Texas Tech University Health Sciences Center Paul L. Foster School of Medicine El Paso, TX
Joshua Sifuentes, MD1, Mahesh Gajendran, MD1, Richard McCallum, MD, FACG2; 1Texas Tech University Health Sciences Center Paul L. Foster School of Medicine, El Paso, TX; 2Texas Tech University Health Sciences Center, El Paso, TX
Introduction: Cyclic vomiting Syndrome (CVS) is characterized by recurrent bouts of vomiting that results in multiple hospital admissions with accompanying economic burden and loss of quality of life. There is no long term follow up studies assessing outcomes in CVS. Our aim was to analyze the long term results of treatment in CVS patients specifically focused on symptom control, treatment, and restoration of quality of life. Methods: A 20-minute questionnaire interview addressed CVS diagnosis, onset of symptoms, treatment, quality of life, employment, ability to return to social activities, and resume hobbies. 48 patients diagnosed with CVS and managed personally by one of the authors (RMC) at an academic referral center were contacted, interviewed and completed the survey. Results: 57% of the respondents were female, 53% Hispanic, average age 39. Prior to CVS diagnosis, 50% had symptom duration of 1-3 years while 19% were not diagnosed for as long as 10 years. The average number of years being followed in clinic from time of diagnosis was 2.7 (range 6 months – 10 years). Stress was the major etiologic factor identified in 50%, 25% had dominant cannabis use documented by > 4 years of daily use, 35% had a background of migraine headaches and one third were diagnosed with diabetes mellitus. 70% were initially treated with amitriptyline with daily dosing ranging from 30-200mg, 20% with doxepin (due to side effects of amitriptyline) and 5% with nortriptyline. 62% of the respondents identified their symptoms on a scale of 1-10 (10 being the worst) as 8 or greater at time of diagnosis compared to follow up when the mean symptom rank of 2 was achieved by 95% of patients. 74% were being maintained with a 50% reduced dose compared to their initial treatment and actually 25% were not taking any medication and remained asymptomatic. 91% were able to return to their social activities with 89% also enjoying their hobbies. All respondents who previously were employed prior to diagnosis were able to return to work. Discussion: This long term follow up study (mean 2.7 yrs.) of a large single-center cohort of CVS patients confirmed that an overwhelming majority responded to initial treatment could be maintained on a reduced dosage, some even without treatment while also re-establish a good quality of life. This data indicates that CVS is not only treatable with the appropriate therapy but is a reversible entity when there is an emphasis on long term continuity of care.
Disclosures: Joshua Sifuentes indicated no relevant financial relationships. Mahesh Gajendran indicated no relevant financial relationships. Richard McCallum indicated no relevant financial relationships.