DIFFERENTIAL-DIAGNOSIS OF CYCLIC VOMITING SYNDROME

Vomiting is a nonspecific symptom and cyclic vomiting is a symptom com plex that may result from a disorder of any major organ system. Childr en with cyclic vomiting syndrome (CVS) need careful review and investi gation at their earliest presentations to exclude potentially lethal a bnormalities such as intestinal volvulus, metabolic disorders, and neu rologic space-occupying lesions. The range of abnormalities that may p resent with features consistent with CVS includes gastrointestinal obs tructive, inflammatory and motility abnormalities, pancreatic disease, metabolic disease (particularly the amino acid-opathies, organic acid urias, fatty acid oxidation defects, and acute intermittent porphyria) , renal disease, epilepsy, migraine, and psychiatric disorders. Carefu l history taking will usually provide clues to these uncommon problems , but all children should undergo baseline assessment of gastrointesti nal morphology and screening tests for renal and metabolic disease.