January 2016 Quiz 2

Q2: ANSWER: B

Critique

Cyclic vomiting syndrome (CVS) is characterized by typical vomiting episodes regarding onset and duration, which usually occur three or more times per year. Typically, there is absence of nausea and vomiting between episodes. CVS affects both genders; however, there does appear to be a hormonal influence in women, with 57% of women with CVS reporting an association with menses. Tricyclic antidepressants have been shown to be effective as a prophylactic agent in several small studies with amitriptyline being the most commonly studied medication. Namin and colleagues investigated 31 adult patients who fit the Rome II criteria for CVS. Twenty-seven patients were treated with amitriptyline and completed scales for anxiety, depression, and symptoms. Eighty-four percent suffered from an anxiety disorder, and 78% revealed depression. The patients were started on a low dose of amitriptyline and titrated up to a goal of 1 mg/kg per day. After an average of 16.8 months, the Visual Analog Scale revealed a significant mean improvement (P less than .05) in severity of their symptoms by 6.1. Additionally, there was 78% improvement in vomiting, 75.3% improvement in pain, and 69.3% improvement in nausea.

Choice A: Domperidone has not been found to be beneficial in CVS.

Choice C: Metoclopramide does not decrease symptom recurrence in CVS.

Choice D: Selective serotonin reuptake inhibitors have not been shown in clinical trials to decrease CVS recurrence.

Choice E: Proton pump inhibitors can help as an adjunct to suppress gastric secretion. However, they do not decrease the frequency of CVS episodes.

References

1. Namin F., et al. Clinical, psychiatric, and manometric profile of cyclic vomiting syndrome in adults and response to tricyclic therapy. Neurogastroenterol Motil. 2007;19:196-202.

Q2: ANSWER: B

Critique

Cyclic vomiting syndrome (CVS) is characterized by typical vomiting episodes regarding onset and duration, which usually occur three or more times per year. Typically, there is absence of nausea and vomiting between episodes. CVS affects both genders; however, there does appear to be a hormonal influence in women, with 57% of women with CVS reporting an association with menses. Tricyclic antidepressants have been shown to be effective as a prophylactic agent in several small studies with amitriptyline being the most commonly studied medication. Namin and colleagues investigated 31 adult patients who fit the Rome II criteria for CVS. Twenty-seven patients were treated with amitriptyline and completed scales for anxiety, depression, and symptoms. Eighty-four percent suffered from an anxiety disorder, and 78% revealed depression. The patients were started on a low dose of amitriptyline and titrated up to a goal of 1 mg/kg per day. After an average of 16.8 months, the Visual Analog Scale revealed a significant mean improvement (P less than .05) in severity of their symptoms by 6.1. Additionally, there was 78% improvement in vomiting, 75.3% improvement in pain, and 69.3% improvement in nausea.

Choice A: Domperidone has not been found to be beneficial in CVS.

Choice C: Metoclopramide does not decrease symptom recurrence in CVS.

Choice D: Selective serotonin reuptake inhibitors have not been shown in clinical trials to decrease CVS recurrence.

Choice E: Proton pump inhibitors can help as an adjunct to suppress gastric secretion. However, they do not decrease the frequency of CVS episodes.

References

1. Namin F., et al. Clinical, psychiatric, and manometric profile of cyclic vomiting syndrome in adults and response to tricyclic therapy. Neurogastroenterol Motil. 2007;19:196-202.

Q2: ANSWER: B

Critique

Cyclic vomiting syndrome (CVS) is characterized by typical vomiting episodes regarding onset and duration, which usually occur three or more times per year. Typically, there is absence of nausea and vomiting between episodes. CVS affects both genders; however, there does appear to be a hormonal influence in women, with 57% of women with CVS reporting an association with menses. Tricyclic antidepressants have been shown to be effective as a prophylactic agent in several small studies with amitriptyline being the most commonly studied medication. Namin and colleagues investigated 31 adult patients who fit the Rome II criteria for CVS. Twenty-seven patients were treated with amitriptyline and completed scales for anxiety, depression, and symptoms. Eighty-four percent suffered from an anxiety disorder, and 78% revealed depression. The patients were started on a low dose of amitriptyline and titrated up to a goal of 1 mg/kg per day. After an average of 16.8 months, the Visual Analog Scale revealed a significant mean improvement (P less than .05) in severity of their symptoms by 6.1. Additionally, there was 78% improvement in vomiting, 75.3% improvement in pain, and 69.3% improvement in nausea.

Choice A: Domperidone has not been found to be beneficial in CVS.

Choice C: Metoclopramide does not decrease symptom recurrence in CVS.

Choice D: Selective serotonin reuptake inhibitors have not been shown in clinical trials to decrease CVS recurrence.

Choice E: Proton pump inhibitors can help as an adjunct to suppress gastric secretion. However, they do not decrease the frequency of CVS episodes.

References

1. Namin F., et al. Clinical, psychiatric, and manometric profile of cyclic vomiting syndrome in adults and response to tricyclic therapy. Neurogastroenterol Motil. 2007;19:196-202.