The target audience for this guideline includes gastroenterologists, emergency medicine physicians, primary care providers, other clinicians, patients, and policymakers. This article represents an official statement of the American Neurogastroenterology and Motility Society (ANMS) and the Cyclic Vomiting Syndrome Association (CVSA) on the diagnosis and management of CVS in adults. For example, many patients with CVS experience abdominal pain during an acute attack, but this feature is not currently incorporated in the Rome IV CVS criteria and should be considered in future revisions. With further research, the clinical features of CVS will become better delineated, and this information is likely to influence future iterations of symptom‐based CVS diagnostic criteria. While other disorders of nausea and vomiting such as gastroparesis may be confused with CVS, these disorders lack the stereotypical and sudden onset of symptoms, features that appear to be fairly unique to CVS. 4, 5 Although their sensitivity and specificity in making a diagnosis of CVS has not been determined, the current Rome IV symptom‐based criteria established a uniform, symptom‐based framework that is useful in clinical practice. The diagnosis for CVS is based on Rome criteria, first developed in 2006 and subsequently revised in 2016. 3 There is considerable variation in recognition, diagnosis, and management of CVS. Approximately one‐third of adult patients become disabled. 1, 2 It is characterized by episodic nausea and vomiting and is associated with significant morbidity. Techniques like meditation, relaxation, and biofeedback may be offered as complementary therapy to improve overall well‐being and patient care outcomes.Ĭyclic vomiting syndrome (CVS) is a chronic functional gastrointestinal disorder that is being increasingly recognized in adults. The committee recommended screening and treatment for comorbid conditions such as anxiety, depression, migraine headache, autonomic dysfunction, sleep disorders, and substance use with referral to appropriate allied health services as indicated. Emergency department treatment is best achieved with the use of an individualized treatment protocol and shared with the care team (example provided). For acute attacks, the committee conditionally recommends using serotonin antagonists, such as ondansetron, and/or triptans, such as sumatriptan or aprepitant to abort symptoms. Zonisamide or levetiracetam and mitochondrial supplements (Coenzyme Q10, L‐carnitine, and riboflavin) are conditionally recommended as alternate prophylactic medications, either alone or concurrently with other prophylactic medications. The committee strongly recommends that adults with moderate‐to‐severe CVS receive a tricyclic antidepressant ( TCA), such as amitriptyline, as a first‐line prophylactic medication and receive topiramate or aprepitant as alternate prophylactic medications. The committee makes recommendations for the prophylaxis of CVS, treatment of acute attacks, diagnosis, and overall management of CVS. The expert committee included the President of the CVSA who brought a patient perspective into the deliberations. GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) framework was used and a professional librarian performed the literature search. The increasing recognition of cyclic vomiting syndrome ( CVS) in adults prompted the development of these evidence‐based guidelines on the management of CVS in adults, which was sponsored by the American Neurogastroenterology and Motility Society ( ANMS) and the Cyclic Vomiting Syndrome Association ( CVSA).
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |