北美儿科胃肠病、肝病和营养学会2025年儿童周期性呕吐综合征管理指南。

North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition 2025 guidelines for management of cyclic vomiting syndrome in children.

作者信息

Karrento Katja, Rosen John M, Tarbell Sally E, Issenman Robert M, Gelfand Amy A, Gamboa Heidi, Parikh Sumit, Adams Kathleen, Wiercioch Wojtek, Li B U K

机构信息

Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.

Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.

出版信息

J Pediatr Gastroenterol Nutr. 2025 Jun;80(6):1028-1061. doi: 10.1002/jpn3.70020. Epub 2025 Apr 14.

DOI:10.1002/jpn3.70020

PMID:40223700

Abstract

BACKGROUND

Cyclic vomiting syndrome (CVS) is a disorder recognized for its unique intensity of vomiting attacks and inordinate impact on quality of life. There is considerable symptom overlap with migraine. Due to the lack of evidence-based treatment algorithms, current management strategies vary.

OBJECTIVE

These evidence-based guidelines were formulated to replace prior expert consensus recommendations and to assist patients and clinicians in the management of pediatric CVS.

METHODS

Guidelines were developed by a multidisciplinary panel of experts and a patient representative who prioritized questions relevant to medical providers and patients. The guidelines were developed based on systematic reviews with assessment of certainty of the evidence, following the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach, including indirect evidence from pediatric migraine headache literature to strengthen the recommendations in areas with limited evidence. The panel used GRADE Evidence-to-Decision frameworks to formulate recommendations, which were subject to public comment.

RESULTS

The panel formulated 16 recommendations on the management of pediatric CVS using nonpharmacological and pharmacological approaches. Recommendations were subdivided into abortive (acute) and prophylactic (preventive) interventions.

CONCLUSIONS

A strong recommendation was formulated for the use of anti-migraine agents in aborting CVS episodes in patients with a personal or family history of migraine. Conditional recommendations for abortive CVS therapies included the use of oral and intravenous (IV) 5-hydroxytryptamine 3 (5-HT) and neurokinin 1 (NK-1) receptor antagonists and early presentation when requiring IV intervention. Conditional recommendations for prophylactic CVS therapies included nonpharmacological treatments such as trigger avoidance, supplements, and various biobehavioral and neuromodulation interventions. Conditional recommendations for prophylactic pharmacological therapies included the use of beta-blockers, NK-1 and 5-hydroxytryptamine 2A (5-HT) receptor antagonists, and tricyclic antidepressants. The panel cautioned regarding potential side effects with several pharmacological agents and the use of anti-convulsants only in refractory CVS.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO 2022 CRD42022310108; available at: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022310108.

摘要

背景

周期性呕吐综合征（CVS）是一种因其独特的呕吐发作强度和对生活质量的过度影响而被认可的疾病。它与偏头痛有相当多的症状重叠。由于缺乏循证治疗算法，目前的管理策略各不相同。

目的

制定这些循证指南以取代先前的专家共识建议，并协助患者和临床医生管理儿童CVS。

方法

指南由一个多学科专家小组和一名患者代表制定，他们对与医疗服务提供者和患者相关的问题进行了优先排序。指南是在对证据的确定性进行评估的系统评价基础上制定的，遵循推荐分级评估、制定和评价（GRADE）方法，包括来自儿童偏头痛文献的间接证据，以加强证据有限领域的建议。该小组使用GRADE证据到决策框架来制定建议，并征求公众意见。

结果

该小组就使用非药物和药物方法管理儿童CVS制定了16项建议。建议分为终止性（急性）和预防性（预防）干预措施。

结论

对于有个人或家族偏头痛病史的患者，强烈建议使用抗偏头痛药物来终止CVS发作。终止性CVS治疗的有条件建议包括使用口服和静脉注射（IV）5-羟色胺3（5-HT）和神经激肽1（NK-1）受体拮抗剂，以及在需要静脉干预时尽早就诊。预防性CVS治疗的有条件建议包括非药物治疗，如避免触发因素、补充剂以及各种生物行为和神经调节干预措施。预防性药物治疗的有条件建议包括使用β受体阻滞剂、NK-1和5-羟色胺2A（5-HT）受体拮抗剂以及三环类抗抑郁药。该小组提醒注意几种药物的潜在副作用，以及仅在难治性CVS中使用抗惊厥药。