Abstract
There are many causes of chronic and/or recurrent vomiting. The differential diagnosis is sometimes difficult because the clinical manifestations are often similar with each other. In this review, common causes of chronic and/or recurrent vomiting, and a general approach to children with vomiting are described. The involuntary passage of ingested material from the stomach into the esophagus, gastroesophageal reflux (GER), is a common event in infants. GER-disease can arise when the refluxed material causes esophagitis, resulting in pain, impaired esophageal function, poor growth or some respiratory symptoms. Esophageal impedance-pH meter will be the golden standard test in these cases. Parental reassurance and dietary management are expected to be the important components of managing mild GER-disease. Eosinophilic esophagitis is a clinicopathological disease characterized by (1) Feeding intolerance and GER-disease symptoms in children; (2) >15 eosinophils/HPF; (3) Exclusion of other disorders associated with similar clinical, histological, or endoscopic features, especially GERD. Appropriate treatments include dietary approaches based upon eliminating exposure to food allergens, or topical corticosteroids. Cyclic vomiting syndrome (CVS), a paroxysmal, especially severe, recurrent vomiting disorder, may be second to GER-disease as a cause of recurrent vomiting in children. It is highly incapacitating brain-gut disorder. The different diagnosis of CVS cuts a broad swath across neurologic, gastrointestinal, renal, metabolic, and endocrinologic disorders. Treatment is divided between acute intervention, when a patient is actively and severe vomiting, and prophylactic treatment in their interictal phase, the goal of which is reducing frequency and intensity of subsequent episodes.
Figures and Tables
Fig. 1
Superior mesenteric artery syndrome. Contrast study showing partial obstruction in the third portion of the duodenum by the superior mesenteric artery.
Table 1
Evaluation of Cyclic Vomiting Pattern
*All testing below obtained during the episode, except, †In non-fasted state, ADH: anti-diuretic hormone, δ-ALA: delta aminolevulinic acid, CCK: cholecystokinin, HIDA: 99mTC-HIDA scintigraphy, HVA: homovanilic acid, VMA: vanillylmandelic acid. Adopted in, Li BUK, Misiewicz L. Cyclic vomiting syndrome: a brain-gut disorder. Gastroenterol Clin N Am 2003;32:997-1019.
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