USE OF BARBITURATES IN THE TREATMENT OF CYCLIC VOMITING DURING CHILDHOOD

Background: Cyclic vomiting is an uncommon disorder that can be descri bed as recurrent, self-limiting, fairly uniform episodes of intractabl e nausea and vomiting with no identifiable organic cause, separated by symptom-free intervals. There is no established therapeutic regimen f or this disorder. Methods: Fourteen children referred to the Pediatric Gastroenterology Clinic were diagnosed with cyclic vomiting from May 1984 to January 1995. Vomiting, the predominant symptom, was present i n all children and was severe enough to require hospitalization in 11. Associated symptoms included abdominal ain, headache, nausea, aura, a nd fever. Diagnostic studies were done to rule out organic causes as i ndicated in individual patients. Daily phenobarbital was prescribed in all 14 patients. The dose ranged from 30 to 120 mg/hr (mean 2 mg.kg(- 1).day(-1)), with a median dose of 60 mg/hr. Prior therapy with propra nolol (3 patients) and butalbital (2 patients) had been ineffective. R esults: Eleven patients had complete resolution of their symptoms, and 3 patients had marked improvement in their symptoms with infrequent a ttacks of reduced severity. The only side effects associated with long -term phenobarbital therapy were behavioral in nature, namely hyperact ivity and disruptive behavior at school. Conclusions: The results of o ur series of 14 patients, all of whom received barbiturates, support t he usefulness of this therapeutic approach. Hence we feel that daily l ow-dose phenobarbital therapy is a safe and effective therapy in preve nting episodes of cyclic vomiting in children. (C) 1997 Lippincott-Rav en Publishers.