DIFFERENTIATING CYCLIC FROM CHRONIC VOMITING PATTERNS IN CHILDREN - QUANTITATIVE CRITERIA AND DIAGNOSTIC IMPLICATIONS

Objective. To establish criteria to differentiate two patterns of vomi ting and to identify the predominant diagnoses for each one. Methods. All children 2 to 18 years of age referred to a pediatric gastroentero logy service who presented with recurrent vomiting (three episodes of vomiting within a 3-month period) as a primary complaint from 1985 to 1991 were retrospectively reviewed (n = 106). The vomiting pattern (em eses per hour and episodes per month), diagnostic studies, and therape utic responses were compared by Mann-Whitney U and chi(2) tests. Resul ts. Based on the criteria of peak intensity (four or more emeses per h our) and frequency (nine or fewer episodes per month), two subgroups w ere differentiated: children with a cyclic pattern (n = 34), who vomit ed at a higher peak intensity (12.6 +/- 1.6 vs 1.5 +/- 0.1 emeses per hour) but at a lower frequency (1.9 +/- 4.8 vs 36.6 +/- 0.3 episodes p er month) than those with a chronic pattern (n = 72). Among children w ith a cyclic pattern, nongastrointestinal (65%) causes, especially abd ominal migraine, predominated over gastrointestinal ones (12%), wherea s among those with a chronic pattern, gastrointestinal disorders (76%) , especially peptic and infectious disorders, predominated over nongas trointestinal ones (10%). Conclusions. On the basis of quantitative hi storical criteria, children with recurrent vomiting can be classified into two subgroups that seem to be clinically and etiologically distin ct. Abdominal migraine was the dominant diagnosis in those with cyclic vomiting, whereas peptic and infectious gastrointestinal disorders pr edominated in those with chronic vomiting. This differentiation betwee n cyclic and chronic patterns of vomiting may be a useful diagnostic c lue to the clinician.