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PEDIATRICS Vol. 102 No. 3 September 1998, pp. 583-587

Heterogeneity of Diagnoses Presenting as Cyclic Vomiting

Received Oct 20, 1997; accepted Mar 13, 1998.

B U. K. Li*, Robert D. Murray*, Leo A. Heitlinger*, Jennifer L. Robbins*, and John R. HayesDagger

From the * Division of Gastroenterology, Department of Pediatrics, Ohio State University; and Dagger  Children's Hospital Research Foundation, Columbus Children's Hospital, Columbus, Ohio.

Objective.  To establish the diagnostic profile in children who present with cyclic vomiting.

Methods.  We studied 225 children <18 years of age who presented to our pediatric gastroenterology service from 1986 to 1997 with at least three discrete episodes of vomiting between which they were well. To determine the diagnoses in those presenting with a pattern of cyclic vomiting, the results of diagnostic testing and responses to various treatments were obtained from a combination of chart review and structured telephone interviews.

Results.  The largest diagnostic category included idiopathic cyclic vomiting syndrome (88%). Extraintestinal disorders (7%) and gastrointestinal disorders (5%) constituting the probable cause of vomiting were established in those having complete cessation of episodes after therapy. In 12%, serious surgical disorders of the gastrointestinal (malrotation), renal (acute hydronephrosis), and central nervous systems (neoplasm) were found. In 2%, serious endocrine (Addison's disease) and metabolic disorders (disorder of fatty acid oxidation) were found. Among those with idiopathic cyclic vomiting syndrome, 41% had associated disorders (gastroesophageal reflux and chronic sinusitis) that could contribute to the vomiting, but, based on a partial response to therapy, were not deemed to be the main cause. Altogether 49% had an identified disorder that probably caused or could contribute to the vomiting.

Conclusions.  The cyclic pattern of vomiting is a symptom complex that can be induced by heterogeneous disorders that either cause or contribute to the vomiting. Once the cyclic vomiting pattern is identified, systematic diagnostic testing is warranted to look for these underlying disorders.  Key words:  recurrent vomiting, cyclic vomiting syndrome, cyclic vomiting pattern.




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