China
Africa
Explore chapters and articles related to this topic
Gastrointestinal Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Gareth Davies, Chris Black, Keeley Fairbrass
If organic causes have been ruled out by 1–4, possible explanations are: Gastroparesis (abnormal gastric emptying due to neuromuscular pathology, one cause being diabetic autonomic neuropathy): Barium meal and follow-through will often demonstrate abnormal gastric emptying. Some centres offer specialized gastric emptying studies.Mechanical obstruction of proximal small bowel (beyond reach of gastroscopy): Barium meal and follow-through and abdominal CT are often diagnostic.Psychological/psychiatric disease (e.g. anorexia nervosa (AN)/bulimia, severe anxiety): Diagnosis is made on typical history and exclusion of organic causes.Functional causes: This is when the cause is unknown, but the key problem is disordered upper GI motility. Cyclical vomiting syndrome gives characteristic story (see 4 above), but otherwise diagnosis is by a process of elimination.
Multiple acyl CoA dehydrogenase deficiency/glutaric aciduria type II ethylmalonic-adipic aciduria
Published in William L. Nyhan, Georg F. Hoffmann, Aida I. Al-Aqeel, Bruce A. Barshop, Atlas of Inherited Metabolic Diseases, 2020
William L. Nyhan, Georg F. Hoffmann, Aida I. Al-Aqeel, Bruce A. Barshop
A few patients developed a progressive extrapyramidal movement disorder [58]. Uziel and colleagues described a boy with gradually progressive spastic ataxia and leukodystrophy without ever having experienced episodic metabolic crises [59]. One adult patient presented for several years with cyclic vomiting and was initially diagnosed with cyclic vomiting syndrome [60]. A depressive state and intermittent nausea were the first symptoms of an adolescent patient with late-onset riboflavin-responsive MADD [61]. Brain magnetic resonance imaging of this patient showed disseminated high-intensity areas in the periventricular white matter and in the splenium of the corpus callosum on T2-weighted images and fluid-attenuated inversion-recovery images before starting the treatment. In summary, late-onset MADD is characterized by a progressive myopathy of varying degrees and time course, risk of acute deteriorations and metabolic decompensation, and, occasionally, additional neurologic symptoms.
Global prevalence and international perspective of paediatric gastrointestinal disorders
Published in Clarissa Martin, Terence Dovey, Angela Southall, Clarissa Martin, Paediatric Gastrointestinal Disorders, 2019
Shaman Rajindrajith, Niranga Devanarayana, Marc Benninga
Data on the epidemiology of CVS in children are limited. A population-based survey from Aberdeen, Scotland, involving children aged 5–15 years, has shown the prevalence of cyclical vomiting to be 1.9% in the United Kingdom (Abu-Arafeh and Russell, 1995a), 2.3% in Australia (Cullen and Macdonald, 1963), 0.5% in Sri Lanka (Devanarayana and Rajindrajith, 2012) and 1.9% in Turkey (Ertekin et al., 2006). Although overall sex ratio for the whole population was 1:1, cyclical vomiting was more common among boys in the younger age group of less than 7 years. The sex ratio reversed in children older than 7 years. Travel, stress, tiredness and lack of sleep were the recognised precipitating factors. In a prospective surveillance study in Ireland, the incidence of CVS was found to be 3.5/100 000 children per annum. In this study, the median age of diagnosis was 7.42 years and the median age of onset was 4 years. The majority of children missed school because of their symptoms, indicating the disabling nature of the disease (Fitzpatrick et al., 2008). Current research is inconclusive, as there seems to be considerable heterogeneity and variability of the prevalence rates in different studies conducted in different geographical locations. (See also ‘Notes on cyclical vomiting syndrome’ in Part III.)
Low patient engagement is associated with reduced health-related quality of life in adults with cyclic vomiting syndrome
Published in Scandinavian Journal of Gastroenterology, 2022
Geoffrey Dang-Vu, Lisa Rein, Aniko Szabo, Thangam Venkatesan
Cyclic Vomiting Syndrome (CVS) is a chronic disorder of gut-brain interaction marked by recurrent episodes of severe nausea and vomiting in between periods of otherwise normal health [1]. This stereotypical pattern of vomiting is often triggered by psychological or physiological stress [2]. CVS is also associated with multiple comorbid chronic conditions such as anxiety, depression, autonomic dysfunction and migraine [3]. As a result, patients generally have the poor health-related quality of life (HRQOL) and increased health care utilization [4]. Treatment of CVS consists of prophylactic therapy to prevent episodes, abortive therapy at the onset of symptoms, and addressing psychosocial comorbidity to help with chronic disease management which is pivotal to achieving better outcomes in these patients [5]. This requires a high degree of engagement by all stakeholders including healthcare providers and patients. However, to date, there is no data on patient engagement in CVS and how this impacts overall HRQOL in these patients.
An overview of the clinical management of cyclic vomiting syndrome in childhood
Published in Current Medical Research and Opinion, 2018
Claudio Romano, Valeria Dipasquale, Anna Rybak, Donatella Comito, Osvaldo Borrelli
Cyclic vomiting syndrome (CVS) is defined as recurrent episodic attacks of intense nausea and vomiting, usually stereotypical in the individual and with predictable timing of episodes, sometimes associated with pallor and lethargy1. CVS has a considerable negative impact on children’s quality of life and school attendance; for instance, children with CVS miss an average of about 20 days of school a year1. The annual average economic burden per patient, including emergency department visits for management of dehydration and electrolyte alterations, hospital admission, and need for diagnostic tests and missed work is significantly high1. Data on the epidemiology of CVS in pediatric populations is difficult to define, despite the increase in case reports published in the last few years2–5 (Table 1). In 2008, the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) published a consensus statement on the diagnosis and management of CVS, based upon a review of medical literature and expert opinion6. Recommendations were intended for use by pediatricians, pediatric gastroenterologists, pediatric neurologists and emergency department physicians, and are still valid worldwide. However, over the last 10 years, over 70 articles have been published on CVS in the pediatric population. The aim of this narrative review is to update CVS pathogenesis, diagnosis and management, based upon the studies published after the official NASPGHAN recommendations.
Cannabinoid hyperemesis syndrome: potential mechanisms for the benefit of capsaicin and hot water hydrotherapy in treatment
Published in Clinical Toxicology, 2018
John R. Richards, Jeff M. Lapoint, Guillermo Burillo-Putze
Calcitonin gene-related peptide, a potent peptide vasodilator, is produced in peripheral and central neurons and is involved in pain transmission. Although not found to have a direct pro-emetic effect, calcitonin gene-related peptide is an important factor in the genesis and duration of migraine and cluster headaches, which are frequently accompanied by nausea and emesis [120]. Topical and intranasal capsaicin has been used successfully for prophylaxis and treatment of migraine and cluster headaches [121–124]. There is a high prevalence of concomitant migraine headache in patients with cyclic vomiting syndrome [52]. Cannabinoid hyperemesis syndrome is considered to be a variant of cyclic vomiting syndrome, which some researchers describe as an “abdominal migraine” [52,125,126]. TRPV1 receptors are expressed by inner ear ganglion cells, and intracranial blood vessels are innervated by trigeminal sensory nerve fibers, which store and release calcitonin gene-related peptide, substance P, and neurokinin A [127–129]. Trigeminal nerve fibers leading to the vestibular-cochlear system have been implicated in basilar and vestibular migraine, in which nausea, vomiting, imbalance, and hearing changes may occur. De Tomasso et al. [130] found that topical capsaicin applied to the hand increased the blink reflex, an experimental measure of diffuse noxious inhibitory controls, in chronic migraine versus non-migraine subjects [130]. This further demonstrates that topical capsaicin has both local and systemic effects which may explain its potential benefit for treatment of cannabinoid hyperemesis syndrome. It is possible that capsaicin-induced depletion of calcitonin gene-related peptide and tachykinins may also have a role in its antiemetic effect in cannabinoid hyperemesis syndrome [10,11,52,53].