Clinical, psychiatric and manometric profile of cyclic vomiting syndrome in adults and response to tricyclic therapy.
Our goal was to investigate 31 adult patients (mean age 29 years, range 18-62 years) meeting Rome II criteria for cyclic vomiting syndrome (CVS). All subjects completed a clinical questionnaire, a Hamilton Rating Scale for Anxiety (HAM-A) and Zung Depression Inventory. Gastric emptying time was assessed in 30 subjects and electrogastrogram (EGG) in 11 between acute attacks. Twenty-seven patients treated with amitriptyline completed a follow-up questionnaire. The mean age of onset of the patients was 30 years (range 14-53 years) and cycles of nausea and vomiting were accompanied by often-severe epigastric and diffuse abdominal pain. A typical attack ranged from 1 to 14 days, with the majority being 4-6 days. The HAM-A revealed that 84% had an anxiety disorder, and based on Zung Depression Inventory 78% suffered from mild-to-severe depression. Only 4 (13%) patients reported migraine, but 14 had a family history of migraine. Gastric emptying time was rapid in 23 (77%), normal in 4 and delayed in 3. The EGG was abnormal in 7 of 11 patients, with 4 having tachygastria. Of 13 patients using marijuana, 7 had symptom relief, while 2 had resolution of CVS after stopping use. The overall treatment experience in the 24 patients receiving amitriptyline up to 1 mg kg(-1) day(-1) for at least 3 months indicated that 93% had decreased symptoms and 26% achieved full remission. Cyclic vomiting syndrome in adults has the following hallmarks: prominence of accompanying abdominal pain and increased prevalence of anxiety and depression, rapid gastric emptying and tachygastric EGG, and successful suppression of attacks by chronic amitriptyline therapy.
Namin
F
F
The Center for Gastrointestinal Nerve and Muscle Function, Department of Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA.
Patel
J
J
Lin
Z
Z
Sarosiek
I
I
Foran
P
P
Esmaeili
P
P
McCallum
R
R
D000293:Adolescent; D000328:Adult; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use*; D001008:Anxiety Disorders / Q000150:complications; D003863:Depression / Q000150:complications; D005260:Female; D005746:Gastric Emptying / Q000502:physiology; D005767:Gastrointestinal Diseases / Q000150:complications / Q000188:drug therapy* / Q000523:psychology*; D006801:Humans; D008297:Male; D008365:Manometry; D001523:Mental Disorders / Q000150:complications*; D008875:Middle Aged; D014839:Vomiting / Q000188:drug therapy* / Q000523:psychology
D000929:Antidepressive Agents, Tricyclic