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North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Consensus Statement on the Diagnosis and Management of Cyclic Vomiting Syndrome

Li, B UK*; Lefevre, Frank; Chelimsky, Gisela G; Boles, Richard G§; Nelson, Susanne P||; Lewis, Donald W; Linder, Steven L#; Issenman, Robert M**; Rudolph, Colin D*

Journal of Pediatric Gastroenterology and Nutrition: September 2008 - Volume 47 - Issue 3 - p 379–393
doi: 10.1097/MPG.0b013e318173ed39
Clinical Report

Cyclic vomiting syndrome (CVS) is a disorder noted for its unique intensity of vomiting, repeated emergency department visits and hospitalizations, and reduced quality of life. It is often misdiagnosed due to the unappreciated pattern of recurrence and lack of confirmatory testing. Because no accepted approach to management has been established, the task force was charged to develop a report on diagnosis and treatment of CVS based upon a review of the medical literature and expert opinion. The key issues addressed were the diagnostic criteria, the appropriate evaluation, the prophylactic therapy, and the therapy of acute attacks. The recommended diagnostic approach is to avoid “shotgun” testing and instead to use a strategy of targeted testing that varies with the presence of 4 red flags: abdominal signs (eg, bilious vomiting, tenderness), triggering events (eg, fasting, high protein meal), abnormal neurological examination (eg, altered mental status, papilledema), and progressive worsening or a changing pattern of vomiting episodes. Therapeutic recommendations include lifestyle changes, prophylactic therapy (eg, cyproheptadine in children 5 years or younger and amitriptyline for those older than 5), and acute therapy (eg, 5-hydroxytryptamine receptor agonists, termed triptans herein, as abortive therapy, and 10% dextrose and ondansetron for those requiring intravenous hydration). This document represents the official recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition for the diagnosis and treatment of CVS in children and adolescents.

*Medical College of Wisconsin, Milwaukee, USA

Northwestern University, USA

Case Western Reserve University, Cleveland, OH, USA

§Children's Hospital of Los Angeles, Los Angeles, CA, USA

||Children's Gastroenterology Specialists, Glenview, IL, USA

Children's Hospital of the King's Daughters, Norfolk, VA, USA

#Dallas Pediatric Neurology Associates, Dallas, TX, USA

**McMaster University, Hamilton, ON, Canada

Authors' disclosures appear at the end of the article.

Received 21 February, 2008

Accepted 21 February, 2008

© 2008 Lippincott Williams & Wilkins, Inc.