The following is a summary of “Natural History of Pediatric Cyclic Vomiting Syndrome: Progression to Dysautonomia,” published in the June 2023 issue of Pediatrics by Tejada, et al.

For a study, researchers sought to determine the proportion of children with pediatric cyclic vomiting syndrome (CVS) who develop chronic symptoms consistent with autonomic nervous system (ANS) dysfunction instead of episodic symptoms.

A retrospective chart review was conducted on children aged 0-18 who were followed in an outpatient tertiary care CVS center. Standardized questionnaires were administered to patients at intake and follow-up visits to document the clinical symptom pattern. Continuous variables were summarized as median [interquartile range (IQR)], and group comparisons were analyzed using the Mann-Whitney test.

A total of 100 subjects were included in the study. Among them, 40% developed symptoms suggestive of ANS dysfunction (ANS+). Of the ANS+ group, 20% were confirmed through comprehensive ANS testing, 11% through orthostatic vital sign abnormalities, and 9% through clinical symptoms. The median (IQR) age at the onset of chronic symptoms was 14 (10.02, 15) years. The presence of another disorder of gut-brain interaction (P = 0.018) and a higher number of comorbidities (P = 0.031) were more prevalent in the ANS+ group. The ANS+ subjects missed more school days (P = 0.047) and visited the emergency department less frequently (P = 0.023).

A significant proportion (40%) of children with CVS develop chronic symptoms consistent with clinical dysautonomia during adolescence. These patients tend to have more comorbid conditions and experience a greater impact on school attendance, suggesting a worsened quality of life as their disease progresses to daily symptoms. Adjustments and targeted therapeutic interventions may be necessary when the symptom pattern of CVS changes over time.

Source: journals.lww.com/jpgn/Abstract/2023/06000/Natural_History_of_Pediatric_Cyclic_Vomiting.9.aspx