Çocukluk Çağı Siklik Kusma Sendromlu Hastaların Klinik ve Demografik Özellikleri: Tek Merkez Deneyimi

Öz

Amaç: Siklik kusma sendromu genellikle günler süren ve intravenöz sıvı tedavisi ihtiyacı olan ağır kusma atakları ile karakterizedir. Bu sendrom çocukların yaklaşık %2’sini etkiler. Biz merkezimizde tanı alan siklik kusmalı hastaların klinik ve demografik özelliklerini sunmayı amaçladık.Gereç ve Yöntemler: Çalışmamız, Ankara Üniversitesi Çocuk Nöroloji Bilim Dalına başvuran ve siklik kusma tanısı alan 24 hastanın geriye dönük taranması şeklinde yapıldı. Hastaların tanısında Roma III kriterleri kullanıldı. Hastaların cinsiyeti, yaşı, ailede migren öyküsü, atak süresi, atak sıklığı ve kullanılan tedavi yöntemi kaydedildi. Ayrıca tüm hastalara kraniyal MRG ve EEG yapıldı.Bulgular: Çalışmaya alınan hastaların 9’u (%37.5) kız, 15’i (%62.5) erkekti, ortalama yaşları 10.9±3.8 (aralık: 5-17 yaş)’dı. Hastaların ortalama takip süresi 39.4±21.2 aydı. Hastaların MRG’lerı normaldi. 7’sinin (%29.2) EEG’sinde yavaş dalga parokisizmi mevcuttu, 17’sinin (%70.2) EEG’si normaldi. Toplam 24 hastanın 11’inde ailede migren öyküsüvardı. 10 hasta flunarizin, 4 hasta valproik asit, 1 hasta topiramat, 3 hasta topiramat+valproik asit, 1 hasta valproik asit+flunarizin, 5 hastaya proflaksi verilmeden takip edildi.Sonuç: Siklik kusma sendromlu hastaların tanısında gastroenterolojik, nörolojik ve metabolik değerlendirme ile birlikte, ataklar arasında hastaların tamamen semptomsuz olması, tipik kusma paternin klinik belirtileri gerekmektedir. Erken tanı ve doğru yaklaşım hastaların yaşam kalitesini belirgin bir şekilde düzeltebilir.

Anahtar Kelimeler

• Çocukluk çağı, Proflaksi, Siklik kusma sendromu, Tanı

Clinical and Demographic Characteristics of Cyclic Vomiting Syndrome in Childhood: Single Center Experience

Öz

Objective: Cyclic vomiting syndrome is usually characterized by severe episodes that last for days and often require intravenous fluid therapy. This syndrome affects approximately 2% of children. We aimed to present the clinical and demographic characteristics of patients diagnosed with cyclic vomiting at our center.Material and Methods: Our study was designed as retrospective screening of 24 patients diagnosed with cyclic vomiting at Ankara University’s Pediatric Neurology Department. The Rome III criteria were used in the diagnosis of the patients. Gender, age, family history of migraine, attack duration, attack frequency, and the treatment of the patients were recorded. In addition, cranial MRI and EEG was performed for all patients.Results: A total of 24 patients were evaluated. The average age of onset of the symptoms was 6.1 ± 2.44 months, the mean age of diagnosis was 8.2 ± 2.62 months and the average follow-up period was 39.4 ± 21.15 months. The MRIs of the patients were normal. While there was slow wave paroxysm in the EEGs of 7 patients (29.2%), the EEG was normal in the remaining 17 patients (70.2%). Ten patients (41.7%) were administered flunarizine, 4 patients (16.7%) valproic acid, 3 patients topiramate+valproic acid, 1 patient valproic acid+ flunarizine, and 1 patient (4.2%) was given topiramate as prophylaxis. No drug was used for prophylaxis in 5 patients (20.8%).conclusion: Other than gastroenterologic, neurologic and metabolic evaluations, the diagnosis of CVS must be based on the detailed history of the clinical manifestations of the vomiting pattern with complete symptom-free intervals between the attacks. Early diagnosis and a proper approach can significantly improve the quality of life of these patients

Anahtar Kelimeler

• Childhood, Prophylaxis, Cyclic vomiting syndrome, Diagnosis

Kaynakça

1. Abu-Arafeh I, Russell G. Cyclical vomiting syndrome in children: A population-based study. J Pediatr Gastroenterol Nutr 1995;21: 454–8.
2. Li BU, Misiewicz L. Cyclic vomiting syndrome: A brain gut disorder. Gastroenterol Clin North Am 2003;32:997–1019.
3. Cullen K, Macdonald W. The periodic syndrome: Its nature and prevalence. Med J Aust 1963;5:167–73.
4. Fitzpatrick E, Bourke B, Drumm B, Rowland M. The incidence of cyclic vomiting syndrome in children: Population-based study. Am J Gastroenterol 2008;103:991–5.
5. Li BU, Lefevre F, Chelimsky GG, Boles RG, Nelson SP, Lewis DW, et al. North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition. North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition consensus statement on the diagnosis and management of cyclic vomiting syndrome. J Pediatr Gastroenterol Nutr 2008;4:379-93.
6. Hejazi RA, McCallum RW. Review article: Cyclic vomiting syndrome in adults-rediscovering and redefining an old entity. Aliment Pharmacol Ther 2011;34: 263-73.
7. Fitzpatrick E, Bourke B, Drumm B, Rowland M. The incidence of cyclic vomiting syndrome in children: Population-based study. Am J Gastroenterol 2008;103:991–5.
8. Li BUK, Murray RD, Heitlinger LA, Robbins JL, Hayes JR. Is cyclic vomiting syndrome related to migraine? J Pediatr 1999;134:567- 72.

9. Boles RG, Adams K, Ito M, Li BU. Maternal inheritance in cyclic vomiting syndrome with neuromuscular disease. Am J Med Genet A 2003;120:474–82.
10. Prakash C, Clouse R. Cyclic vomiting syndrome in adults: Clinical features and response to tricyclic antidepressants. Am J Gastroenterol 1999;94:2856–60.
11. Anderson JM, Sugerman KS, Lockhart JR, Weinberg WA. Effective prophylactic therapy for cyclic vomiting syndrome in children using amitriptyline or cyproheptadine. Pediatrics 1997;100:977–81.
12. Lee WS, Kaur P, Boey CC, Chan KC. Cyclic vomiting syndrome in South-East Asian children. J Paediatr Child Health 1998;34:568– 70.
13. Van Calcar S, Harding C, Wolff J. L-carnitine administration reduces number of episodes in cyclic vomiting syndrome. Clin Pediatr 2002;41:171–4.
14. Hejazi RA, McCallum RW. Review article: Cyclic vomiting syndrome in adults rediscovering and redefining an old entity. Aliment Pharmacol Ther 2011;34:263-73.
15. Liao KY, Chang FY, Wu LT, Wu TC. Cyclic vomiting syndrome in Taiwanese children. J Formos Med Assoc 2011;110:14-8.
16. Fitzpatrick E, Bourke B, Drumm B, Rowland M. The incidence of cyclic vomiting syndrome in children: Population-based study. Am J Gastroenterol 2008;103:991–5.
17. Fleisher D. Cyclic vomiting and migraine (editorial). J Pediatr 1999; 134:533–4. 2007;102:2832–40.
18. Vanderhoof JA, Young R, Kaufmann SS, Ernst L. Treatment of cyclic vomiting syndrome in childhood with erythromycin. J Pediatr Gastroenterol Nutr 1993;17:387–91.