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Review
. 2019 Jun;31 Suppl 2(Suppl 2):e13605.
doi: 10.1111/nmo.13605.

Management of cyclic vomiting syndrome in adults: Evidence review

Ravi N Sharaf  1 , Thangam Venkatesan  2 , Raj Shah  3 , David J Levinthal  4 , Sally E Tarbell  5 , Safwan S Jaradeh  6 , William L Hasler  7 , Robert M Issenman  8 , Kathleen A Adams  9 , Irene Sarosiek  10 , Christopher D Stave  11 , B U K Li  12 , Shahnaz Sultan  13
Affiliations
Review

Management of cyclic vomiting syndrome in adults: Evidence review

Ravi N Sharaf et al. Neurogastroenterol Motil. 2019 Jun.

Abstract

Background: This evidence review was conducted to inform the accompanying clinical practice guideline on the management of cyclic vomiting syndrome (CVS) in adults.

Methods: We followed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework and focused on interventions aimed at prophylactic management and abortive treatment of adults with CVS. Specifically, this evidence review addresses the following clinical questions: (a) Should the following pharmacologic agents be used for prophylaxis of CVS: amitriptyline, topiramate, aprepitant, zonisamide/levetiracetam, or mitochondrial supplements? (b) Should the following pharmacologic agents be used for abortive treatment: triptans or aprepitant?

Results: We found very low-quality evidence to support the use of the following agents for prophylactic and abortive treatment of CVS: amitriptyline, topiramate, aprepitant, zonisamide/levetiracetam, and mitochondrial supplements. We have moderate certainty of evidence for the use of triptans as abortive therapy. We found limited evidence to support the use of ondansetron and the treatment of co-morbid conditions and complementary therapies.

Conclusions: This evidence review helps inform the accompanying guideline for the management of adults with CVS which is aimed at helping clinicians, patients, and policymakers, and should improve patient outcomes.

Keywords: cyclic vomiting; technical review; treatment.

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