Management of Pediatric Cyclic Vomiting Syndrome (NASPGHAN, 2025)
Editorial Note: These are some of the highlights of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.
Guidelines on pediatric cyclic vomiting syndrome (CVS) were published in April 2025 by the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition in the Journal of Pediatric Gastroenterology and Nutrition .[1]
Abortive Treatment
Antimigraine agents, such as triptans and nonsteroidal anti-inflammatory drugs, are strongly recommended for treating acute episodes of pediatric CVS in patients who have a personal or family history of migraine.
Other options for treating acute CVS episodes in children and adolescents are 5-hydroxytryptamine 3 and neurokinin 1 (NK-1) receptor antagonists.
Administration of intravenous fluids is suggested for patients who do not respond to outpatient abortive therapy.
Prophylactic Treatment
To prevent CVS episodes, suggested nonpharmacologic approaches are trigger avoidance and the use of dietary supplements, such as coenzyme Q10, riboflavin, and magnesium.
Medications that are suggested for prophylaxis include beta-blockers and NK-1 and 5-hydroxytryptamine 2A receptor antagonists. Tricyclic antidepressants may be considered for patients with frequent and severe symptoms.
Because of their adverse effects, anticonvulsants are generally not recommended for prophylaxis and should be reserved for patients who have refractory CVS.
For more information, please go to Cyclic Vomiting Syndrome.
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Medscape
3 days ago
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Management of Pediatric Cyclic Vomiting Syndrome (NASPGHAN, 2025)
Editorial Note: These are some of the highlights of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference. Guidelines on pediatric cyclic vomiting syndrome (CVS) were published in April 2025 by the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition in the Journal of Pediatric Gastroenterology and Nutrition .[1] Abortive Treatment Antimigraine agents, such as triptans and nonsteroidal anti-inflammatory drugs, are strongly recommended for treating acute episodes of pediatric CVS in patients who have a personal or family history of migraine. Other options for treating acute CVS episodes in children and adolescents are 5-hydroxytryptamine 3 and neurokinin 1 (NK-1) receptor antagonists. Administration of intravenous fluids is suggested for patients who do not respond to outpatient abortive therapy. Prophylactic Treatment To prevent CVS episodes, suggested nonpharmacologic approaches are trigger avoidance and the use of dietary supplements, such as coenzyme Q10, riboflavin, and magnesium. Medications that are suggested for prophylaxis include beta-blockers and NK-1 and 5-hydroxytryptamine 2A receptor antagonists. Tricyclic antidepressants may be considered for patients with frequent and severe symptoms. Because of their adverse effects, anticonvulsants are generally not recommended for prophylaxis and should be reserved for patients who have refractory CVS. For more information, please go to Cyclic Vomiting Syndrome.
Miami Herald
3 days ago
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Two patients faced chemo. The one survivor demanded a test to see if it was safe
JoEllen Zembruski-Ruple, while in the care of New York City's renowned Memorial Sloan Kettering Cancer Center, swallowed the first three chemotherapy pills to treat her squamous cell carcinoma on Jan. 29, her family members said. They didn't realize the drug could kill her. Six days later, Zembruski-Ruple went to Sloan Kettering's urgent care department to treat sores in her mouth and swelling around her eyes. The hospital diagnosed oral yeast infection and sent her home, her sister and partner said. Two days later, they said, she returned in agony — with severe diarrhea and vomiting — and was admitted. 'Enzyme deficiency,' Zembruski-Ruple texted a friend. The 65-year-old, a patient advocate who had worked for the National Multiple Sclerosis Society and other groups, would never go home. Covered in bruises and unable to swallow or talk, she eventually entered hospice care and died March 25 from the very drug that was supposed to extend her life, said her longtime partner, Richard Khavkine. Zembruski-Ruple was deficient in the enzyme that metabolizes capecitabine, the chemotherapy drug she took, said Khavkine and Susan Zembruski, one of her sisters. Zembruski-Ruple was among about 1,300 Americans each year who die from the toxic effects of that pill or its cousin, the IV drug fluorouracil known as 5-FU. Doctors can test for the deficiency — and then either switch drugs or lower the dosage if patients have a genetic variant that carries risk. The FDA approved an antidote in 2015, but it's expensive and must be administered within four days of the first chemotherapy treatment. Newer cancer drugs sometimes include a companion diagnostic to determine whether a drug works with an individual patient's genetics. But 5-FU went on the market in 1962 and sells for about $17 a dose; producers of its generic aren't seeking approval for toxicity tests, which typically cost hundreds of dollars. Doctors have only gradually understood which gene variants are dangerous in which patients, and how to deal with them, said Alan Venook, a colorectal and liver cancer specialist at the University of California-San Francisco. By the time Zembruski-Ruple's doctors told her she had the deficiency, she had been on the drug for eight days, said Khavkine, who watched over his partner with her sister throughout the seven-week ordeal. Khavkine said he 'would have asked for the test' if he had known about it, but added 'nobody told us about the possibility of this deficiency.' Zembruski-Ruple's sister also said she wasn't warned about the fatal risks of the chemo, or told about the test. 'They never said why they didn't test her,' Zembruski said. 'If the test existed, they should have said there is a test. 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But Richard Pazdur, the FDA's top cancer expert, said it was time to end the debate and commence testing, even if the results could be ambiguous. 'If you don't have the information, how do you have counseling?' he asked. Two months later, Venook's panel changed course. The price of tests has fallen below $300 and results can be returned as soon as three days, Venook said. Doubts about the FDA's ability to further confront the issue spurred the panel's change of heart, he said. 'I don't know if FDA is going to exist tomorrow,' Venook told KFF Health News. 'They're taking a wrecking ball to common sense, and that's one of the reasons we felt we had to go forward.' On May 20, the FDA posted a Federal Register notice seeking public input on the issue, a move that suggested it was considering further action. Venook said he often tests his own patients, but the results can be fuzzy. If the test finds two copies of certain dangerous gene variants in a patient, he avoids using the drug. 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