosed due to the indefinite pattern of recurrence and lack of confirmatory testing. 

The authors observed that CVS mainly occurs in the pre-school or early school-age; however, infants and elderly onset have been also described. Besides, the etiopathogenesis is likely to be multifactorial; multiple intrinsic factors in response to a triggering environmental stimulus have been implicated.

The manifestations include – acute, stereotyped and recurrent episodes of intense nausea and uncontrollable episodic vomiting, followed by healthy in-between phases. While the diagnosis remains a challenge for clinicians, owing to the need for ruling out numerous other etiologies of emesis. 

It was advised that the treatment of CVS in children should be individualized. The acute phase is mainly managed by supportive and symptomatic care. The prodromal phase can be controlled by early intervention with abortive agents—for terminating the attack. Meanwhile, during the interictal period, non-pharmacologic measures like lifestyle changes and the use of reassurance and anticipatory guidance could be effective preventive strategies.

Prophylactic pharmacotherapy can be advised based on the attack intensity and severity, the impairment of the QoL, and if treatments prove to be ineffective or cause side effects. When children remain refractory to acute or prophylactic treatment or in cases with variable episodes, differential diagnoses must be considered. Additionally, mono- or combination therapy and psychotherapy may be employed, guided by comorbidities and specific sub-phenotype. 

Source: Frontiers in Neurology. 2020; 11: 583425.doi: 10.3389/fneur.2020.583425