Management of cyclic vomiting syndrome in adults: Evidence review

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

Research output: Contribution to journalReview articlepeer-review

3 Scopus citations

Abstract

Background: This evidence review was conducted to inform the accompanying clinical practice guideline on the management of cyclic vomiting syndrome (CVS) in adults. Methods: We followed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework and focused on interventions aimed at prophylactic management and abortive treatment of adults with CVS. Specifically, this evidence review addresses the following clinical questions: (a) Should the following pharmacologic agents be used for prophylaxis of CVS: amitriptyline, topiramate, aprepitant, zonisamide/levetiracetam, or mitochondrial supplements? (b) Should the following pharmacologic agents be used for abortive treatment: triptans or aprepitant?. Results: We found very low-quality evidence to support the use of the following agents for prophylactic and abortive treatment of CVS: amitriptyline, topiramate, aprepitant, zonisamide/levetiracetam, and mitochondrial supplements. We have moderate certainty of evidence for the use of triptans as abortive therapy. We found limited evidence to support the use of ondansetron and the treatment of co-morbid conditions and complementary therapies. Conclusions: This evidence review helps inform the accompanying guideline for the management of adults with CVS which is aimed at helping clinicians, patients, and policymakers, and should improve patient outcomes.

Original languageEnglish (US)
Article numbere13605
JournalNeurogastroenterology and Motility
Volume31
Issue numberS2
DOIs
StatePublished - Jun 2019

Bibliographical note

Funding Information:
None of the authors had any competing interests. Full disclo‐ sure statement included. Dr. Sharaf was supported by Academy Health DSSF, NY State ECRIP Award, NCI K07CA216326 and NCI R01CA211723. Dr. Sharaf is a paid consultant for the non‐profit Institute for Clinical and Economic Review, Boston, Massachusetts. Dr. Sultan has no financial disclosures.

Funding Information:
This work was funded by the Cyclic Vomiting Syndrome Association (CVSA), a non‐profit organization for patients with CVS and their caregivers.

Publisher Copyright:
© 2019 The Authors. Neurogastroenterology & Motility Published by John Wiley & Sons Ltd

Keywords

  • cyclic vomiting
  • technical review
  • treatment

PubMed: MeSH publication types

  • Review
  • Journal Article

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