Zespół wymiotów cyklicznych

Zespół wymiotów cyklicznych
Epidemiologia

Zespół wymiotów cyklicznych (ZWC) to zaburzenie osi mózgowo-jelitowej charakteryzujące się nawracającymi epizodami nudności i wymiotów, z okresami całkowitego zdrowia pomiędzy atakami. Epidemiologia ZWC wykazuje znaczne zróżnicowanie geograficzne i demograficzne – globalna częstość występowania wynosi około 0,3% (95% CI: 0,3-0,4%), z najwyższą częstością w Brazylii (1%, 95% CI: 0,6-1,5) i niską lub zerową w Japonii i Niemczech. W populacji dorosłych w USA, Wielkiej Brytanii i Kanadzie częstość wynosi odpowiednio około 2%, 1% i 0,7%. U dzieci w wieku szkolnym częstość występowania waha się od 1,7% do 2,7%, z najwyższą w Australii Zachodniej (2,3%) i Szkocji (1,9%). Średni wiek zachorowania u dzieci to 4,6-6,9 lat, a u dorosłych 21-25 lat, z przewagą kobiet (stosunek 57:43). Opóźnienie w diagnozie wynosi średnio 2,7-3 lata, a u dorosłych często przekracza 10 lat. ZWC wiąże się z licznymi chorobami współistniejącymi, w tym migreną, zaburzeniami lękowymi i depresją (OR 3,14, 95% CI 2,05-4,82), co znacząco obniża jakość życia pacjentów i generuje wysokie koszty opieki zdrowotnej (np. 17 035 USD rocznie na pacjenta w USA). Mimo to tylko 32-35% pacjentów otrzymuje leczenie profilaktyczne, a 47-55% leczenie ostrego ataku w ciągu pierwszych 30 dni po diagnozie.

Epidemiologia Zespołu Wymiotów Cyklicznych

Zespół wymiotów cyklicznych (ZWC) jest zaburzeniem osi mózgowo-jelitowej charakteryzującym się nawracającymi, stereotypowymi epizodami nudności i wymiotów, pomiędzy którymi występują okresy całkowitego zdrowia. Chociaż choroba ta została po raz pierwszy opisana w literaturze angielskiej w 1882 roku przez Samuela Gee, przez długi czas była uważana za zaburzenie występujące wyłącznie u dzieci. Obecnie wiadomo, że dotyka również osoby dorosłe, powodując znaczne obciążenie dla pacjentów, ich rodzin oraz systemu opieki zdrowotnej.¹²

Występowanie globalne

Określenie rzeczywistej częstości występowania ZWC jest trudne ze względu na częste błędne lub opóźnione diagnozy. Badanie przeprowadzone przez Fundację Rome z udziałem 54 127 osób (51% mężczyzn, średni wiek 44,3 lat) wykazało, że globalna częstość występowania ZWC wynosi 0,3% (95% przedział ufności: 0,3-0,4%), co odpowiada 187 przypadkom w badanej grupie. Występowanie ZWC różni się znacznie w zależności od regionu geograficznego – najwyższe odnotowano w Brazylii (1%, 95% CI: 0,6-1,5), natomiast w Japonii i Niemczech nie zidentyfikowano żadnego przypadku spełniającego kryteria tej choroby.¹²

W Stanach Zjednoczonych, Wielkiej Brytanii i Kanadzie częstość występowania ZWC wynosi odpowiednio około 2%, 1% i 0,7% w populacji dorosłych. Badanie argentyńskie wykazało częstość występowania na poziomie 1% wśród nastolatków, natomiast w badaniu przeprowadzonym wśród meksykańskich dzieci w wieku szkolnym odnotowano częstość występowania na poziomie 0,3%.¹

Japońskie badanie wykazało, że standaryzowana według wieku i płci częstość występowania ZWC w tym kraju wynosi 0,32 na 1000 osób (95% CI: 0,30-0,34), co przekłada się na około 49 000 pacjentów z ZWC w całej Japonii. Częstość występowania u dzieci japońskich oszacowano na 2,10 na 1000 (95% CI: 2,01-2,19), a u dorosłych na 0,05 na 1000 (95% CI: 0,04-0,06).¹²³

Częstotliwość występowania u dzieci

Badania populacyjne przeprowadzone wśród dzieci w wieku szkolnym w zachodniej Australii i Szkocji wykazały częstość występowania ZWC na poziomie odpowiednio 2,3% i 1,9%. Podobnie, badanie przeprowadzone wśród tureckich dzieci w wieku szkolnym wykazało częstość występowania na poziomie 1,9%. Zgłaszane wskaźniki zapadalności wahają się od 1,7% do 2,7% dzieci w wieku szkolnym.¹

W Irlandii w 2005 roku odnotowano zapadalność na poziomie 3,15 przypadków na 100 000 dzieci rocznie, co jest porównywalne z innymi poważnymi chorobami przewodu pokarmowego u dzieci (np. chorobą Crohna) w tym kraju.¹²

W środkowym Ohio, w populacji złożonej głównie z osób rasy białej, częstość występowania ZWC u dzieci (oceniana przez jedyny pediatryczny ośrodek konsultacyjny gastroenterologii) wynosiła 0,04%. W badaniu przeprowadzonym w szpitalu KEM w Pune w Indiach, ZWC stanowił 0,5% przyjęć na oddziały pediatryczne w latach 1998-2000.¹

Częstotliwość występowania u dorosłych

Chociaż ZWC był tradycyjnie uważany za zaburzenie pediatryczne, coraz częściej jest rozpoznawany u dorosłych. Według najnowszych badań przeprowadzonych w USA, częstość występowania ZWC u dorosłych szacuje się na 16,7 (u osób z ubezpieczeniem komercyjnym/Medicare) i 42,9 (u osób z Medicaid) na 100 000 osób. Zapadalność na ZWC w 2019 roku oszacowano na 10,6 (Commercial/Medicare) i 26,6 (Medicaid) na 100 000 osób.¹²

W badaniu przeprowadzonym w Japonii częstość występowania ZWC u dorosłych oszacowano na 0,05 na 1000 osób, podczas gdy w jednostce sił powietrznych całkowita częstość występowania ZWC wynosiła 5,05%, przy czym 3,42% u personelu latającego i 5,45% u personelu naziemnego.¹²

Badanie przeprowadzone w ośrodku opieki wtórnej w Wielkiej Brytanii wykazało, że częstość występowania ZWC w dorosłej populacji pacjentów ambulatoryjnych gastroenterologicznych wynosiła 6,6%. Młodszy wiek, płeć żeńska, palenie tytoniu i obecność objawów zgodnych z innymi czynnościowymi zaburzeniami przewodu pokarmowego były związane z prawdziwym ZWC.¹

Demografia pacjentów z ZWC

Cecha demograficzna	Charakterystyka	Źródła danych
Wiek zachorowania	– Dzieci: zazwyczaj między 3 a 7 rokiem życia (średnio 4,6-6,9 lat) – Dorośli: średni wiek zachorowania 21-25 lat, średni wiek diagnozy 31-37 lat	Liczne badania epidemiologiczne
Rozkład płci	– Nieznaczna przewaga kobiet (55-60% vs 40-45% mężczyzn) – Stosunek kobiet do mężczyzn: 57:43	Badania populacyjne
Rozkład rasowy	– Występuje we wszystkich rasach – Większa częstość u osób rasy białej – W USA: 78% biali, 17% Afroamerykanie, 5% Latynosi	Badania epidemiologiczne w USA i innych krajach
Opóźnienie diagnozy	– Średnio 2,7-3 lata od wystąpienia objawów do diagnozy – U dorosłych często powyżej 10 lat opóźnienia	Dane z rejestrów pacjentów i badań klinicznych

Częstość występowania ZWC jest wyższa wśród kobiet, ze średnim wiekiem zachorowania u dorosłych wynoszącym 37 lat. Badanie oceniające 101 dorosłych z diagnozą ZWC wykazało, że 86% badanej grupy stanowiły kobiety. Jeśli chodzi o rasę, 78% stanowiły osoby białe, 17% Afroamerykanie, a 5% Latynosi.¹²

ZWC występuje we wszystkich rasach, ale wydaje się nieproporcjonalnie częściej dotykać osoby rasy białej. Stosunek kobiet do mężczyzn wynosi 57:43, wskazując na niewielką przewagę kobiet. Mediana wieku zachorowania wynosi 4,8 lat, jednak ZWC obserwowano u niemowląt już w 6 dniu życia oraz u dorosłych w wieku do 73 lat.¹²

Czynniki ryzyka i choroby współistniejące

Badania epidemiologiczne zidentyfikowały kilka czynników niezależnie związanych z ZWC, w tym: płeć żeńską (iloraz szans [OR] 1,52, 95% CI 1,13-2,03), młody wiek (OR 2,57, 95% CI 1,34-4,94 dla osób w wieku 18-39 lat w porównaniu z osobami powyżej 65 roku życia), depresję (OR 3,14, 95% CI 2,05-4,82, P<0,001) i lęk (OR 1,79, 95% CI 1,15-2,78, P<0,001).¹²

ZWC jest związany z licznymi chorobami współistniejącymi, takimi jak migrena, uogólnione zaburzenia lękowe, zaburzenia paniczne, ciężka depresja, dysfunkcja autonomiczna i używanie konopi indyjskich. Prawdopodobieństwo wystąpienia współistniejącego zaburzenia psychicznego u dorosłych z ZWC jest 40 razy wyższe niż w populacji ogólnej, a najczęstsze są lęk (69%) i depresja (48%).¹

W badaniu przeprowadzonym w USA, wśród chorób współistniejących najczęściej występowały: ból brzucha (56-64%), lęk (32-39%), depresja (26-34%), choroby sercowo-naczyniowe (39-42%) i choroba refluksowa przełyku (30-40%). Historia rodzinna migreny została wykryta w 86,6% klinik, czynnościowe zaburzenia przewodu pokarmowego w 44,8%, dziecięce zespoły okresowe w 29,9%, a zespół wymiotów cyklicznych w 14,9%.¹²

Wpływ na jakość życia i system opieki zdrowotnej

ZWC ma znaczący negatywny wpływ na jakość życia zarówno dzieci, jak i ich rodzin ze względu na częste hospitalizacje i reperkusje w funkcjonowaniu społecznym i akademickim. Osoby z ZWC mają obniżoną jakość życia (średnia wartość fizycznej jakości życia 12,9 vs 15,5, P<0,001; średnia wartość psychicznej jakości życia 12,3 vs 14,4, P<0,001) w porównaniu z innymi.¹²

Około 50% pacjentów z ZWC odwiedza oddział ratunkowy co najmniej raz w roku, a 1 na 3 dorosłych z ZWC staje się niepełnosprawny. ZWC prowadzi do około 24 dni nieobecności w szkole i rocznego kosztu opieki wynoszącego 17 035 dolarów. W Stanach Zjednoczonych koszt pobytów szpitalnych dla dorosłych z ZWC wyniósł 400 milionów dolarów w ciągu 2 lat, a roczny koszt dla systemu opieki zdrowotnej szacuje się na około 200 milionów dolarów.¹²³⁴

Pomimo diagnozy ZWC, tylko 32-35% pacjentów miało recepty na leczenie profilaktyczne, a 47-55% na leczenie ostrego ataku w ciągu pierwszych 30 dni po diagnozie, co wskazuje na niewystarczające leczenie tej choroby.¹

Różnice geograficzne i demograficzne

Występowanie ZWC różni się znacząco w zależności od regionu geograficznego. Najwyższą częstość odnotowano w Brazylii (1%), podczas gdy w niektórych krajach, jak Japonia i Niemcy, nie zidentyfikowano żadnych przypadków spełniających kryteria ZWC w badaniu przeprowadzonym przez Fundację Rome.¹

W Stanach Zjednoczonych wykazano istotne różnice w wynikach leczenia ZWC, szczególnie wśród Afroamerykanów i Latynosów, co podkreśla potrzebę zrozumienia społecznych determinantów zdrowia, które wpływają na wyniki choroby. W analizie wieloczynnikowej wykazano, że rasa afroamerykańska i hiszpańska była rzadziej związana z ZWC w porównaniu z rasą białą. Podobnie, pacjenci z ZWC częściej posiadali prywatne ubezpieczenie.¹²

Dodatkowo, szpitale o większej liczbie łóżek miały niższe prawdopodobieństwo hospitalizacji z powodu ZWC w porównaniu z szpitalami o mniejszej liczbie łóżek. Podobnie, szpitale miejskie były rzadziej związane z hospitalizacjami z powodu ZWC w porównaniu ze szpitalami wiejskimi.¹

Trendy hospitalizacji i rozpoznawalność

Według danych z USA, całkowita liczba hospitalizacji związanych z ZWC wynosiła 12 396 w porównaniu do 60 735 dla dopasowanych wiekiem i płcią podmiotów kontrolnych. Ogólny wskaźnik hospitalizacji pediatrycznych w okresie badania wynosił 3,54 na 10 000 hospitalizacji. Wskaźnik hospitalizacji związanych z ZWC wynosił 3,64 na 10 000 w 2003 roku, osiągnął szczyt 4,13 na 10 000 w 2012 roku, a następnie zmniejszył się do 2,4 na 10 000 hospitalizacji. Mimo wahań wskaźnika hospitalizacji, nie było znaczących zmian w analizie trendu.¹

ZWC pozostaje niedodiagnozowany i w konsekwencji niedostatecznie leczony. Większość pacjentów doświadcza wieloletnich opóźnień diagnostycznych, rozległych i bezcelowych badań, a nawet niepotrzebnych zabiegów chirurgicznych. Dorosły wiek przy pierwszej diagnozie to średnio 34,8 lat, chociaż średni wiek wystąpienia objawów to 22 lata, co wskazuje na znaczne opóźnienia w diagnozie. U wielu pacjentów postawienie ostatecznej diagnozy ZWC zajmuje od kilku miesięcy do lat.¹²

Większość ośrodków otrzymuje skierowanie z podejrzeniem ZWC po 3-5 ostrych epizodach, podczas gdy prawie jedna trzecia ośrodków otrzymuje skierowania po więcej niż 5 ostrych atakach. Przed postawieniem diagnozy pacjenci często wielokrotnie odwiedzają oddział ratunkowy (średnio 15 razy).¹²

Rokowanie i przyszłe kierunki badań

Rokowanie w ZWC jest generalnie korzystne. Około 40-60% pacjentów doświadcza ustąpienia objawów z czasem. Jednak 20-35% dzieci z ZWC może później rozwinąć migrenowe bóle głowy, w porównaniu do 15% w populacji ogólnej. Wiele dzieci wyrasta z ZWC przed dorosłością, najczęściej w okresie przedszkolnym lub wczesnym okresie nastoletnim.¹²

Istnieje silny pośredni dowód na znaczne kliniczne nakładanie się ZWC, migreny brzusznej i bólu głowy typu migrenowego. Lekarze zwracają uwagę na potrzebę zwiększenia świadomości na temat tego zespołu, aby uniknąć niedodiagnozowania i poprawić praktykę kliniczną.¹²

Przyszłe priorytety kliniczne i badawcze obejmują lepszą identyfikację czynników wyzwalających ZWC, charakterystykę różnych podgrup ZWC, w tym tych z częstymi ciężkimi epizodami, oraz udoskonalenie opisu epidemiologii, aby umożliwić ukierunkowanie na populacje predysponowane do rozwoju ZWC. Badania wykorzystujące duże rejestry krajowe dają nadzieję na zmniejszenie częstości występowania ZWC i poprawę jakości życia dorosłych z tym schorzeniem.¹²

Ankieta przeprowadzona we Włoszech podkreśliła brak konsensusu wśród klinicystów w tym kraju w zakresie diagnozy i postępowania z dziećmi z ZWC, wskazując na potrzebę stworzenia krajowych wytycznych w celu standaryzacji praktyki.¹

Lepszy dostęp do opieki, wczesne rozpoznanie ZWC i odpowiednie leczenie mogą zmniejszyć objawy ZWC, zmniejszyć wykorzystanie opieki zdrowotnej i poprawić jakość życia pacjentów. Edukacja społeczności medycznej oraz opracowanie lepszych strategii przesiewowych i bardziej skutecznych opcji leczenia są konieczne, aby poprawić rozpoznawanie i szybkie leczenie pacjentów z ZWC.¹²

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Materiały źródłowe

#1 Cyclic vomiting syndrome: Future clinical and research priorities for: Special supplement/proceedâ¦
https://ouci.dntb.gov.ua/en/works/456Q2eZl/
Cyclic vomiting syndrome (CVS) is common in adults and children and negatively impacts patients, families, and the healthcare system. […] Large cross-sectional population analyses are clarifying CVS prevalence and factors related to age, ethnicity, and geographic region. […] Several areas warrant further scrutiny including better identification of CVS triggers and characterization of different CVS subsets including those with frequent severe episodes, refined description of epidemiology to allow targeting of populations predisposed to CVS development.
#1 Worldwide Prevalence and Description of Cyclic Vomiting Syndrome According to the Results of the Rome Foundation Global Epidemiology Study.
https://lirias.kuleuven.be/4189460?limo=0
Worldwide Prevalence and Description of Cyclic Vomiting Syndrome According to the Results of the Rome Foundation Global Epidemiology Study. […] Cyclic vomiting syndrome (CVS) is a disorder of gut-brain interaction of unknown origin. […] The aim of this study was to evaluate the global prevalence of this disorder and its associated factors. […] A total of 54,127 participants completed the questionnaire (51% male, mean age 44.3 years). […] The pooled prevalence of CVS was 0.3% (95% confidence interval [CI] 0.3%-0.4%; n = 187), highest in Brazil (1%, 95% CI 0.6-1.5), and lowest in Japan and Germany (with no subject who fulfilled the criteria for CVS). […] The mean age of participants with CVS was 36.7 years (SD 13.5), and it was more common in women (56.7% vs 43.5%). […] Factors independently associated with this syndrome were female sex (odds ratio [OR] 1.52, 95% CI 1.13-2.03), young age (OR 2.57, 95% CI 1.34-4.94, for people between the ages of 18 and 39 years, compared with those older than 65 years), depression (OR 3.14, 95% CI 2.05-4.82, P
#1 Cyclic vomiting syndrome: From pathophysiology to treatment | Revista de GastroenterologÃa de MÃ©xico
https://www.revistagastroenterologiamexico.org/en-cyclic-vomiting-syndrome-from-pathophysiology-articulo-S2255534X24000616
Cyclic vomiting syndrome (CVS) affects both children and adults. A study on an adult population showed a prevalence of 2%, 1%, and 0.7% in the United States, the United Kingdom, and Canada, respectively. Likewise, an Argentinian study reported a prevalence of 1% in adolescents. The prevalence of CVS is unknown in the Mexican population but a study conducted on Mexican school-age children evaluated the prevalence of gut-brain axis disorders, and found a 0.3% prevalence of CVS in that selected group. […] CVS is more frequent in women and the mean adult age at presentation is 37 years. A study that evaluated 101 adults diagnosed with CVS showed that 86% of the cohort were women. Regarding race, 78% were White, 17% were African-American, and 5% were Hispanic. […] CVS is associated with numerous comorbidities, such as migraine, generalized anxiety disorder, panic disorder, major depression, autonomic dysfunction, and cannabis use. The probability of presenting with a psychiatric comorbidity in adults with CVS is 40-times higher than in the general population, and the most frequent are anxiety (69%) and depression (48%). This underlines the need for conducting a biopsychosocial evaluation to obtain better patient results. Another important finding is that approximately 40% of patients with CVS use, or have occasionally used, cannabis, reporting symptom improvement. In contrast, daily or prolonged cannabis use is associated with hyperemesis.
#1 Prevalence and incidence of cyclic vomiting syndrome in Japan: A study using Japanese claims data | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0279502
Cyclic vomiting syndrome (CVS) is a gastrointestinal disorder that is characterized by recurrent episodes of vomiting. Previous studies have provided reliable data on the prevalence of CVS among children in Japan; however, neither prevalence data nor incidence of CVS is available for adults. […] The overall age-and-sex-standardized prevalence was 0.32 per 1,000 population (95% confidence interval [CI]: 0.300.34), projected to approximately 49,000 patients with CVS across Japan. The pediatric age-and-sex-standardized prevalence was 2.10 per 1,000 population (95% CI: 2.012.19), and the adult prevalence was 0.05 per 1,000 population (95% CI: 0.040.06). […] Our study provides the first large-population-based estimates of CVS prevalence and incidence in Japan, and currently, the only estimates for adult CVS in Japan.
#1 Cyclical vomiting syndrome: Recognition, assessment and management
https://www.wjgnet.com/2219-2808/full/v3/i3/54.htm
Cyclical vomiting syndrome (CVS) is a functional disorder in childhood which is increasingly being recognised. […] In recent years, there have been increasing reports of cases of CVS worldwide. However, the true prevalence and incidence of CVS is difficult to establish as it often remains undiagnosed after the onset of symptoms. […] Population based studies in school aged children done in Western Australia and Scotland showed prevalence rates of 2.3% and 1.9%, respectively. Similarly, Ertekin et al reports a 1.9% prevalence rate in a cohort of school aged Turkish children. Reported incidence rates range from 1.7% to 2.7% of school aged children. […] In Ireland, an incidence of 3.15 per 100000 children per annum was reported in 2005.
#1 Cyclic Vomiting Syndrome: Practice Essentials, Pathophysiology and Etiology, Epidemiology
https://emedicine.medscape.com/article/933135-overview
In a population-based study from Ireland, the incidence of CVS was relatively high at 3.15 cases per 100,000 children. This incidence is comparable to those of other major GI diseases of childhood (eg, Crohn disease) in Ireland. […] The median age at onset is 4.8 years; however, CVS has been observed in infants as young as 6 days and in adults as old as 73 years. […] The typical interval from onset of symptoms to diagnosis is 2.7 years. […] In adults, the average age of onset is 21 years and the average age of evaluation for recurrent vomiting 34 years. […] Females show a slight predominance over males (female-to-male ratio, 57:43). […] CVS occurs in all races but seems to affect White persons disproportionately.
#1 Cyclic Vomiting Syndrome: Practice Essentials, Pathophysiology and Etiology, Epidemiology
https://emedicine.medscape.com/article/933135-overview
The true incidence and prevalence of CVS in the United States are unknown, although a prevalence of about 2% among US children and adults has been estimated. […] In central Ohio, amid a predominantly White population, the prevalence of CVS in children (evaluated by the sole pediatric gastroenterology referral center) was 0.04%. […] On the basis of limited epidemiologic data, Cullen and MacDonald estimated the prevalence of periodic vomiting in western Australia to be 2.3%. […] Similarly, Abu-Arafeh and Russell observed a prevalence of 1.9% in school-aged children in Aberdeen, Scotland. […] In a study performed at KEM Hospital in Pune, India, CVS accounted for 0.5% of admissions to pediatric wards during 1998-2000. […] In a retrospective study conducted in Japan, Chang et al found that the prevalence of CVS among children was 2.10 per 1000 population, and the prevalence among adults was 0.05 per 1000 population.
#1 Epidemiology, comorbidities, and treatment of cyclic vomiting syndrome in the United States : Falk Foundation
https://falkfoundation.org/en/fgr/detail/epidemiology-comorbidities-and-treatment-of-cyclic-vomiting-syndrome-in-the-united-states/?bte=1
Cyclic vomiting syndrome (CVS) imposes a substantial burden, but epidemiological data are scarce. This study aimed to estimate the incidence and prevalence of CVS, comorbid conditions, and treatment patterns, using administrative databases in the United States. The estimated prevalence of CVS was 16.7 (Commercial/Medicare) and 42.9 (Medicaid) per 100,000 individuals. The incidence of CVS was estimated to be 10.6 (Commercial/Medicare) and 26.6 (Medicaid) per 100,000 individuals. Both prevalence and incidence rates were higher among female individuals (for both Commercial/Medicare and Medicaid). Comorbid conditions were common and included abdominal pain (5664%), anxiety (3239%), depression (2634%), cardiac conditions (3942%), and gastroesophageal reflux disease (3040%). Despite a diagnosis of CVS, only 3235% had prescriptions for prophylactic treatment and 4755% for acute treatment within the first 30-day period following diagnosis.
#1 PTH-118âCyclic vomiting syndrome: a prevalent and under-recognised condition | Gut
https://gut.bmj.com/content/66/Suppl_2/A265.1
Cyclic vomiting syndrome (CVS) is a functional gastrointestinal disorder (FGID) whose aetiology is poorly understood. It is characterised by acute episodes of vomiting and nausea followed by asymptomatic periods. Average age of symptom onset in adults is 22 years but average age of diagnosis is 31 years. This delay is probably because, until recently, CVS was considered to be a paediatric condition. Few studies have reported the prevalence in adults or risk factors for CVS. We examined this issue in patients attending gastroenterology clinics in a single secondary care centre. […] Prevalence of true CVS in this adult secondary care outpatient population was 6.6%. Younger age, female gender, tobacco smoking and presence of symptoms compatible with other FGIDs were associated with true CVS. Presence of vomiting was poorly documented by consulting physicians and the diagnosis was considered in 10% of individuals who met criteria for the condition. These data provide clarification as to why diagnosis is often delayed in adults with typical symptoms.
#1
https://journals.lww.com/ajg/fulltext/9900/worldwide_prevalence_and_description_of_cyclic.1344.aspx
Cyclic vomiting syndrome (CVS) is a disorder of gut-brain interaction of unknown origin. The aim of this study was to evaluate the global prevalence of this disorder and its associated factors. A total of 54,127 participants completed the questionnaire (51% male, mean age 44.3 years). The pooled prevalence of CVS was 0.3% (95% confidence interval [CI] 0.3%0.4%; n = 187), highest in Brazil (1%, 95% CI 0.61.5), and lowest in Japan and Germany (with no subject who fulfilled the criteria for CVS). The mean age of participants with CVS was 36.7 years (SD 13.5), and it was more common in women (56.7% vs 43.5%). Factors independently associated with this syndrome were female sex (odds ratio [OR] 1.52, 95% CI 1.132.03), young age (OR 2.57, 95% CI 1.344.94, for people between the ages of 18 and 39 years, compared with those older than 65 years), depression (OR 3.14, 95% CI 2.054.82, P 0.001), and anxiety (OR 1.79, 95% CI 1.152.78, P 0.001). Individuals with CVS had impaired quality of life (QoL) (Patient-Reported Outcomes Measurement and Information System 10-item score: physical QoL mean, 12.9 vs 15.5, P 0.001; mental QoL mean 12.3 vs 14.4, P 0.001) compared with others. CVS is a relatively common disorder that has a negative impact on QoL. It is important to raise awareness on this syndrome to avoid underdiagnosis and improve clinical practice.
#1
https://journals.lww.com/ajg/fulltext/2024/05000/epidemiology,_comorbidities,_and_treatment_of.30.aspx
Cyclic vomiting syndrome (CVS) imposes a substantial burden, but epidemiological data are scarce. This study aimed to estimate the incidence and prevalence of CVS, comorbid conditions, and treatment patterns, using administrative databases in the United States. The estimated prevalence of CVS was 16.7 (Commercial/Medicare) and 42.9 (Medicaid) per 100,000 individuals. The incidence of CVS was estimated to be 10.6 (Commercial/Medicare) and 26.6 (Medicaid) per 100,000 individuals. Both prevalence and incidence rates were higher among female individuals (for both Commercial/Medicare and Medicaid). Comorbid conditions were common and included abdominal pain (56%64%), anxiety (32%39%), depression (26%34%), cardiac conditions (39%42%), and gastroesophageal reflux disease (30%40%). This study provides the first population-level estimates of CVS incidence and prevalence in the United States. These findings underscore the need for improving disease awareness and developing better screening strategies and effective treatments. The prevalence rate of CVS was 16.7 (Commercial/Medicare) and 42.9 (Medicaid) per 100,000 individuals in 2019. The observed incidence rate of CVS in 2019 was 10.6 (Commercial/Medicare) and 26.6 (Medicaid) per 100,000 individuals. In this study, the estimated prevalence rates of CVS were 16.7 and 42.9 and the incidence rates were 10.6 and 26.6 per 100,000 individuals with employer-sponsored insurance and Medicaid coverage, respectively.
#1 Cyclic vomiting syndrome in children: a nationwide survey of current practice on behalf of the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition (SIGENP) and Italian Society of Pediatric Neurology (SINP) | Italian Journal of Pediatri
https://ijponline.biomedcentral.com/articles/10.1186/s13052-022-01346-y
Cyclic Vomiting Syndrome (CVS) is a rare functional gastrointestinal disorder, which has a considerable burden on quality of life of both children and their family. […] The incidence of CVS is estimated at 3.2 per 100,000 subjects, whilst the prevalence ranges between 1.9 and 2.3%; however, the latter could be an underestimation due to either under-ascertainment or under-diagnosis of the disorder. […] CVS has a considerable burden on quality of life of both children and their family due to the frequent hospital admissions and its repercussion on both social and academic functioning ability. […] The present study aimed to evaluate the diagnostic modalities and therapeutic approach to CVS among Italian tertiary care centers and the differences according to subspecialties, as well as to explore whether potential predictive factors associated with either a poor outcome or a response to a specific treatment.
#1 Diagnosis and Management of Cyclic Vomiting SyndromeAGA Logo_Horizontal
https://gastro.org/clinical-guidance/diagnosis-and-management-of-cyclic-vomiting-syndrome/
Cyclic vomiting syndrome (CVS) is a chronic disorder of gutâbrain interaction characterized by acute episodes of nausea, vomiting, and retching, separated in time by episode-free periods. Individuals with CVS can identify a stereotypic pattern of symptoms that present during both the prodromal and emetic phases. Although there are effective treatments for most patients, the condition remains underdiagnosed and thus undertreated. Most patients experience years of diagnostic delays, extensive and futile investigations, and even unnecessary surgical procedures. Approximately one-half of people with CVS visit the emergency department (ED) at least annually, and 1 in 3 adults with CVS will become disabled. Access to care, early recognition of CVS, and appropriate treatment can reduce CVS symptoms, reduce health care utilization, and improve patientsâ quality of life.
#1 Exploring cyclic vomiting syndrome (CVS) worldwide: Current epidemiological insights and recent developments Â· ç é£ivySCI
https://www.ivysci.com/articles/5140245__Exploring_cyclic_vomiting_syndrome_scpCVSscp_worldwide_Current_epidemiological_insights_and_recent_developments
Exploring cyclic vomiting syndrome (CVS) worldwide: Current epidemiological insights and recent developments […] Cyclic vomiting syndrome (CVS), a disorder of gutbrain interaction, presents with recurrent episodes of severe nausea and vomiting. […] Despite historical recognition dating back to the 19th century, epidemiological insights remain limited, with research predominantly originating from specific regions, such as the US. CVS prevalence and incidence rates vary widely and are hindered by inconsistent methodologies and disease recognition. […] This review aims to provide a comprehensive overview of CVS prevalence and incidence rates. It reviews the currently available data and identifies gaps in knowledge. Understanding the global epidemiology of CVS, increasing awareness of the disease, and fostering global collaboration are crucial. Other pertinent issues include disparities in outcomes, particularly among African Americans and Hispanics in the United States, underscoring the need to understand the social determinants of health that drive disease outcomes. This understanding can inform targeted interventions to address these barriers and achieve equitable healthcare both in the United States and globally.
#1 Cyclic Vomiting Syndrome-Related Hospitalizations Trends, Comorbidities & Health Care Costs in Children: A Population Based Study
https://www.mdpi.com/2227-9067/9/1/55
On multivariate analysis, AA and Hispanic race were less likely to be associated with CVS when compared to White race. Similarly, patients with CVS had higher odds of having private insurance. Further, hospitals with larger bed size had lower odds of CVS hospitalizations when compared to hospitals with smaller bed size. Similarly, urban hospitals were less likely to be associated with CVS hospitalizations compared to rural hospitals. […] CVS-related hospitalizations had higher odds of being associated with comorbid conditions including dyspepsia, dysautonomia, migraine headache, GERD and Irritable bowel syndrome (IBS). The CVS group also had an increased odds of associated cannabis use and decreased alcohol use than controls. CVS was also more likely associated with an anxiety disorder and stress reaction, compared to the non-CVS control group.
#1 Cyclic Vomiting Syndrome-Related Hospitalizations Trends, Comorbidities & Health Care Costs in Children: A Population Based Study
https://www.mdpi.com/2227-9067/9/1/55
Most studies in CVS are from specialized, tertiary referral centers and there is a paucity of data on the national trends in pediatric CVS in the U.S. We therefore aimed to analyze the clinical characteristics, trends in hospitalization and health care resource utilization of pediatric patients with cyclical vomiting syndrome (CVS) using a large nationwide database. […] The total number of CVS-related hospitalizations was 12,396 compared to 60,735 for the age and gender-matched control subjects. The overall pediatric hospitalization rate during the study period was 3.54 per 10,000 hospitalizations. The rate of CVS-related hospitalization was 3.64 per 10,000 in 2003 which increased to a peak of 4.13 per 10,000 in 2012 followed by a decrease to 2.4 per 10,000 hospitalizations. Although the rate of hospitalization was fluctuating, there was no significant change in the trend analysis.
#1 Cyclic vomiting syndrome in children: a nationwide survey of current practice on behalf of the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition (SIGENP) and Italian Society of Pediatric Neurology (SINP) | Italian Journal of Pediatri
https://ijponline.biomedcentral.com/articles/10.1186/s13052-022-01346-y
The majority of units received a referral for suspected CVS after 3 to 5 acute episodes, whilst almost one third of centers used to receive the referrals after more than 5 acute attacks. […] A family history of migraine was detected by 58 clinics (86.6%), functional GI disorders by 30 (44.8%), childhood periodic syndromes by 20 (29.9%), cyclic vomiting syndrome by 10 (14.9%). […] Our survey highlights poor consensus amongst clinicians in our country in the diagnosis and the management of children with CVS, raising the need for a national consensus guideline in order to standardize the practice.
#1 Cyclic Vomiting Syndrome – Migraine Canada
https://migrainecanada.org/cyclic-vomiting-syndrome/
Cyclic Vomiting Syndrome (CVS) primarily affects children aged 4-7 but can also occur in adults aged 25-32. […] Nearly one-third of patients report a family history of migraine. […] The exact cause of CVS is not fully understood, but the brain and gut share several biological mechanisms, including the role of serotonin. […] CVS attacks could be triggered by stressors affecting either the brain or the gut, with vomiting controlled by specialized centers in the brain. […] Triggers for CVS are similar to those for migraine and include infections, psychological stress, certain foods (e.g., glutamate, cheese, chocolate), physical exhaustion, lack of sleep, menstruation, and motion sickness. […] No, around 40-60% of patients will experience a resolution of symptoms over time. However, 20% to 35% of children with CVS may develop migraine headaches later in life, compared to 15% in the general population.
#1 CME: New hope for children with cyclic vomiting syndrome
https://www.contemporarypediatrics.com/view/cme-new-hope-children-cyclic-vomiting-syndrome
Strong circumstantial evidence points to substantial clinical overlap between CVS, abdominal migraine, and migraine headache. […] Although CVS can no longer be regarded as a rare disorder, it is still often misdiagnosed as gastroenteritis, gastroesophageal reflux, food poisoning, and psychogenic vomiting.
#2 Cyclic Vomiting Syndrome in 41 adults: the illness, the patients, and problems of management | BMC Medicine | Full Text
https://bmcmedicine.biomedcentral.com/articles/10.1186/1741-7015-3-20
Cyclic Vomiting Syndrome (CVS) is a disorder characterized by recurrent, stereotypic episodes of incapacitating nausea, vomiting and other symptoms, separated by intervals of comparative wellness. This report describes the clinical features, co-morbidities and problems encountered in management of 41 adult patients who met the diagnostic criteria for CVS. […] CVS was first described in the English literature in 1882 by Samuel Gee who reported a series of nine children ranging in age from 4 to 8 years. Thereafter, CVS was considered to be a pediatric disorder, and the absence of characteristic physical, laboratory or radiological markers for CVS resulted in its poor recognition by physicians who practice adult medicine. Cyclic Vomiting Syndrome has been reported in adults with onset ranging from childhood to middle age.
#2 Worldwide Prevalence and Description of Cyclic Vomiting Syndrome According to the Results of the Rome Foundation Global Epidemiology Study.
https://lirias.kuleuven.be/4189460
Worldwide Prevalence and Description of Cyclic Vomiting Syndrome According to the Results of the Rome Foundation Global Epidemiology Study. […] Cyclic vomiting syndrome (CVS) is a disorder of gut-brain interaction of unknown origin. […] The aim of this study was to evaluate the global prevalence of this disorder and its associated factors. […] A total of 54,127 participants completed the questionnaire (51% male, mean age 44.3 years). […] The pooled prevalence of CVS was 0.3% (95% confidence interval [CI] 0.3%-0.4%; n = 187), highest in Brazil (1%, 95% CI 0.6-1.5), and lowest in Japan and Germany (with no subject who fulfilled the criteria for CVS). […] Factors independently associated with this syndrome were female sex (odds ratio [OR] 1.52, 95% CI 1.13-2.03), young age (OR 2.57, 95% CI 1.34-4.94, for people between the ages of 18 and 39 years, compared with those older than 65 years), depression (OR 3.14, 95% CI 2.05-4.82, P < 0.001), and anxiety (OR 1.79, 95% CI 1.15-2.78, P < 0.001). [...] CVS is a relatively common disorder that has a negative impact on QoL. [...] It is important to raise awareness on this syndrome to avoid underdiagnosis and improve clinical practice.
#2 Prevalence and incidence of cyclic vomiting syndrome in Japan: A study using Japanese claims data | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0279502
In Japan, neither the prevalence nor the incidence of CVS in the adult population has been reported. […] Our data suggest that the age-and-sex-standardized prevalence of symptoms fulfilling the Rome IV criteria for CVS was 0.32 per 1,000 population in Japan in 2017 and that the standardized incidence rate was 1.83 per 100,000 person-years. Prevalence and incidence varied with age. The highest prevalence and incidence were observed in children, followed by adolescents and adults. […] Approximately 49,000 patients and 2,0002,500 children and adolescents satisfy the Rome IV criteria for CVS annually across Japan.
#2 Cyclical vomiting syndrome: Recognition, assessment and management
https://www.wjgnet.com/2219-2808/full/v3/i3/54.htm
Cyclical vomiting syndrome (CVS) is a functional disorder in childhood which is increasingly being recognised. […] In recent years, there have been increasing reports of cases of CVS worldwide. However, the true prevalence and incidence of CVS is difficult to establish as it often remains undiagnosed after the onset of symptoms. […] Population based studies in school aged children done in Western Australia and Scotland showed prevalence rates of 2.3% and 1.9%, respectively. Similarly, Ertekin et al reports a 1.9% prevalence rate in a cohort of school aged Turkish children. Reported incidence rates range from 1.7% to 2.7% of school aged children. […] In Ireland, an incidence of 3.15 per 100000 children per annum was reported in 2005.
#2
https://journals.lww.com/ajg/fulltext/2024/05000/epidemiology,_comorbidities,_and_treatment_of.30.aspx
Cyclic vomiting syndrome (CVS) imposes a substantial burden, but epidemiological data are scarce. This study aimed to estimate the incidence and prevalence of CVS, comorbid conditions, and treatment patterns, using administrative databases in the United States. The estimated prevalence of CVS was 16.7 (Commercial/Medicare) and 42.9 (Medicaid) per 100,000 individuals. The incidence of CVS was estimated to be 10.6 (Commercial/Medicare) and 26.6 (Medicaid) per 100,000 individuals. Both prevalence and incidence rates were higher among female individuals (for both Commercial/Medicare and Medicaid). Comorbid conditions were common and included abdominal pain (56%64%), anxiety (32%39%), depression (26%34%), cardiac conditions (39%42%), and gastroesophageal reflux disease (30%40%). This study provides the first population-level estimates of CVS incidence and prevalence in the United States. These findings underscore the need for improving disease awareness and developing better screening strategies and effective treatments. The prevalence rate of CVS was 16.7 (Commercial/Medicare) and 42.9 (Medicaid) per 100,000 individuals in 2019. The observed incidence rate of CVS in 2019 was 10.6 (Commercial/Medicare) and 26.6 (Medicaid) per 100,000 individuals. In this study, the estimated prevalence rates of CVS were 16.7 and 42.9 and the incidence rates were 10.6 and 26.6 per 100,000 individuals with employer-sponsored insurance and Medicaid coverage, respectively.
#2 Epidemiology of cyclic vomiting syndrome in air force
https://xuebao.301hospital.com.cn/en/article/doi/10.3969/j.issn.2095-5227.2013.06.007
Objective To study the epidemiology of cyclic vomiting syndrome (CVS) in a certain air force unit and analyze its risk factors. […] The total incidence of CVS was 5.05% in air force servicemen, 3.42% in air servicemen and 5.45% in ground servicemen. […] Younger age, shorter military service length, lower rank and education level are the risk factors for CVS when the constitution of air force servicemen is similar.
#2 Cyclic Vomiting Syndrome: Practice Essentials, Pathophysiology and Etiology, Epidemiology
https://emedicine.medscape.com/article/933135-overview
In a population-based study from Ireland, the incidence of CVS was relatively high at 3.15 cases per 100,000 children. This incidence is comparable to those of other major GI diseases of childhood (eg, Crohn disease) in Ireland. […] The median age at onset is 4.8 years; however, CVS has been observed in infants as young as 6 days and in adults as old as 73 years. […] The typical interval from onset of symptoms to diagnosis is 2.7 years. […] In adults, the average age of onset is 21 years and the average age of evaluation for recurrent vomiting 34 years. […] Females show a slight predominance over males (female-to-male ratio, 57:43). […] CVS occurs in all races but seems to affect White persons disproportionately.
#2 Cyclic vomiting syndrome – Wikipedia
https://en.wikipedia.org/wiki/Cyclic_vomiting_syndrome
Cyclic vomiting syndrome (CVS) is a rare abnormality of the neuroendocrine system that affects 2% of children. […] The average age at onset is 37 years, with described cases as young as 6 days and as old as 73 years. Typical delay in diagnosis from onset of symptoms is 3 years. Females show a slight predominance over males. […] One study found that 3 in 100,000 five-year-olds are diagnosed with the condition. Two studies on childhood CVS suggest nearly 2% of school-age children may have CVS.
#2 Cyclic vomiting syndrome in children: a nationwide survey of current practice on behalf of the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition (SIGENP) and Italian Society of Pediatric Neurology (SINP) | Italian Journal of Pediatri
https://ijponline.biomedcentral.com/articles/10.1186/s13052-022-01346-y
The majority of units received a referral for suspected CVS after 3 to 5 acute episodes, whilst almost one third of centers used to receive the referrals after more than 5 acute attacks. […] A family history of migraine was detected by 58 clinics (86.6%), functional GI disorders by 30 (44.8%), childhood periodic syndromes by 20 (29.9%), cyclic vomiting syndrome by 10 (14.9%). […] Our survey highlights poor consensus amongst clinicians in our country in the diagnosis and the management of children with CVS, raising the need for a national consensus guideline in order to standardize the practice.
#2
https://journals.lww.com/ajg/fulltext/9900/worldwide_prevalence_and_description_of_cyclic.1344.aspx
Cyclic vomiting syndrome (CVS) is a disorder of gut-brain interaction of unknown origin. The aim of this study was to evaluate the global prevalence of this disorder and its associated factors. A total of 54,127 participants completed the questionnaire (51% male, mean age 44.3 years). The pooled prevalence of CVS was 0.3% (95% confidence interval [CI] 0.3%0.4%; n = 187), highest in Brazil (1%, 95% CI 0.61.5), and lowest in Japan and Germany (with no subject who fulfilled the criteria for CVS). The mean age of participants with CVS was 36.7 years (SD 13.5), and it was more common in women (56.7% vs 43.5%). Factors independently associated with this syndrome were female sex (odds ratio [OR] 1.52, 95% CI 1.132.03), young age (OR 2.57, 95% CI 1.344.94, for people between the ages of 18 and 39 years, compared with those older than 65 years), depression (OR 3.14, 95% CI 2.054.82, P 0.001), and anxiety (OR 1.79, 95% CI 1.152.78, P 0.001). Individuals with CVS had impaired quality of life (QoL) (Patient-Reported Outcomes Measurement and Information System 10-item score: physical QoL mean, 12.9 vs 15.5, P 0.001; mental QoL mean 12.3 vs 14.4, P 0.001) compared with others. CVS is a relatively common disorder that has a negative impact on QoL. It is important to raise awareness on this syndrome to avoid underdiagnosis and improve clinical practice.
#2 Cyclic vomiting syndrome | MedLink Neurology
https://www.medlink.com/articles/cyclic-vomiting-syndrome
The onset of symptoms is usually age 5 years in children and 37 years in adults. The prevalence in children is about 2%. A large population-based study of adults in the U.S., United Kingdom, and Canada found the overall prevalence of cyclic vomiting syndrome to be similar to children at 1.2%. Cyclic vomiting syndrome occurs in all races but seems to affect whites disproportionately. The annual cost of a cyclic vomiting syndrome per child with the condition is around $17,035, and in the United States, the cost of hospital stays for adults with cyclic vomiting syndrome totaled $400 million over 2 years.
#2 Cyclic Vomiting Syndrome-Related Hospitalizations Trends, Comorbidities & Health Care Costs in Children: A Population Based Study
https://www.mdpi.com/2227-9067/9/1/55
On multivariate analysis, AA and Hispanic race were less likely to be associated with CVS when compared to White race. Similarly, patients with CVS had higher odds of having private insurance. Further, hospitals with larger bed size had lower odds of CVS hospitalizations when compared to hospitals with smaller bed size. Similarly, urban hospitals were less likely to be associated with CVS hospitalizations compared to rural hospitals. […] CVS-related hospitalizations had higher odds of being associated with comorbid conditions including dyspepsia, dysautonomia, migraine headache, GERD and Irritable bowel syndrome (IBS). The CVS group also had an increased odds of associated cannabis use and decreased alcohol use than controls. CVS was also more likely associated with an anxiety disorder and stress reaction, compared to the non-CVS control group.
#2 Recent Concepts on Cyclic Vomiting Syndrome in Children
https://www.jnmjournal.org/journal/view.html?uid=135&vmd=Full
CVS had been regarded as a rare disease before, but now it seems to be relatively common in pediatric population with the prevalence between 1.9% and 2.3% according to the data of previous reports. The annual incidence of CVS was 3.15 per 100,000 children for 2005 in Ireland. […] There are no data on the prevalence of CVS in adults until now, but recently there are several articles reporting CVS cases in adults. It is assumed that CVS might be more common even in adults than expected before. […] CVS has been reported to be slightly more common in female than in male (55:45 or 60:40) in all age groups. […] CVS can develop in any age, but it has been mainly reported in childhood, with mean age between 4.6 years and 6.9 years. There are some reports on adults with CVS, and in adults, mean age at initial diagnosis was 34.8 years. In many patients with CVS, it took several months to years in making a definite diagnosis for CVS.
#2 Cyclic Vomiting Syndrome
https://fpnotebook.com/GI/Sx/CyclcVmtngSyndrm1.htm
Incidence in chronic unexplained Vomiting: Adults: 3 to 14% (mean diagnosis age 25 years) […] Children: 2% (mean diagnosis age 5 years) […] More common in caucasian patients […] Slightly more common in males […] Associated with frequent Emergency Department visits (mean 15 before diagnosis) […] Delayed Diagnosis is common.
#2 CME: New hope for children with cyclic vomiting syndrome
https://www.contemporarypediatrics.com/view/cme-new-hope-children-cyclic-vomiting-syndrome
Cyclic vomiting syndrome (CVS) is characterized by recurrent stereotypical spells of vomiting between which the child is completely well. […] Although the prevalence of CVS in the United States has not been established, it can no longer be considered a rare disorder based on the available evidence. Two population surveys among Caucasian children in Scotland and Australia estimated the prevalence at 2%. […] We suspect that many cases of CVS are missed, judging from the fact that the apparent prevalence is much higher than the actual number of cases diagnosed. […] The good news is that most children appear to outgrow CVS with advancing age, most often during the preteen or early teenage years. […] The bad news is that many children trade cyclic vomiting for migraine headaches at 10 years or older.
#2 Cyclic Vomiting Syndrome: Recognition and Guidelines for Treatment | UPMC Physician Resources
https://www.upmcphysicianresources.com/news/011822-cyclic-vomiting-syndrome
Analyses using this large registry or a nationwide disease registry hold great promise to reduce the incidence of CVS and improve the quality of life of adults with CVS. […] Recognition of CVS is key to improving the lives of these patients. CVS is treatable in most patients with drugs that are widely available and known to be well-tolerated. Guidelines are available to help non specialists catch and care for patients with CVS who respond readily to standard treatments.
#2 Cyclic Vomiting Syndrome: What to Know About Incidence, Comorbidities, and Treatments
https://www.gastroenterologyadvisor.com/news/cyclic-vomiting-syndrome-incidence-comorbidities-treatments/
Researchers collected population-level data from Medicare and Medicaid databases on cyclic vomiting syndrome in the US. The estimated prevalence rates in 2019 of cyclic vomiting syndrome (CVS) were 16.7 and 42.9 per 100,000 individuals with employer-sponsored insurance and Medicaid coverage, respectively, although about one-third had a prescription for prophylactic treatment within 30 days of diagnosis, investigators reported in the American Journal of Gastroenterology. The cross-sectional study used de-identified data from 3 Merative MarketScan US administrative claims research databases to estimate the incidence and prevalence of CVS in 2019. The overall population with enrollment in 2019 in MarketScan commercial or Medicare was 15,045,070 (for prevalence estimates), and enrollment was 11,872,021 for 2018 and 2019 (for incidence estimates). Among the cohort, 2513 prevalent patients with CVS and 1263 patients with newly diagnosed (incident) CVS were identified in 2019. Among Medicaid participants (enrollment in full year 2019, 7,888,771; enrollment in 2018 and 2019, 5,669,915), 3382 and 1507 patients had prevalent and newly diagnosed (incident) CVS. The prevalence rate in 2019 of CVS was 16.7 for participants with commercial/Medicare and 42.9 for those with Medicaid per 100,000 individuals. Higher prevalence rates were observed in women (19.9, 48.4 per 100,000 individuals; male patients: 13.3, 36.0 per 100,000 individuals) in the commercial/Medicare and Medicaid groups, respectively. The incidence rate of CVS in 2019 was 10.6 in the commercial/Medicare group and 26.6 in the Medicaid group per 100,000 individuals. Similar trends in incidence rates were observed based on age, sex, US region, and race and ethnicity. Education of the medical community and the development of better screening strategies and more effective treatment options are warranted. These findings underscore the need for better recognition and prompt management of patients with CVS, study authors noted.
#3 Cyclic Vomiting Syndrome: Practice Essentials, Pathophysiology and Etiology, Epidemiology
https://emedicine.medscape.com/article/933135-overview
The true incidence and prevalence of CVS in the United States are unknown, although a prevalence of about 2% among US children and adults has been estimated. […] In central Ohio, amid a predominantly White population, the prevalence of CVS in children (evaluated by the sole pediatric gastroenterology referral center) was 0.04%. […] On the basis of limited epidemiologic data, Cullen and MacDonald estimated the prevalence of periodic vomiting in western Australia to be 2.3%. […] Similarly, Abu-Arafeh and Russell observed a prevalence of 1.9% in school-aged children in Aberdeen, Scotland. […] In a study performed at KEM Hospital in Pune, India, CVS accounted for 0.5% of admissions to pediatric wards during 1998-2000. […] In a retrospective study conducted in Japan, Chang et al found that the prevalence of CVS among children was 2.10 per 1000 population, and the prevalence among adults was 0.05 per 1000 population.
#3 Cyclic Vomiting Syndrome in Children
https://www.uspharmacist.com/article/cyclic-vomiting-syndrome-in-children
Cyclic vomiting syndrome (CVS) is a functional brain-gut disorder characterized by recurrent severe prolonged episodes of nausea and vomiting in otherwise healthy people. […] Although it is difficult to determine the exact prevalence of CVS, it is estimated to be somewhere between 0.3% and 2.2% of children. […] The condition also affects females more often than males, with an average age of onset of 4 years. […] CVS has been described in all ethnicities, but it is most common among Caucasians. […] CVS results in 24 missed school days and an annualized cost of care of $17,035.
#4 Update in Cyclical Vomiting Syndrome – Practical Gastro
https://practicalgastro.com/2022/12/07/update-in-cyclical-vomiting-syndrome/
Cyclical vomiting syndrome (CVS) is a functional idiopathic gastrointestinal disorder characterized by recurrent episodes of severe emesis with periods of remission in between. […] A recent population-based study shows CVS is prevalent in 2% of adults in America. […] Cyclical vomiting syndrome can be misrecognized and is probably underdiagnosed causing significant impact on health and quality of life leading to multiple emergency visits and increasing morbidity. […] This lack of clinical insight has led to a burden on the health care system in the US with cost estimated to be up to $200 million annually.