WordNet

of a compound having atoms arranged in a ring structure
recurring in cycles (同)cyclical
conforming to the Carnot cycle
forming a whorl or having parts arranged in a whorl; "cyclic petals"; "cyclic flowers"
marked by repeated cycles
a pattern of symptoms indicative of some disease
a complex of concurrent things; "every word has a syndrome of meanings"

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(疾患の徴候となる一群の)症徴候,症候群 / (事件・社会的状態などのパターンを示す)徴候形態

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/08/04 17:06:14」(JST)

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Cyclic vomiting syndrome (US English) or cyclical vomiting syndrome (UK English) (CVS) is a chronic functional condition of unknown etiology characterised by recurring attacks of intense nausea, vomiting and sometimes abdominal pain, headaches or migraines. CVS typically develops during childhood, usually between ages 3 and 7; although it often remits during adolescence, it can persist into adult life.^[1]^[2]^[3]

Patient characteristics

The average age at onset is 3–7 years, but CVS has been seen in infants who are as young as 6 days and in adults who are as old as 73 years.^[4] Typical delay in diagnosis from onset of symptoms is 2.7 – 3 years.^[4] Females show a slight predominance over males; the female-to-male ratio is 57:43.^[4] CVS occurs in all races but seems to disproportionately affect Caucasians. ***Special note*** Many people often lose the ability to eat and suffer from a loss of throat functions.

Presentation

Sufferers may vomit or retch six to twelve times an hour, and an episode may last from a few hours to well over three weeks, and in some cases months, with a median episode duration of 41 hours.^[5] Acid, bile and (if the vomiting is severe) blood may be vomited. Some sufferers will ingest water to reduce the irritation of bile and acid on the esophagus during emesis. Between episodes the sufferer is usually normal and healthy otherwise but can be in a weak state of fatigue or suffer from muscle pain. In approximately half of cases the attacks, or episodes, occur in a time-related manner. Each attack is stereotypical: that is, in any given individual, the timing, frequency and severity of attacks is similar.

Episodes may happen every few days, every few weeks or every few months. For some there is not a pattern in time that can be recognized. Some sufferers have a warning of an attack: They may experience a prodrome, usually intense nausea and pallor, heightened sensitivity, especially to light, though sensitivity to smell, sound, pressure, and temperature, as well as oncoming muscle pain and fatigue, are also reported by some patients. The majority of sufferers can identify triggers that may precipitate an attack. The most common are various foods, infections (such as colds), menstruation, extreme physical exertion, lack of sleep, and psychological stresses both positive and negative.

A sufferer may also be light-sensitive (photophobic) during an attack, as well as sound-sensitive (phonophobic) and, less frequently, temperature- or pressure-sensitive.^[1] Some sufferers also have a strong urge to bathe in warm or cold water. Some sufferers report that they experience a restless sensation or stinging pain along the spine, hands, and feet followed by weakness in both legs. Some of these symptoms may be due to dehydration rather than the underlying cause of CVS.

Diagnosis

The cause of CVS has not been determined; there are no diagnostic tests for CVS. Several other medical conditions can mimic the same symptoms, and it is important to rule these out. If all other possible causes have been excluded, a diagnosis of CVS may be appropriate.

Diagnostic criteria

There are established criteria to aid in diagnosis of CVS; essential criteria are:

A history of three or more periods of intense, acute nausea and unremitting vomiting, as well as pain in some cases, lasting hours to days and even weeks or months
Intervening symptom-free or reduced-symptom intervals, lasting weeks to months
There are repeated cycles of periods (of varying duration) with intense/acute nausea, with or without vomiting, with or without severe pain, followed by periods of reduced symptoms, followed by gradual increase in CVS symptoms until it peaks (peak intensity is generally relative to cycle intensity).
There are differences between early-onset CVS (babies & children) and late onset CVS (adult)
Exclusion of metabolic, gastrointestinal, or central nervous system structural or biochemical disease, e.g., individuals with specific physical causes (such as intestinal malrotation)

Investigations

Once formal investigations to rule out gastrointestinal or other etiologies have been conducted, these tests do not need to be repeated in the event of future episodes.^[1]

Treatment

There is no known cure for CVS, but there are medications that can be used for treatment, intervention, and prevention. There is a growing body of publications on both individual cases and the experiences of the CVS cohort. Treatment is usually on an individual basis, based on trial and error.

The most common therapeutic strategies for those already in an attack are maintenance of salt balance by appropriate intravenous fluids and, in some cases, sedation. Having vomited for a long period prior to attending a hospital, patients are typically severely dehydrated. For a number of patients, potent anti-emetic drugs such as ondansetron (Zofran) or granisetron (Kytril), and dronabinol (Marinol) may be helpful in either preventing an attack, aborting an attack, or reducing the severity of an attack. Lifestyle changes may be recommended, such as extended rest and reduction of stress.^{[citation needed]} Because the symptoms of CVS are similar (or perhaps identical) to those of the disease well-identified as "abdominal migraine," treatment of CVS with a regimen of anti-migraine drugs, such as Topirimate and amitryptiline, is showing promise in preventing recurrent attacks.

Genetics

Many affected individuals have a family history of related conditions, such as migraines, in their mothers and maternal relatives, suggesting mitochondrial inheritance. Single base-pair and DNA rearrangements in the mitochondrial DNA have been associated with these traits.^[6]

Prognosis

Fitzpatrick et al. (2007) identified 41 children with CVS. The mean age of the sample was 6 years at the onset of the syndrome, 8 years at first diagnosis, and 13 years at follow-up. As many as 39% of the children had resolution of symptoms immediately or within weeks of the diagnosis. Vomiting had resolved at the time of follow-up in 61% of the sample. Many children, including those in the remitted group, continued to have somatic symptoms such as headaches (in 42%) and abdominal pain (in 37%).^[7]

Most children who have this disorder miss on average 24 school days a year.^[2] The frequency of episodes is higher for some people during times of excitement.^[2] Charitable organizations to support sufferers and their families and to promote knowledge of CVS exist in several countries.

Mortality

There is little hard evidence of death as a result of the condition. However, in severe cases the fluid loss can lead to potentially life-threatening electrolyte imbalances. The patient can also become malnourished if the attacks last too long without adequate replenishment of nutrients. With adequate medical interventions, most patients can be properly supported during an episode.^{[citation needed]}

Epidemiology

The prevalence of the condition is not clear. Two published studies on childhood CVS suggest nearly 2% of school-age children may have CVS. However, diagnosis is problematic and, as knowledge of CVS has increased in recent years, more and more cases are emerging. This suggests a tendency toward under-diagnosis, and thus the true figure may be higher.

History

It was first described by paediatrician Samuel Gee in 1882. It has been suggested that Charles Darwin's adult illnesses may have been due to this syndrome.^[8]

References

^ ^a ^b ^c Lindley, Keith J; Andrews, Paul L (2005). "Pathogenesis and Treatment of Cyclical Vomiting". Journal of Pediatric Gastroenterology & Nutrition 41 (Suppl 1): S38–40. doi:10.1097/01.scs.0000180299.04731.cb. PMID 16131963.
^ ^a ^b ^c Li, B UK; Lefevre, Frank; Chelimsky, Gisela G; Boles, Richard G; Nelson, Susanne P; Lewis, Donald W; Linder, Steven L; Issenman, Robert M et al. (2008). "North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Consensus Statement on the Diagnosis and Management of Cyclic Vomiting Syndrome". Journal of Pediatric Gastroenterology and Nutrition 47 (3): 379–93. doi:10.1097/MPG.0b013e318173ed39. PMID 18728540.
^ Abell, T. L.; Adams, K. A.; Boles, R. G.; Bousvaros, A.; Chong, S. K. F.; Fleisher, D. R.; Hasler, W. L.; Hyman, P. E. et al. (2008). "Cyclic vomiting syndrome in adults". Neurogastroenterology & Motility 20 (4): 269–84. doi:10.1111/j.1365-2982.2008.01113.x. PMID 18371009.
^ ^a ^b ^c Li, B U.K; Misiewicz, Larry (2003). "Cyclic vomiting syndrome: A brain–gut disorder". Gastroenterology Clinics of North America 32 (3): 997–1019. doi:10.1016/S0889-8553(03)00045-1. PMID 14562585.
^ Li, BU; Fleisher, DR (1999). "Cyclic vomiting syndrome: Features to be explained by a pathophysiologic model". Digestive diseases and sciences 44 (8 Suppl): 13S–18S. PMID 10490033.
^ "What is cyclic vomiting syndrome?".
^ Fitzpatrick, E; Bourke B; Drumm B; Rowland M (April 2008). "The incidence of cyclic vomiting syndrome in children: population-based study". Am J Gastroenterol. 103 (4): 991–5. doi:10.1111/j.1572-0241.2007.01668.x. PMID 18070235.
^ Hayman, J. A (2009). "Darwin's illness revisited". BMJ 339: b4968. doi:10.1136/bmj.b4968. PMID 20008377.

External links

Cyclic Vomiting Syndrome Emedicine article
The UK Cyclical Vomiting Syndrome Association
The USA/Canadian CVS association
CVS page at the US National Digestive Diseases Clearinghouse, NIH Publication No. 04-4548
An article in the Washington Post describing how the syndrome can be confused for other things

UpToDate Contents

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1. 周期性嘔吐症候群 cyclic vomiting syndrome
2. 悪心および嘔吐を伴う成人に対するアプローチ approach to the adult with nausea and vomiting
3. 悪心および嘔吐を呈する幼児または小児に対するアプローチ approach to the infant or child with nausea and vomiting
4. 6ヶ月以上の乳幼児、小児、および思春期における体重減少の評価 evaluation of weight loss in infants over six months of age children and adolescents
5. 小児における片頭痛の分類 classification of migraine in children

English Journal

Neurochemical mechanisms and pharmacologic strategies in managing nausea and vomiting related to cyclic vomiting syndrome and other gastrointestinal disorders.

Bashashati M1, McCallum RW2.Author information 1Hotchkiss Brain Institute, Department of Physiology and Pharmacology, University of Calgary, Calgary, AB, Canada.2Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA. Electronic address: richard.mccallum@ttuhsc.edu.AbstractNausea and vomiting are common gastrointestinal complaints which could be triggered by stimuli in both the peripheral and central nervous systems. They may be considered as defense mechanisms when threatening toxins/agents enter the gastrointestinal tract or there is excessive retention of gastrointestinal contents due to obstruction. The pathophysiology of nausea and vomiting is complex and much still remains unknown. Therefore, treatments are restricted or ineffective in many cases. Nausea and vomiting with functional etiologies including cyclic vomiting syndrome are challenging in gastroenterology. In this article, we review potential pathways, neurochemical transmitters, and their receptors which are possibly involved in the pathophysiology of nausea and vomiting including the entity cyclic vomiting syndrome.
European journal of pharmacology.Eur J Pharmacol.2014 Jan 5;722:79-94. doi: 10.1016/j.ejphar.2013.09.075. Epub 2013 Oct 22.
Nausea and vomiting are common gastrointestinal complaints which could be triggered by stimuli in both the peripheral and central nervous systems. They may be considered as defense mechanisms when threatening toxins/agents enter the gastrointestinal tract or there is excessive retention of gastroint
PMID 24161560

Rapid Response to Mirtazapine in Cyclic Vomiting Syndrome Refractory to Conventional Prokinetics.

Min Bae S1, Kang SG1, Lee YJ1, Cho SJ1, Seo CM2.
Psychosomatics.Psychosomatics.2013 Dec 19. pii: S0033-3182(13)00139-4. doi: 10.1016/j.psym.2013.07.004. [Epub ahead of print]
PMID 24360530

Prevalence of Functional Gastrointestinal Disorders in Colombian School Children.

Saps M1, Nichols-Vinueza DX2, Rosen JM3, Velasco CA4.Author information 1Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.2Department of Pediatrics, Boston Children's Hospital, Boston, MA.3Department of Pediatrics, Children's Mercy Hospitals and Clinics, Kansas City, MO.4Department of Pediatrics, Universidad del Valle, Cali, Colombia.AbstractOBJECTIVES: To determine prevalence for functional gastrointestinal disorders (FGIDs) in Colombian school children using the Questionnaire on Pediatric Gastrointestinal Symptoms-Rome III Version (QPGS-III) and to determine possible risk factors.
The Journal of pediatrics.J Pediatr.2013 Dec 12. pii: S0022-3476(13)01384-X. doi: 10.1016/j.jpeds.2013.10.088. [Epub ahead of print]
OBJECTIVES: To determine prevalence for functional gastrointestinal disorders (FGIDs) in Colombian school children using the Questionnaire on Pediatric Gastrointestinal Symptoms-Rome III Version (QPGS-III) and to determine possible risk factors.STUDY DESIGN: The QPGS-III was translated into Spanish
PMID 24332822

Japanese Journal

小児消化器疾患の心身医学(<特集>心身医学と消化器症状)

石崎優子
心身医学 50(10), 955-959, 2010-10-01
小児消化器心身症を診るうえでの留意点として,(1)成人と同じ診断名でも成人とは病態が異なる疾患があること,(2)小児期特有もしくは主に小児期にみられる病態があることの2点が挙げられる.(1)にあたる疾患としては,過敏性腸症候群,胃食道逆流症,(2)にあたる疾患としては,頭痛関連疾患である周期性嘔吐症,腹部片頭痛がある.また,小児の症状は身体機能の未熟性による生理的要因と心理的要因との相互作用により …
NAID 110007730317

Effective prophylactic therapy for cyclic vomiting syndrome in children using valproate

HIKITA Toshiyuki,KODAMA Hiroko,NAKAMOTO Natsue,KAGA Fumiaya,AMAKATA Kaori,OGITA Kaori,KANEKO Sono,FUJII Yasushi,YANAGAWA Yukishige
Brain & development 31(6), 411-413, 2009-06-01
NAID 10025580237