Cyclic Vomiting Syndrome Program
From a recent issue of Referring to Children's.
Children's Hospital of Wisconsin recently welcomed B Li, MD, pediatric gastroenterologist, who is seeing patients in the newly created interdisciplinary Cyclic Vomiting Syndrome (CVS) Program. He also is a professor of Pediatrics (Gastroenterology) at the Medical College of Wisconsin.
CVS is one of the more unrecognized and misdiagnosed childhood diseases. It is marked by severe, recurrent attacks of vomiting in a child who is otherwise completely healthy for weeks or even months at a time before and after the attacks. Over the course of 24 to 48 hours, a child may have more than 30 vomiting episodes, occurring every five to 10 minutes at its peak.
 Gastroenteritis is a common misdiagnosis of CVS, as are food poisoning, gastroesophagealreflux and even bulimia.
"With stomach flu, once the stomach is empty, the vomiting stops," Li said. "With CVS, the physical act of dry heaving will continue long after the stomach is empty. The drive to vomit is relentless."
Such episodes often begin in the early morning around 2 a.m. to 6 a.m. The child is non-responsive and pale, often curled in a fetal position.
The peak age for the first onset of CVS is 5 years. Sixty percent of those afflicted are female. Most children will outgrow CVS around puberty, but they often then begin developing migraine headaches. While the specific cause of CVS remains unknown, Li's studies indicated that 83 percent of CVS sufferers have at least one family member who has migraine headaches.
Li, who comes to Children's Hospital from Children's Memorial Hospital in Chicago, has seen 715 CVS cases from 42 states and as far away as Australia and Hong Kong in his career. The program he is overseeing will shed a bright light on an often-misunderstood disease.
"Our program's interdisciplinary team will spend hours on each patient before the child even comes into the clinic," Li said. "We will collect all available medical records, a standardized questionnaire and a diary of vomiting episodes including a narrative summary from parents. When that information has been reviewed, we meet with the child and parents to discuss how we can best assist the child."
The program will include a psychologist, neurologist, researcher and nurse.
On average, a child has been misdiagnosed for 2 1⁄2 years before coming to Li.
"If an episode takes place every one-to-two months, that is about 15 attacks or more where the child is suffering and the parents are unsure of the reason," Li said.
Pediatricians should consider CVS in children who suffer nearly identical recurrent attacks of vomiting. For example, repetitive, such as three instances over a six-month period, episodes that require emergency room visits due to dehydration.
For more information on the new Cyclic Vomiting Program at Children's Hospital, call (414) 266-3690. |
