Tsinghua Changgeng Xu Xiwei: long term management in remission of periodic vomiting syndrome is the key to prevent recurrence

Tsinghua Changgeng Xu Xiwei: long term management in remission of periodic vomiting syndrome is the key to prevent recurrence.

Tsinghua Changgeng Xu Xiwei: long term management in remission of periodic vomiting syndrome is the key to prevent recurrence.

Vomiting occurs repeatedly. Vomiting lasts for half a day or even several days, Periodic vomiting syndrome (CVS) makes children miserable and poor quality of life. Professor Xu Xiwei, director of Pediatrics of Beijing Tsinghua Changgeng Hospital Affiliated to Tsinghua University, introduced that the diagnosis and treatment of periodic vomiting syndrome not only requires early diagnosis, but also the more important goal is the long-term management of the disease remission period to control the recurrence of vomiting.

Periodic vomiting syndrome is prone to repeated attacks and great harm

According to the literature, the prevalence rate of cyclic vomiting syndrome is 1.9% – 2.3%, the incidence rate is 3.2/100000, which is relatively rare and complex. The incidence of recurrent vomiting is recurrent vomiting, which occurs mostly in preschool children and early school age children, Xu Xiwei said. Children may suddenly vomit without warning, ranging from a few hours, a day or up to ten days. After the vomiting attack, the child’s performance is no different from normal, repeated and difficult to control.

Periodic vomiting syndrome is a kind of functional gastrointestinal disease. The etiology is unknown. Why it is high in children has not been studied clearly. Before the attack, children may have no symptoms, and some may have symptoms such as nausea, pale complexion, abdominal pain, dizziness, fear of light, excessive saliva secretion, and then vomiting.

Although the cause of the disease is unknown, it does great harm. Repeated vomiting made the child very painful and the quality of life decreased significantly; Lead to a large loss of nutrition, resulting in varying degrees of malnutrition and backward growth and development of children; It can also cause damage to gastroesophageal mucosa, ulcer erosion, gastritis, reflux esophagitis, cardiac tear, etc. when the symptoms are serious, it can cause dehydration and need emergency infusion.

Periodic vomiting syndrome is difficult to root out, and the treatment is mainly to alleviate symptoms

There are many diseases with vomiting symptoms. How to diagnose periodic vomiting syndrome? Take acute gastroenteritis as an example, which is one of the most common causes of vomiting in children. Different from periodic vomiting syndrome, gastroenteritis often shows “vomiting and diarrhea”, that is, vomiting has diarrhea symptoms at the same time, and recovers quickly; The latter only showed vomiting, with long attack time and repeated vomiting.
Xu Xiwei said that it can be seen that periodic vomiting syndrome is not difficult to be found due to the characteristics of “repeated vomiting”. However, since there is no clear etiology, other organic diseases, such as central nervous system diseases, should be excluded during the diagnosis, Gastrointestinal diseases (such as gastrointestinal volvulus, intestinal malrotation, etc.), genetic metabolic diseases, endocrine diseases, etc. the diagnosis of periodic vomiting syndrome can be made only after these causes are eliminated through imaging examination and serological corresponding detection.

The treatment of periodic vomiting syndrome is mainly divided into vomiting attack treatment and remission

reventive medication. Seizure medication is given during the onset of vomiting to alleviate symptoms. Maintain the acid-base balance of water and electrolyte through intravenous infusion to prevent dehydration and ketosis. Place the children in a dark and quiet room to avoid various stimuli as far as possible. The difficulty in the treatment of this disease often lies in the long-term drug treatment in remission. It is divided into light, medium and severe according to the condition. Different drug ratios are selected. Children are also required to accept long-term management, reasonably control the drug dosage and avoid attack.

Grasp the drug and diet management in remission period to effectively avoid disease attack
Long term management can control the recurrence of periodic vomiting. If the effect is ideal, the child’s vomiting can be completely relieved and the vomiting will not occur again. On the contrary, if the long-term management is not ideal, it is likely that the disease will occur once every two months and last for more than two days. It must be treated in emergency or hospitalization, which will not only cause children’s frequent absence from school, but also cause great harm to their health.

Children in remission should pay attention to light diet, not too full, and eat less cheese, chocolate and other foods, which may induce vomiting. In particular, after some children vomit, their appetite increases greatly. Being too full can cause another attack. Parents should also be careful of food allergies, such as children allergic to milk and eggs. Children are easy to vomit when they eat food with these ingredients.

Others include excessive excitement and fatigue, which are also the inducing factors of periodic vomiting syndrome. Try to ensure sleep and avoid staying up too late in life.

Multidisciplinary diagnosis and treatment is helpful to manage periodic vomiting syndrome

Periodic vomiting syndrome is often misdiagnosed. It takes 2.6-3.1 years from onset to diagnosis, and the duration of the disease is also long. It is reported that the median total duration is 66 months. In order to avoid misdiagnosis, missed diagnosis and over examination, multidisciplinary joint diagnosis and treatment is needed to improve the level of disease diagnosis and treatment.

Since May 2021, children with gastrointestinal diseases have been treated in the pediatric ward of Professor Xu Xiwei of Tsinghua Changgeng hospital. Patients with periodic vomiting syndrome from 21 regions have come to see a doctor. The condition of most children has been controlled and is under continuous follow-up.

Xu Xiwei said that the most common department to see a doctor after the onset of children’s vomiting is the children’s digestive department. Doctors here should take the first step. The disease attack is often accompanied by dizziness and headache, which requires consultation of neurologists, or secondary increase of cortisol and aldosterone. Endocrine experts should be invited to evaluate these complications. Drug use involves many kinds of diseases and also needs the help of clinical pharmacists. The distress caused by children’s long-term vomiting can bring a variety of psychological obstacles, and the joint cooperation of children’s psychological experts is needed when necessary.

Many extremely emaciated children are hospitalized in wheelchairs. Through reasonable treatment, they gradually gain weight and can walk out of the hospital. After the children are discharged from the hospital, they also need to adjust the dosage and observe the state through long-term clinical follow-up to avoid recurrence. Although periodic vomiting syndrome is an incurable disease, it can inhibit the disease to the greatest extent through reasonable preventive medication in remission period, and finally achieve the result of no attack and no impact on life.

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