Jessica Shearer1, Pavit Luthra1, Alexander C Ford1,2. 1. Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK. 2. Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK.
Abstract
OBJECTIVE: Cyclic vomiting syndrome (CVS) is under-recognised. Treatment is difficult as the pathophysiology is incompletely understood. We report our experience of treating patients with amitriptyline, and review the literature to summarise symptoms and associated features, epidemiology, potential pathophysiological mechanisms, differential diagnoses and treatment. DESIGN: Consecutive adult patients with CVS were identified during a 5-year period from January 2010 until December 2015. Medical records were reviewed retrospectively, and age and sex of the patient, symptoms, associated features and response to treatment with amitriptyline were recorded. SETTING: A luminal gastroenterology clinic at a teaching hospital. RESULTS: Seventeen patients were identified (mean age 29.8 years, 13 (76.5%) female). Five had a history of cannabis use. Duration of symptoms prior to diagnosis ranged from 5 months to 15 years. Fourteen patients commenced amitriptyline, and in eight (57.1%) symptoms either ceased entirely or improved. Review of the literature suggested the prevalence of CVS was 0.5%. Symptoms are stereotypical, with acute episodes of nausea and vomiting, interspersed by periods when the patient is symptom-free. Proposed pathophysiologies include neuroendocrine dysfunction, mutations in mitochondrial DNA and re-intoxication effects from cannabis stored in fat tissues. Treatment during the acute phase is supportive, with rehydration, sedation and antiemetics. Prophylaxis to prevent future attacks with antihistamines, antimigraine drugs, antiepileptics and tricyclic antidepressants may be beneficial. Complete cessation of cannabis smoking should be advised. CONCLUSIONS: Diagnosis of CVS is often delayed in adults. Once identified, patients respond well to amitriptyline.
OBJECTIVE: Cyclic vomiting syndrome (CVS) is under-recognised. Treatment is difficult as the pathophysiology is incompletely understood. We report our experience of treating patients with amitriptyline, and review the literature to summarise symptoms and associated features, epidemiology, potential pathophysiological mechanisms, differential diagnoses and treatment. DESIGN: Consecutive adult patients with CVS were identified during a 5-year period from January 2010 until December 2015. Medical records were reviewed retrospectively, and age and sex of the patient, symptoms, associated features and response to treatment with amitriptyline were recorded. SETTING: A luminal gastroenterology clinic at a teaching hospital. RESULTS: Seventeen patients were identified (mean age 29.8 years, 13 (76.5%) female). Five had a history of cannabis use. Duration of symptoms prior to diagnosis ranged from 5 months to 15 years. Fourteen patients commenced amitriptyline, and in eight (57.1%) symptoms either ceased entirely or improved. Review of the literature suggested the prevalence of CVS was 0.5%. Symptoms are stereotypical, with acute episodes of nausea and vomiting, interspersed by periods when the patient is symptom-free. Proposed pathophysiologies include neuroendocrine dysfunction, mutations in mitochondrial DNA and re-intoxication effects from cannabis stored in fat tissues. Treatment during the acute phase is supportive, with rehydration, sedation and antiemetics. Prophylaxis to prevent future attacks with antihistamines, antimigraine drugs, antiepileptics and tricyclic antidepressants may be beneficial. Complete cessation of cannabis smoking should be advised. CONCLUSIONS: Diagnosis of CVS is often delayed in adults. Once identified, patients respond well to amitriptyline.
Authors: Alexander C Ford; David Forman; Alastair G Bailey; Anthony T R Axon; Paul Moayyedi Journal: Am J Gastroenterol Date: 2008-03-26 Impact factor: 10.864
Authors: Thangam Venkatesan; David J Levinthal; Sally E Tarbell; Safwan S Jaradeh; William L Hasler; Robert M Issenman; Kathleen A Adams; Irene Sarosiek; Christopher D Stave; Ravi N Sharaf; Shahnaz Sultan; B U K Li Journal: Neurogastroenterol Motil Date: 2019-06 Impact factor: 3.598