A Study on the Disease Course and Prognosis of Cyclic Vomiting Syndrome

Yang, Hye Ran; Ko, Jae Sung; Seo, Jeong Kee

Abstract

PURPOSE: To describe clinical features of cyclic vomiting syndrome(CVS), managements during episodes, prophylactic drugs as long term therapy and to investigate the disease course and prognostic factors of CVS.
METHODS
Thirty two children who fulfilled the diagnostic criteria of CVS and who presented to Seoul National University Children's Hospital from March 1989 to December 2000, were included. Data were obtained from chart review and telephone interview.
RESULTS
All had recurrent, self-limited episodes and were free of symptoms between episodes. During the acute phase of episodes, lorazepam and ondansetron were effective in some patients. Various prophylactic drugs were tried and some patients recovered after the use of clobazam, clonazepam, erythromycin and imipramine. Among 32 patients, 18 had recovered from CVS. The age at recovery was 9.4 +/- 4.0 years. It took 3.4 +/- 2.2 years from the onset to the recovery. The age at onset was later in the recovery group than in the non-recovery group(6.1 +/- 3.2 vs 1.7 +/- 1.8 years; P=0.015) and the duration of episodes was longer in the recovery group(5.2 +/- 1.6 vs 2.3 +/- 1.2 days; P=0.003).
CONCLUSION
Many patients recovered from CVS spontaneously. The prognosis in patients with later onset of the disease and the longer duration of episodes seemed to be better. Prophylactic drugs such as clobazam, clonazepam, erythromycin and imipramine may be beneficial. A total approach including trials of prophylactic drugs, removal of the triggering factor and psychiatric support is needed in the management of CVS.