Cyclic vomiting syndrome in Thai children

Abstract

Cyclic vomiting syndrome (CVS) is a severe childhood vomiting disorder of unknown etiology and pathogenesis. Clinical manifestations and prophylactic therapy of vomiting have been described in the literature. The data were limited in Asian children. The aim of this study was to study the clinical manifestation, to evaluate using antimigraine prophylactic drugs and response in Thai children with CVS. The medical records of children with a diagnosis of CVS in the Department of Pediatrics, Siriraj Hospital, Mahidol University from 1994 to 2001 were retrospectively reviewed. Demographic data, clinical manifestations, investigations, treatment and outcome were collected and analyzed. Twenty five patients were enrolled in this study including 13 females and 12 males. Their ages ranged from 2.3 years to 14 years (7.8 +/- 3.4 years). The age of onset was 5.2 +/- 3.2 years. They had 14.7 +/- 6.5 episodes per year with a duration of each attack 4 +/- 1.8 days. There were 8 mild, 10 moderate and 7 severe cases. There were only 6 patients (24%) who had headache and 50 per cent of these had a family history of migraine. Eight patients received pizotifen which had 3 good, 1 fair, and 4 poor responses. Of this group, in 3 patients pizotifen was changed to amitriptyline. Eighteen patients received amitriptyline and the result of treatments were 11 good, 4 fair, and 3 poor. The other 2 patients were on propranolol with one good and one poor responses. The efficacy of amitriptyline and pizotifen were compared (83.3% vs 50%) which revealed no statistical significance (p = 0.14). There was no side effect from any of the medication in this study. In conclusion, the present report showed similar data of clinical features, prophylactic treatment and outcome as previous reports, except for fewer migraine headaches in patients and their families. Amitriptyline and pizotifen were effective in prophylactic therapy of vomiting episodes.