Cyclic Vomiting Syndrome in Children

Frontiers in Neurology

Renato Tambucci¹  Agnese Suppiej²  Michela Ada Noris Ferilli³  Letizia Zenzeri⁴  Salvatore Grosso⁴  Massimiliano Valeriani⁵  Saverio Mallardo⁶  Alberto Verrotti⁷  Annamaria Staiano⁸  Diego Martinelli⁹  Paolo Quitadamo^1,10  Maria Pia Villa^1,11  Licia Pensabene^1,12  Pasquale Striano^1,13  Pasquale Parisi^1,14  Claudio Romano^1,15  Salvatore Savasta^1,16  Alberto Spalice^1,17  Caterina Strisciuglio^1,18  Martino Ruggieri^1,19  Giovanni Di Nardo^1,19  Raffaele Falsaperla^2,20  Duccio Maria Cordelli^2,21  Piero Pavone^2,22  Osvaldo Borrelli^2,23  Enrico Felici^2,24  Maria Elisabetta Baldassarre^2,25  Umberto Raucci^2,26  Silvia Salvatore^2,27 

[1] Psychology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy;0Department of Woman, Child, General and Specialistic Surgery, University of Campania “Luigi Vanvitelli,”Naples, Italy;0Unit of Pediatrics, The Children Hospital, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy;1Division of Neurology, Bambino Gesù Children's Hospital, Institute for Research, Hospitalization and Health Care (IRCCS), Rome, Italy;1Pediatric Section, Department of Medical Sciences, University of Ferrara, Ferrara, Italy;2Clinical Pediatrics, Department of Molecular Medicine and Development, University of Siena, Siena, Italy;2Emergency Pediatric Department, Santobono-Pausilipon Children's Hospital, Naples, Italy;3Department of Pediatrics, University of L'Aquila, L'Aquila, Italy;3Pediatric Department, Santa Maria Goretti Hospital, Sapienza University of Rome, Latina, Italy;4Division of Metabolism, Department of Pediatric Specialties, Bambino Gesù Children's Hospital, Institute for Research, Hospitalization and Health Care (IRCCS), Rome, Italy;4Section of Pediatrics, Department of Translational Medical Science, “Federico II” University of Naples, Naples, Italy;5Department of Pediatrics, A.O.R.N. Santobono-Pausilipon, Naples, Italy;5Unit of Rare Diseases of the Nervous System in Childhood, Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy;6Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genova, Italy;6Pediatric Unit, Department of Medical and Surgical Sciences, University “Magna Graecia” of Catanzaro, Catanzaro, Italy;7Pediatric Gastroenterology Unit, Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University of Messina, Messina, Italy;8Pediatric Unit “Hospital ASST of Crema,” Crema, Italy;9Child Neurology Division, Department of Pediatrics, “Sapienza,” University of Rome, Rome, Italy;;Chair of Pediatrics, Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Faculty of Medicine &Child Neurology Unit, University of Bologna, Bologna, Italy;Department of Biomedical Science and Human Oncology Aldo Moro University of Bari, Bari, Italy;Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital, Institute for Research, Hospitalization and Health Care (IRCCS), Rome, Italy;Division of Neurogastroenterology and Motility, Department of Pediatric Gastroenterology, University College London (UCL) Institute of Child Health and Great Ormond Street Hospital, London, United Kingdom;Neonatal Intensive Care and Pediatric Units, S. Marco Hospital, Vittorio Emanuele Hospital, Catania, Italy;Pediatric Department, Ospedale “F. Del Ponte,” University of Insubria, Varese, Italy;Pediatric Emergency Department, Bambino Gesù Children's Hospital, Institute for Research, Hospitalization and Health Care (IRCCS), Rome, Italy;Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy;

关键词: functional gastrointestinal disorders;    migraine;    vomiting;    antiemetics;    anticonvulsants;    cyclic vomiting syndrome;   

DOI  :  10.3389/fneur.2020.583425

来源: DOAJ

【 摘 要 】

Cyclic Vomiting Syndrome (CVS) is an underdiagnosed episodic syndrome characterized by frequent hospitalizations, multiple comorbidities, and poor quality of life. It is often misdiagnosed due to the unappreciated pattern of recurrence and lack of confirmatory testing. CVS mainly occurs in pre-school or early school-age, but infants and elderly onset have been also described. The etiopathogenesis is largely unknown, but it is likely to be multifactorial. Recent evidence suggests that aberrant brain-gut pathways, mitochondrial enzymopathies, gastrointestinal motility disorders, calcium channel abnormalities, and hyperactivity of the hypothalamic-pituitary-adrenal axis in response to a triggering environmental stimulus are involved. CVS is characterized by acute, stereotyped and recurrent episodes of intense nausea and incoercible vomiting with predictable periodicity and return to baseline health between episodes. A distinction with other differential diagnoses is a challenge for clinicians. Although extensive and invasive investigations should be avoided, baseline testing toward identifying organic causes is recommended in all children with CVS. The management of CVS requires an individually tailored therapy. Management of acute phase is mainly based on supportive and symptomatic care. Early intervention with abortive agents during the brief prodromal phase can be used to attempt to terminate the attack. During the interictal period, non-pharmacologic measures as lifestyle changes and the use of reassurance and anticipatory guidance seem to be effective as a preventive treatment. The indication for prophylactic pharmacotherapy depends on attack intensity and severity, the impairment of the QoL and if attack treatments are ineffective or cause side effects. When children remain refractory to acute or prophylactic treatment, or the episode differs from previous ones, the clinician should consider the possibility of an underlying disease and further mono- or combination therapy and psychotherapy can be guided by accompanying comorbidities and specific sub-phenotype. This review was developed by a joint task force of 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 CVS.

【 授权许可】

Unknown