Zyklisches Erbrechenssyndrom (CVS) beim Erwachsenen - eine häufig übersehene Erkrankung?

Abstract

CVS (cyclic vomiting syndrome) is a functional disorder that can occur in all age groups. Adults typically develop CVS in middle age (around the 35th year of life). CVS is characterised by recurrent stereotypic episodes of nausea and vomiting lasting hours or some days. Between these episodes there are intervals free of symptoms. The main symptoms include nausea, vomiting and often abdominal pain. CVS is a rare disorder in adult patients. Because of the lack of awarness, making the correct diagnosis is not easy und often delayed for some months or years. There is no specific test to secure the diagnosis. The accurate diagnosis is based on the typical anamnestic report and the exclusion of other disorders associated with a recurrent vomiting. No standard evidence-based treatment is currently available either to manage the acute vomiting episode or to manage the prophylactic therapy. For the acute treatment of the vomiting episodes antiemetic, antimigraine and sedative medications were used. The medications frequently used for the prophylactic therapy are amitriptyline and propranolol.

Mitochondrial disorder caused Charles Darwin's cyclic vomiting syndrome

“…CVS is characterized by recurrent, stereotypic episodes of intense nausea, intractable nonbilious vomiting, and abdominal pain lasting hours or days 4,5. Between the attacks, patients remain symptom-free and return to baseline health, unless CVS has become coalescent 5. The most common prodromal symptoms are nausea and abdominal discomfort 6.…”

“…CVS occurs in all age groups, with a mean age of onset of 4 years in children14 and 35 years in adults 5. The demographic profile and disease characteristics are similar in pediatric and adult-onset CVS; however, pediatric CVS more likely occurs in females and has a higher prevalence of concomitant neurological abnormalities 3.…”

“…Laboratory and radiographic studies are typically normal 32,35,40. Because of the lack of awareness, CVS is often diagnosed with delay, particularly in adults 5. The diagnosis may be also delayed because there is no specific test to confirm the diagnosis.…”

“…There is no standard evidence-based generally accepted treatment of CVS 5. Only symptomatic measures are available, which can be separated into prophylactic measures and treatment of the acute symptoms.…”

“…Therapy of acute symptoms includes application of intravenous fluids with up to 10% glucose to limit ketosis 42. In addition to fluid resuscitation, various drugs are applied; most frequently antiemetic medication, like ondansetron, antimigrainous drugs, α-blocking agents such as dexmedetomidine or clonidine, proton-pump inhibitors, or sedatives are applied 5. Sartanes have also been shown to have beneficial effects in episodes of CVS 43.…”