The duration of the CVS at the time of consultation ranged from less than 1 year to 43 years (mean, 12 yrs median, 7 yrs.). The age at onset of the first episode ranged from 2 to 49 years (mean, 21 yrs median 20 yrs). This study was approved by the Institutional Review Board of the University of Missouri – Columbia.įorty-one adults (24 men and 17 women) presented at between 20 and 64 years of age (average, 34 years median, 34 yrs) for evaluation of recurrent vomiting. They contained three questions: "Is your CVS better, worse or the same as it was at the time of our initial consultation?", "What made a difference, if any?", and, "About how many episodes have you had in the past 12 months and how long have they usually lasted?". Follow-up data were collected by mailed questionnaires supplemented when necessary by telephone contact. Data for this report were extracted from patients' charts, which in some cases were insufficient for analysis of every feature described in our results therefore, the sizes of databases from which statistics were derived vary. Each patient was physically examined and a plan of management was negotiated. Three hours were scheduled for each patient so that his/her illness, including psychological, social and developmental histories, could be explored phenomenologically within the framework of the bio-psycho-social model of clinical practice. Clinical data were recorded on a standardized form to facilitate later retrospective analysis. Our purpose is to improve recognition of this frequently missed diagnosis by further describing the features of the disorder, the characteristics of patients afflicted with it, and problems encountered in its management.įorty-one adult patients were seen by one of us (DRF) between 19 with complaints compatible with the diagnostic criteria for CVS, namely, recurrent, self-limited, stereotypic episodes of intractable nausea and vomiting with no identifiable organic cause, separated by intervals of comparative well-being. We present a retrospective study of 41 consecutive adult patients selected from a cohort of 237 children and adults with CVS. These features of CVS and their possible synergy in cyclic vomiting attacks have not been addressed previously. Although the high prevalence of migraine diathesis has been noted for more than 70 years, co-morbid anxiety, panic attacks and inter-episodic dyspeptic nausea are additional features of CVS in many adult patients. By contrast, we found, and herein describe, the phenomenon of episode coalescence, which characterizes deterioration in the course of the illness. Moreover, the impression is gained that the pattern of episodes in untreated CVS tends to remain more or less constant with respect to inter-episodic duration, duration of the emetic phase and associated symptoms. However, naturalistic observation of patients with CVS made during personalized continuity of care indicates that adults often present features and management challenges not typical of pediatric patients. CVS in adults has been characterized as similar to CVS in children. Cyclic Vomiting Syndrome has been reported in adults with onset ranging from childhood to middle age. Thereafter, CVS was considered to be a pediatric disorder, and the absence of characteristic physical, laboratory or radiological markers for CVS resulted in its poor recognition by physicians who practice adult medicine. Schematic representation of the four phases of Cyclic Vomiting Syndrome and their therapeutic goals.ĬVS was first described in the English literature in 1882 by Samuel Gee who reported a series of nine children ranging in age from 4 to 8 years.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |