HETEROGENEITY OF DIAGNOSES PRESENTING AS CYCLIC VOMITING

Objective. To establish the diagnostic profile in children who present with cyclic vomiting. Methods. We studied 225 children <18 years of a ge who presented to our pediatric gastroenterology service from 1986 t o 1997 with at least three discrete episodes of vomiting between which they were well. To determine the diagnoses in those presenting with a pattern of cyclic vomiting, the results of diagnostic testing and res ponses to various treatments were obtained from a combination of chart review and structured telephone interviews. Results. The largest diag nostic category included idiopathic cyclic vomiting syndrome (88%). Ex traintestinal disorders (7%) and gastrointestinal disorders (5%) const ituting the probable cause of vomiting were established in those havin g complete cessation of episodes after therapy. In 12%, serious surgic al disorders of the gastrointestinal (malrotation), renal (acute hydro nephrosis), and central nervous systems (neoplasm) were found. In 2%, serious endocrine (Addison's disease) and metabolic disorders (disorde r of fatty acid oxidation) were found. Among those with idiopathic cyc lic vomiting syndrome, 41% had associated disorders (gastroesophageal reflux and chronic sinusitis) that could contribute to the vomiting, b ut, based on a partial response to therapy, were not deemed to be the main cause. Altogether 49% had an identified disorder that probably ca used or could contribute to the vomiting. Conclusions. The cyclic patt ern of vomiting is a symptom complex that can be induced by heterogene ous disorders that either cause or contribute to the vomiting. Once th e cyclic vomiting pattern is identified, systematic diagnostic testing is warranted to look for these underlying disorders.