Division of Gastroenterology, University of Michigan Health System, Ann Arbor, Michigan.
Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Neurogastroenterol Motil. 2019 Jun;31 Suppl 2(Suppl 2):e13607. doi: 10.1111/nmo.13607.
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.
周期性呕吐综合征（CVS）的特征是成人和儿童严重的阵发性呕吐。大麻素过度呕吐综合征是一种越来越被认可的类似 CVS 的疾病，与慢性大麻使用有关。我们对 CVS 的病理生理学、临床特征、合并症和有效管理选择的理解存在重大差距。治疗 CVS 的建议基于有限的临床数据，因为尚未进行安慰剂对照、随机试验。与 CVS 相关的疾病，包括偏头痛、线粒体疾病、自主神经功能障碍和精神共病，为病理生理机制提供了线索，并提示了潜在的治疗方法。我们回顾了我们目前对 CVS 的理解，并提出了未来的研究方向，旨在开发有效的治疗方法。建立一个 CVS 患者的多中心、标准化登记处，可以推动多个方面的研究，包括开发 CVS 特定的结局指标，以扩大我们对临床特征的理解，作为临床试验的治疗终点，并为随机临床试验提供患者招募的平台。这样一个强大的数据库也将有助于确定 CVS 的潜在病理生理机制和遗传基础，并确定该疾病的潜在生物标志物。争取政府和行业的支持对于建立必要的基础设施和实现这些目标至关重要。患者倡导组织，如周期性呕吐综合征协会（CVSA），与临床医生和研究人员合作，传播新信息，促进患者、他们的家人、临床医生、研究人员之间的持续互动，支持持续的 CVS 研究和教育，必须是这项努力的一个组成部分。
