Patients with pediatric- and adult-onset cyclic vomiting syndrome experienced similar symptoms and response to treatment in a recent study.
In a retrospective review, researchers evaluated 101 patients with cyclic vomiting syndrome (CVS) treated at the Medical College of Wisconsin in Milwaukee between 2006 and 2008. The cohort included 29 patients with pediatric-onset and 72 with adult-onset CVS. Most patients (62%) indicated abdominal pain as a prominent symptom, along with nausea and vomiting. Treatment most commonly included tricyclic antidepressants (76% of patients), along with topiramate (20%) and coenzyme Q-10, L-carnitine or riboflavin (30%).
Patients with pediatric-onset CVS were more likely also to have neurocognitive disorders compared with adult-onset CVS patients (14% vs. 3%, P=.05). Investigators also found a significantly longer delay in diagnosis for pediatric-onset patients (10 ± 7 years) than adult-onset patients (5 ± 7 years) (P=.001). Pediatric-onset patients were significantly less prone to chronic opiate use than adult-onset patients (0% vs. 23%, P=.004).
The two groups were similar with regard to clinical features of CVS, and the time of onset was not found to be a predictive factor for treatment response. Most participants (86% of 76 evaluable patients) were responsive to treatment, including 44 with a complete response and 21 with a partial response. Eleven patients had no response. No significant difference in treatment response was observed between the two groups (P=.27). Nonresponse was associated only with therapy compliance after multivariate analysis (OR=9.6; 95% CI, 1.18-77.05).
“Adult-onset CVS patients have similar symptoms to those with pediatric-onset CVS and have similar rates of response to therapy,” the researchers concluded. “CVS is associated with an enormous psychosocial and economic burden, and patients must be diagnosed early and treated with appropriate medications. Combination of medical and behavioral therapy based on a bio-psycho-social model is key to successfully treating patients.”