North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition consensus statement on the diagnosis and management of cyclic vomiting syndrome
North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition consensus statement on the diagnosis and management of cyclic vomiting syndrome
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DOI：
10.1097/mpg.0b013e318173ed39
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发表时间：
2008-09-01
影响因子：
2.9
通讯作者：
Rudolph, Colin D.
中科院分区：
文献类型：
--
作者：
Li, B. U. K.;Lefevre, Frank;Rudolph, Colin D.
周期性呕吐综合征（CVS）是一种以其独特的呕吐强度，反复急诊和住院以及生活质量下降而闻名的疾病。它经常被误诊，由于复发的不受重视的模式和缺乏验证性测试。由于尚未建立公认的管理方法，工作组负责根据对医学文献和专家意见的审查编写CVS诊断和治疗报告。讨论的关键问题是诊断标准、适当的评估、预防性治疗和急性发作的治疗。推荐的诊断方法是避免“鸟枪”测试，而是使用针对性测试的策略，该策略随4个红旗的存在而变化：腹部体征（例如胆汁性呕吐，压痛），触发事件（例如禁食）。高蛋白膳食）、异常神经学检查（例如，精神状态改变、视神经乳头水肿）。以及呕吐发作的进行性恶化或改变模式。治疗建议包括改变生活方式、预防性治疗（例如，5岁或以下儿童使用赛庚啶，5岁以上儿童使用阿米替林）和急性治疗（例如，5-羟色胺受体激动剂，本文称为曲坦类药物，作为流产治疗，需要静脉补液的患者使用10%葡萄糖和昂丹司琼）。本文件代表了北美儿科胃肠病学、肝病学和营养学会对儿童和青少年CVS诊断和治疗的官方建议。
Cyclic vomiting syndrome (CVS) is a disorder noted for its unique intensity of vomiting, repeated emergency department visits and hospitalizations, and reduced quality of life. It is often misdiagnosed due to the unappreciated pattern of recurrence and lack of confirmatory testing. Because no accepted approach to management has been established, the task force was charged to develop a report on diagnosis and treatment of CVS based upon a review of the medical literature and expert opinion. The key issues addressed were the diagnostic criteria, the appropriate evaluation, the prophylactic therapy, and the therapy of acute attacks. The recommended diagnostic approach is to avoid "shotgun" testing and instead to use a strategy of targeted testing that varies with the presence of 4 red flags: abdominal signs (eg, bilious vomiting, tenderness), triggering events (eg, fasting. high protein meal), abnormal neurological examination (eg. altered mental status, papilledema). and progressive worsening or a changing pattern of vomiting episodes. Therapeutic recommendations include lifestyle changes, prophylactic therapy (eg, cyproheptadine in children 5 years or younger and amitriptyline for those older than 5), and acute therapy (eg, 5-hydroxytryptamine receptor agonists, termed triptans herein, as abortive therapy, and 10% dextrose and ondansetron for those requiring intravenous hydration). This document represents the official recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition for the diagnosis and treatment of CVS in children and adolescents.