Cyclic vomiting syndrome

Pathophysiology, comorbidities, and future research directions

William L. Hasler*, David J. Levinthal, Sally E Tarbell, Kathleen A. Adams, B. U.K. Li, Robert M. Issenman, Irene Sarosiek, Safwan S. Jaradeh, Ravi N. Sharaf, Shahnaz Sultan, Thangam Venkatesan

*Corresponding author for this work

Research output: Contribution to journalReview article

Abstract

Cyclic vomiting syndrome (CVS) is characterized by severe episodic emesis in adults and children. Cannabinoid hyperemesis syndrome is an increasingly recognized CVS-like illness that has been associated with chronic cannabis use. There are significant gaps in our understanding of the pathophysiology, clinical features, comorbidities, and effective management options of CVS. Recommendations for treating CVS are based on limited clinical data, as no placebo-controlled, randomized trials have yet been conducted. Diseases associated with CVS, including migraine, mitochondrial disorders, autonomic dysfunction, and psychiatric comorbidities, provide clues about pathophysiologic mechanisms and suggest potential therapies. We review our current understanding of CVS and propose future research directions with the aim of developing effective therapy. Establishing a multicenter, standardized registry of CVS patients could drive research on multiple fronts including developing CVS-specific outcome measures to broaden our understanding of clinical profiles, to serve as treatment end points in clinical trials, and to provide a platform for patient recruitment for randomized clinical trials. Such a robust database would also facilitate conduct of research that aims to determine the underlying pathophysiological mechanisms and genetic basis for CVS, as well as identifying potential biomarkers for the disorder. Soliciting government and industry support is crucial to establishing the necessary infrastructure and achieving these goals. Patient advocacy groups such as the Cyclic Vomiting Syndrome Association (CVSA), which partner with clinicians and researchers to disseminate new information, to promote ongoing interactions between patients, their families, clinicians, investigators, to support ongoing CVS research and education, must be an integral part of this endeavor.

Original languageEnglish (US)
Article numbere13607
JournalNeurogastroenterology and Motility
Volume31
Issue numberS2
DOIs
StatePublished - Jun 1 2019

Fingerprint

Comorbidity
Familial cyclic vomiting syndrome
Direction compound
Randomized Controlled Trials
Research
Research Personnel
Patient Advocacy
Mitochondrial Diseases
Cannabinoids
Cannabis
Migraine Disorders
Patient Selection
Vomiting
Psychiatry
Registries
Industry
Therapeutics
Biomarkers
Placebos
Outcome Assessment (Health Care)

Keywords

  • Cannabinoids
  • cyclic vomiting
  • migraine headaches
  • multicenter registry
  • psychosocial dysfunction

ASJC Scopus subject areas

  • Physiology
  • Endocrine and Autonomic Systems
  • Gastroenterology

Cite this

Hasler, W. L., Levinthal, D. J., Tarbell, S. E., Adams, K. A., Li, B. U. K., Issenman, R. M., ... Venkatesan, T. (2019). Cyclic vomiting syndrome: Pathophysiology, comorbidities, and future research directions. Neurogastroenterology and Motility, 31(S2), [e13607]. https://doi.org/10.1111/nmo.13607
Hasler, William L. ; Levinthal, David J. ; Tarbell, Sally E ; Adams, Kathleen A. ; Li, B. U.K. ; Issenman, Robert M. ; Sarosiek, Irene ; Jaradeh, Safwan S. ; Sharaf, Ravi N. ; Sultan, Shahnaz ; Venkatesan, Thangam. / Cyclic vomiting syndrome : Pathophysiology, comorbidities, and future research directions. In: Neurogastroenterology and Motility. 2019 ; Vol. 31, No. S2.
@article{a3d4a81628c843399b0445ff136493c5,
title = "Cyclic vomiting syndrome: Pathophysiology, comorbidities, and future research directions",
abstract = "Cyclic vomiting syndrome (CVS) is characterized by severe episodic emesis in adults and children. Cannabinoid hyperemesis syndrome is an increasingly recognized CVS-like illness that has been associated with chronic cannabis use. There are significant gaps in our understanding of the pathophysiology, clinical features, comorbidities, and effective management options of CVS. Recommendations for treating CVS are based on limited clinical data, as no placebo-controlled, randomized trials have yet been conducted. Diseases associated with CVS, including migraine, mitochondrial disorders, autonomic dysfunction, and psychiatric comorbidities, provide clues about pathophysiologic mechanisms and suggest potential therapies. We review our current understanding of CVS and propose future research directions with the aim of developing effective therapy. Establishing a multicenter, standardized registry of CVS patients could drive research on multiple fronts including developing CVS-specific outcome measures to broaden our understanding of clinical profiles, to serve as treatment end points in clinical trials, and to provide a platform for patient recruitment for randomized clinical trials. Such a robust database would also facilitate conduct of research that aims to determine the underlying pathophysiological mechanisms and genetic basis for CVS, as well as identifying potential biomarkers for the disorder. Soliciting government and industry support is crucial to establishing the necessary infrastructure and achieving these goals. Patient advocacy groups such as the Cyclic Vomiting Syndrome Association (CVSA), which partner with clinicians and researchers to disseminate new information, to promote ongoing interactions between patients, their families, clinicians, investigators, to support ongoing CVS research and education, must be an integral part of this endeavor.",
keywords = "Cannabinoids, cyclic vomiting, migraine headaches, multicenter registry, psychosocial dysfunction",
author = "Hasler, {William L.} and Levinthal, {David J.} and Tarbell, {Sally E} and Adams, {Kathleen A.} and Li, {B. U.K.} and Issenman, {Robert M.} and Irene Sarosiek and Jaradeh, {Safwan S.} and Sharaf, {Ravi N.} and Shahnaz Sultan and Thangam Venkatesan",
year = "2019",
month = "6",
day = "1",
doi = "10.1111/nmo.13607",
language = "English (US)",
volume = "31",
journal = "Neurogastroenterology and Motility",
issn = "1350-1925",
publisher = "Wiley-Blackwell",
number = "S2",

}

Hasler, WL, Levinthal, DJ, Tarbell, SE, Adams, KA, Li, BUK, Issenman, RM, Sarosiek, I, Jaradeh, SS, Sharaf, RN, Sultan, S & Venkatesan, T 2019, 'Cyclic vomiting syndrome: Pathophysiology, comorbidities, and future research directions', Neurogastroenterology and Motility, vol. 31, no. S2, e13607. https://doi.org/10.1111/nmo.13607

Cyclic vomiting syndrome : Pathophysiology, comorbidities, and future research directions. / Hasler, William L.; Levinthal, David J.; Tarbell, Sally E; Adams, Kathleen A.; Li, B. U.K.; Issenman, Robert M.; Sarosiek, Irene; Jaradeh, Safwan S.; Sharaf, Ravi N.; Sultan, Shahnaz; Venkatesan, Thangam.

In: Neurogastroenterology and Motility, Vol. 31, No. S2, e13607, 01.06.2019.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Cyclic vomiting syndrome

T2 - Pathophysiology, comorbidities, and future research directions

AU - Hasler, William L.

AU - Levinthal, David J.

AU - Tarbell, Sally E

AU - Adams, Kathleen A.

AU - Li, B. U.K.

AU - Issenman, Robert M.

AU - Sarosiek, Irene

AU - Jaradeh, Safwan S.

AU - Sharaf, Ravi N.

AU - Sultan, Shahnaz

AU - Venkatesan, Thangam

PY - 2019/6/1

Y1 - 2019/6/1

N2 - Cyclic vomiting syndrome (CVS) is characterized by severe episodic emesis in adults and children. Cannabinoid hyperemesis syndrome is an increasingly recognized CVS-like illness that has been associated with chronic cannabis use. There are significant gaps in our understanding of the pathophysiology, clinical features, comorbidities, and effective management options of CVS. Recommendations for treating CVS are based on limited clinical data, as no placebo-controlled, randomized trials have yet been conducted. Diseases associated with CVS, including migraine, mitochondrial disorders, autonomic dysfunction, and psychiatric comorbidities, provide clues about pathophysiologic mechanisms and suggest potential therapies. We review our current understanding of CVS and propose future research directions with the aim of developing effective therapy. Establishing a multicenter, standardized registry of CVS patients could drive research on multiple fronts including developing CVS-specific outcome measures to broaden our understanding of clinical profiles, to serve as treatment end points in clinical trials, and to provide a platform for patient recruitment for randomized clinical trials. Such a robust database would also facilitate conduct of research that aims to determine the underlying pathophysiological mechanisms and genetic basis for CVS, as well as identifying potential biomarkers for the disorder. Soliciting government and industry support is crucial to establishing the necessary infrastructure and achieving these goals. Patient advocacy groups such as the Cyclic Vomiting Syndrome Association (CVSA), which partner with clinicians and researchers to disseminate new information, to promote ongoing interactions between patients, their families, clinicians, investigators, to support ongoing CVS research and education, must be an integral part of this endeavor.

AB - Cyclic vomiting syndrome (CVS) is characterized by severe episodic emesis in adults and children. Cannabinoid hyperemesis syndrome is an increasingly recognized CVS-like illness that has been associated with chronic cannabis use. There are significant gaps in our understanding of the pathophysiology, clinical features, comorbidities, and effective management options of CVS. Recommendations for treating CVS are based on limited clinical data, as no placebo-controlled, randomized trials have yet been conducted. Diseases associated with CVS, including migraine, mitochondrial disorders, autonomic dysfunction, and psychiatric comorbidities, provide clues about pathophysiologic mechanisms and suggest potential therapies. We review our current understanding of CVS and propose future research directions with the aim of developing effective therapy. Establishing a multicenter, standardized registry of CVS patients could drive research on multiple fronts including developing CVS-specific outcome measures to broaden our understanding of clinical profiles, to serve as treatment end points in clinical trials, and to provide a platform for patient recruitment for randomized clinical trials. Such a robust database would also facilitate conduct of research that aims to determine the underlying pathophysiological mechanisms and genetic basis for CVS, as well as identifying potential biomarkers for the disorder. Soliciting government and industry support is crucial to establishing the necessary infrastructure and achieving these goals. Patient advocacy groups such as the Cyclic Vomiting Syndrome Association (CVSA), which partner with clinicians and researchers to disseminate new information, to promote ongoing interactions between patients, their families, clinicians, investigators, to support ongoing CVS research and education, must be an integral part of this endeavor.

KW - Cannabinoids

KW - cyclic vomiting

KW - migraine headaches

KW - multicenter registry

KW - psychosocial dysfunction

UR - http://www.scopus.com/inward/record.url?scp=85067985638&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85067985638&partnerID=8YFLogxK

U2 - 10.1111/nmo.13607

DO - 10.1111/nmo.13607

M3 - Review article

VL - 31

JO - Neurogastroenterology and Motility

JF - Neurogastroenterology and Motility

SN - 1350-1925

IS - S2

M1 - e13607

ER -