A survey of emergency department use in patients with cyclic vomiting syndrome

Venkatesan, Thangam; Tarbell, Sally E.; Adams, Kathleen; McKanry, Jennifer; Barribeau, Trish; Beckmann, Kathleen; Hogan, Walter J.; Kumar, Nilay; Li, Buk U K

doi:10.1186/1471-227x-10-4

Cited by 75 publications

(58 citation statements)

References 17 publications

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“…Patients with CVS frequently visit the emergency department or are admitted to the hospital because of CVS symptoms and their physical complications ( Venkatesan et al, 2010 ). Cyclic vomiting syndrome symptoms and frequent use of medical services cause social and work-related issues.…”

Section: Methodsmentioning

confidence: 99%

Challenges With Acute Care and Response to Treatment Among Adult Patients With Cyclic Vomiting Syndrome

Jensen

2015

Gastroenterology Nursing

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Cyclic vomiting syndrome is a chronic gastrointestinal tract disorder. The symptoms include cycles of extreme nausea, vomiting, and abdominal pain separated by periods of wellness. Previous research suggests a quality gap in early recognition and appropriate management of adults with cyclic vomiting syndrome. The purpose of this study was to explore and describe adult patients' experiences with cyclic vomiting syndrome, including challenges receiving a diagnosis and responses to treatment. This study was conducted using a phenomenological research design. A purposeful sample included 16 adult patients with cyclic vomiting syndrome. All data were collected electronically via Survey Monkey and analyzed using content analysis and constant comparison techniques. Two global themes emerged from the data. These were perceived lack of knowledge among healthcare providers and responses to cyclic vomiting syndrome-related treatments. Perceived lack of healthcare provider knowledge contributed to diagnostic delay, inappropriate treatment, and avoidance of care. A combination of medications aimed at managing symptoms and inducing sleep was the most effective abortive medical regimen described. Marijuana use was common. Hot-water bathing was practiced by users and nonusers of marijuana.

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Section: Methodsmentioning

confidence: 99%

Challenges With Acute Care and Response to Treatment Among Adult Patients With Cyclic Vomiting Syndrome

Jensen

2015

Gastroenterology Nursing

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“…The diagnosis is often delayed and typically it takes a mean of 15 emergency department visits [3] or B6 years before a diagnosis is made [4], with patients often labelled as showing 'drugseeking behaviour'.…”

Section: Introductionmentioning

confidence: 99%

The management of cyclic vomiting syndrome

L¹,

Abbott²,

Mahlangu³

et al. 2012

European Journal of Gastroenterology & Hepatology

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Cyclic vomiting syndrome (CVS) is a rare abnormality of the neuroendocrine system that affects 2% of children. It is a frequently missed diagnosis in the emergency department and may require a number of emergency department visits before the diagnosis is made. The objectives of this review are to identify the clinical features that suggest a diagnosis of CVS and to review the literature on its management. The MEDLINE and EMBASE databases were searched from January 1948 to October 2011 using the keywords 'Cyclic' or 'Vomiting'. Papers were excluded if they did not follow the consensus guidelines or if they were case reports. This review analysed 1093 cases of cyclic vomiting in 25 papers that fulfilled the inclusion criteria. All except one paper were retrospective studies. The size of these cohort studies ranged from three to 181 patients, with a mean patient size of 29. This review found that over 40% of patients have headaches/migraines, with associated anxiety and depression in ≈ 30% of cases. There is a family history of headaches/migraines in 38.9%, and this association was much stronger in the adult CVS cohort compared with the paediatric cohort. Compared with paediatric CVS, adults have a longer duration of attacks and they occur more frequently (5.9 vs. 3.4 days, 14.4 vs. 9.6 episodes/year). Limited data are available on the treatment of the acute phase of CVS, but in adults, sumatriptan has been shown to be effective. For prophylactic treatment, tricyclics are effective in both adult and paediatric CVS, with a clinical response in 75.5 and 67.6% of patients, respectively, in nonplacebo-controlled cohort studies. Furthermore, propranolol has been shown to be useful in children. CVS is an intractable illness with a major impact on the patient's quality of life. There is a long duration between the onset of symptoms and the diagnosis of the condition. There is a high association with headaches/migraines and anxiety/depression. The symptoms are more severe in adult-onset CVS. Tricyclic antidepressants have good efficacy in reducing the frequency/duration or the intensity of attacks. There is limited evidence on the acute management of CVS.

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“…3 These cycles may occur six to twelve times per year 4 and often require utilization of emergency services to treat pain, dehydration, and electrolyte abnormalities. 5 As with other functional gastrointestinal (GI) disorders, symptoms cannot be explained by other structural or biochemical abnormalities. 1 Thus, while undergoing evaluation for other etiologies, most patients experience a delay in diagnosis of 3-8 years.…”

Section: Introductionmentioning

confidence: 99%

“…1 Thus, while undergoing evaluation for other etiologies, most patients experience a delay in diagnosis of 3-8 years. 5 Although originally thought to be a disease of childhood, CVS has been increasingly described in adults. 6 Reported prevalence rates range from 0.04% to 1.9%, with a femaleto-male predominance of 55:45.…”

Section: Introductionmentioning

confidence: 99%