Clinical, psychiatric and manometric profile of cyclic vomiting syndrome in adults and response to tricyclic therapy1

Abstract Our goal was to investigate 31 adult patients (mean age 29 years, range 18–62 years) meeting Rome II criteria for cyclic vomiting syndrome (CVS). All subjects completed a clinical questionnaire, a Hamilton Rating Scale for Anxiety (HAM‐A) and Zung Depression Inventory. Gastric emptying time was assessed in 30 subjects and electrogastrogram (EGG) in 11 between acute attacks. Twenty‐seven patients treated with amitriptyline completed a follow‐up questionnaire. The mean age of onset of the patients was 30 years (range 14–53 years) and cycles of nausea and vomiting were accompanied by often‐severe epigastric and diffuse abdominal pain. A typical attack ranged from 1 to 14 days, with the majority being 4–6 days. The HAM‐A revealed that 84% had an anxiety disorder, and based on Zung Depression Inventory 78% suffered from mild‐to‐severe depression. Only 4 (13%) patients reported migraine, but 14 had a family history of migraine. Gastric emptying time was rapid in 23 (77%), normal in 4 and delayed in 3. The EGG was abnormal in 7 of 11 patients, with 4 having tachygastria. Of 13 patients using marijuana, 7 had symptom relief, while 2 had resolution of CVS after stopping use. The overall treatment experience in the 24 patients receiving amitriptyline up to 1 mg kg −1 day −1 for at least 3 months indicated that 93% had decreased symptoms and 26% achieved full remission. Cyclic vomiting syndrome in adults has the following hallmarks: prominence of accompanying abdominal pain and increased prevalence of anxiety and depression, rapid gastric emptying and tachygastric EGG, and successful suppression of attacks by chronic amitriptyline therapy.