Clinical features, response to therapy and outcome in pediatric cyclical vomiting syndrome: Experience from the developing world.

BACKGROUND AND

OBJECTIVE

Cyclical vomiting syndrome (CVS) is a functional gastrointestinal disorder marked by recurrent vomiting. Lack of awareness and symptom overlap often leads to incorrect diagnosis. There is limited data from the developing world, especially on the natural history of the disease in children. Thus, the aim of our study was to evaluate the clinical presentation, natural history, treatment and outcomes of CVS in children.

METHODS

Retrospective audit of children (≤ 18 years) diagnosed with CVS between January 2008 to December 2024. Clinical data was retrieved from hospital records and telephonic interviews.

RESULTS

Seventy-one patients (age of onset 7[IQR 4-9] years, boys [39, 54.9%]) were enrolled. Median diagnostic delay was 1.2 (IQR 1-3) years and 31(43.6%) were misdiagnosed elsewhere initially. Patients had five (IQR 4-8) episodes of vomiting per year. Most (n = 55, 77.5%) required hospitalization. Precipitants were identified in 48 (67.6%) cases, most common being psychological stress (n = 23, 32.4%). Family history of migraine was present in 37 (52.1%) cases. Rome IV, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) and International Classification of Headache Disorders, 3rd edition (ICHD-3) criteria fulfilled in 71(100%), 47 (66.2%) and 44 (62%) cases, respectively. Younger children (≤ 5 years) had longer delay in diagnosis, more often required hospitalization and had fewer early morning episodes as compared to older children. All patients presented with severe disease phenotype and received prophylaxis. At follow-up of eight (interquartile range [IQR] 5-12) years, 36 (50.7%) had complete, 25 (35.3%) significant, five (7.6%) partial and five (7.5%) no response. Prophylaxis was successfully stopped in 13 (36.1%) complete responders of which three relapsed post-withdrawal.

CONCLUSION

CVS is often underdiagnosed in children. Awareness of CVS is necessary for early diagnosis and reduced morbidity. Younger children had longer diagnostic delay and more often required hospitalization. Timely recognition and optimal management were associated with favorable outcomes.