This is an automatically translated article.
Posted by Doctor Mai Vien Phuong - Department of Medical Examination & Internal Medicine - Vinmec Central Park International General Hospital
Alternating pattern of illness and disease-free period distinguishes cyclic vomiting syndrome (CVS) from other nausea and vomiting disorders. This pathology is increasingly recognized in adults and leads to significant morbidity and poor quality of life.
Recent referral models show prevalence up to 0.2% in the adult population and an explanation for nausea and vomiting in 12% of the referral population to an academic center. teach. In this article, we discuss the direction of treatment of this pathology.
1. Introduction
Adult cyclic vomiting syndrome (CVS) is a disorder characterized by sudden recurrent episodes of nausea, vomiting, and abdominal pain, separated by different periods of normal health. This alternating pattern of illness and disease-free periods distinguishes cyclic vomiting syndrome from other nausea and vomiting disorders. This entity is increasingly recognized in adults and results in significant morbidity and poor quality of life. Recent referral models show prevalence up to 0.2% in the adult population and account for nausea and vomiting in 12% of the referral population to an academic teaching center.
2. Diagnostic evaluation
Diagnosis of cyclic vomiting syndrome requires exclusion of known and treatable disorders. The differential diagnosis of patients with cyclic vomiting syndrome should be ruled out, whereby patients presenting with acute nausea, vomiting, and epigastric pain should be evaluated so that other diagnoses can be made. excluded by history, physical examination, and basic laboratory studies including complete blood count (CBC), complete metabolic panel (CMP) with liver function tests, amylase, and lipase , urinalysis as well as investigations for diseases of the upper gastrointestinal tract/small intestine. Abdominal ultrasound can help assess the possibility of gallstones, pancreatitis, and ureteral junction obstruction.
Gastroduodenal endoscopy (EGD) should be performed in patients with acute vomiting with or without vomiting to rule out gastric outlet obstruction or peptic ulcer disease as well as H. pylori. Imaging studies such as abdominal CT should be considered to exclude structural lesions.
Người bệnh có biểu hiện đau bụng vùng thượng vị giúp bác sĩ chẩn đoán hội chứng
3. Choosing a diagnostic test
The decision on which diagnostic test to perform should be tailored to the patient's clinical presentation. In adults, many considerations must be made to distinguish cyclic vomiting syndrome from gastroparesis. A small number of patients with idiopathic or diabetic gastroparesis present with cyclic vomiting similar to cyclic vomiting syndrome. Patients with gastroparesis had more severe chronic daily symptoms and delayed gastric emptying in the scintigraphy study. In contrast, gastric emptying is often accelerated or normalized and not delayed in patients with cyclic vomiting syndrome during the asymptomatic period in the absence of vomiting.
4. Treatment
Once cyclic vomiting is in progress, supportive measures come first in management. Intravenous fluids should be given to prevent dehydration and electrolyte imbalance. The therapeutic approach in the emergency setting is sedation, sleep, and relaxation primarily through IV lorazepam (1-2 mg every 4 hours) with the help of morphine, antihistamines, and antiemetics to terminate the episode. episodes of vomiting despite often requiring hospitalization to achieve therapeutic goals. Family involvement is an important part of management for dealing with an unpredictable, disruptive, unexplained illness that is often misdiagnosed.
5. Long-term treatment of cyclic vomiting syndrome
Long-term treatment of cyclic vomiting syndrome is based on trying to identify etiological subtypes, especially the role of psychological stress in prescribing preventive and reliever therapy and measures. adjuvant therapy to ameliorate acute episodes of vomiting. Regarding psychological stressors, stress management techniques as well as daily lorazepam (1mg up to every 6 hours) will help reduce anxiety. For a small number of patients with major depression, co-management with a psychiatrist may be indicated to select antidepressant therapies that are less likely to aggravate vomiting. Migraine prophylaxis should be initiated in patients with cyclic vomiting syndrome with a family or personal history of migraine. Anti-migraine medications that are effective in reducing the number or severity of migraines include sumatriptan, propranolol, and topamax.
Sau quá trình thăm khám, bác sĩ sẽ đưa ra phác đồ điều trị phù hợp
6. Treatment of cyclic vomiting syndrome in patients with a history of chronic drug use
Patients with a history of chronic drug use should be counseled on how discontinuation often leads to symptom improvement. Studies from our patient population show a high prevalence of narcotic drug use in a small subset of patients with cyclic vomiting syndrome. These patients needed higher doses of amitriptyline to control their cyclic vomiting syndrome attacks than those who did not use marijuana. Therefore, it is important to identify cannabinoid vomiting as part of the cyclic vomiting syndrome, as the long-term goal is to reduce and discontinue narcotic use in these patients.
7. Minimizing and actually preventing future episodes of nausea should be emphasized
Long-term management is focused on minimizing and actually preventing future episodes of nausea. At the forefront of the management of cyclic vomiting syndrome, tricyclic antidepressants (tricyclic antidepressants), particularly amitriptyline, have been shown to be effective in pharmacological prophylaxis . They are well tolerated and very effective in the treatment of adult patients with cyclic vomiting syndrome at doses ranging from 50 to 200 mg as needed and tolerated. Tricyclics work by reducing cholinergic neurotransmission and modulating alpha-2-adrenorenorenoreceptors, thereby reducing the sympathetic nervous system and gut-brain autonomic dysfunction.
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