Cyclic vomiting syndrome is a common, idiopathic, functional disorder that is difficult to treat due to lack of standard diagnostic and treatment guidelines, and it requires collaborative care between medicine and psychiatry.
There is a high prevalence of psychiatric disorders comorbid with cyclic vomiting syndrome among both children and adults. These findings strongly suggest the need for careful and detailed psychiatric screenings in patients who have this disorder. If comorbid conditions are left untreated, the consequences may have significant medical and/or mental health impact, which could lead to social, family, or academic impairment. While amitriptyline may be beneficial in some individuals, further studies are needed to confirm its true efficacy. The cardiotoxic potential and side-effect profile of amitriptyline is an important limitation of use of this drug, which providers must keep in mind. Long-term outcomes could be understood with prospective studies with larger sample sizes. The lack of awareness of cyclic vomiting syndrome among health care professionals presents a great deal of challenge in early diagnosis and treatment.
KEY POINTS/CLINICAL PEARLS
• The most frequent psychiatric comorbidities observed in patients with cyclic vomiting syndrome appear to be anxiety and depression.
• The exact pathophysiology of cyclic vomiting syndrome is unknown, and thus further studies are needed to investigate the causes of this disorder.
• Amitriptyline has shown promise when used as a preventive measure, but more studies are needed to confirm its efficacy in treating cyclic vomiting syndrome.
• Treatment requires an integrated approach between medicine, gastroenterology, and psychiatry
by Dr. Ramkrishna Makani MD, MPH
Child and Adolescent Fellow, Children’s Hospital of Philadelphia (Philadelphia, PA)