Cyclic vomiting syndrome in adults: Clinical features and response to tricyclic antidepressants
Cyclic vomiting syndrome in adults: Clinical features and response to tricyclic antidepressants
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DOI：
10.1016/s0002-9270(99)00484-0
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发表时间：
1999-10-01
影响因子：
9.8
通讯作者：
Clouse, RE
中科院分区：
文献类型：
--
作者：
Prakash, C;Clouse, RE
目的：周期性呕吐综合征(CVS)在成人中很少见，在儿童和成人中的治疗仍然不令人满意。我们报告了一组患有CVS的成年人的临床特征和三环类抗抑郁药开放标签治疗的轶事结果，这些药物对其他原因不明的胃肠道疾病有一定的疗效。方法：研究了IO-年期间出现的17名成年CVS患者的临床数据，每个人都接受了三环类抗抑郁药的治疗。回顾门诊记录，根据先验标准提取临床结果，并将结果与37例接受三环类抗抑郁药物治疗的常见功能性恶心呕吐患者进行比较。结果：CVS的症状开始于35岁(14-73岁)，平均发作时间6天(1-21天)，无症状间隔平均3.1个月(0.5-6个月)。呕吐周期通常在没有征兆的情况下开始，不到三分之一的受试者报告了前驱症状或潜在的触发事件，如月经、怀孕或大餐。23.5%的人认为睡眠是有益的。三环类抗抑郁药的完全缓解率为17.6%，部分缓解率为58.8%，但对功能性恶心呕吐的有效率较低(p=0.02)。结论：CVS是一种少见的成人疾病，具有独特的特点。发作和周期的持续时间在不同的受试者之间有很大的差异。在开放的、不加控制的使用中，三环类抗抑郁药似乎对某些受试者有益，但对CVS的疗效不如对慢性持续性功能性恶心和呕吐的疗效。(C)1999年由上午牢房。胃肠病学的研究。
OBJECTIVE: Cyclic vomiting syndrome (CVS) has been described infrequently in adults, and treatment in both children and adults remains unsatisfactory. We report clinical features of a group of adults with CVS and anecdotal outcome from open-label treatment with tricyclic antidepressants, medications that have some efficacy in other unexplained gastrointestinal disorders.METHODS: Clinical data were examined from 17 adult patients with CVS seen over a IO-yr period, each having been treated with a tricyclic antidepressant. Outpatient records were reviewed, clinical outcome was extracted using a priori criteria, and findings were compared with 37 patients having usual functional nausea and vomiting who also received tricyclic antidepressant therapy.RESULTS: Symptoms in CVS began at age 35 yr (range 14-73 yr); the average episode length was 6 days (range 1-21 days) and the symptom-free interval averaged 3.1 months (range 0.5-6 months). Vomiting cycles typically began without warning, and fewer than one-third of the subjects reported a prodrome or potential trigger event, such as menstrual periods, pregnancy, or large meals. Sleep was seemingly beneficial in 23.5%. Tricyclic antidepressant therapy was associated with complete remission in 17.6% and partial response in 58.8%, but was less effective than for functional nausea and vomiting (p = 0.02).CONCLUSIONS: CVS is a rare diagnosis with distinctive features in adults. Duration of episodes and cycles varies considerably across subjects. In open-label, uncontrolled use, tricyclic antidepressants appear beneficial for some subjects but are less effective in CVS than in chronic, persistent functional nausea and vomiting. (C) 1999 by Am. Cell. of Gastroenterology.