Natural history and complications

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There are limited data on the natural history of CVS. From our data of over 440 patients, the median age of resolution of symptoms is 9.9 years and one-third (28%) of the children have thus far undergone the transition from CVS into migraine headaches as they reached early adolescence. Our projection analysis estimates that 75% of patients will develop migraine headaches by the of age 18. Other long-term studies have shown that up to half of CVS patients will continue with CVS or migraine headaches.17 Several studies have noted the mean duration of illness to be around 6 years,13,38 but in our cohort, the younger the age of onset, the longer the duration. Also, 5% of patients will progress through all three phases of periodic disease including CVS to abdominal migraine and finally to migraine headaches.13

Complications and medical morbidity include iatrogenic tests and interventions from the mis-diagnoses that were often applied to recurrent vomiting. Most are mislabeled as gastroenteritis, gastroesophageal reflux and food poisoning, and are treated in urgent care settings. Some with severe pain, bilious vomiting and intractability have undergone inappropriate laparotomy, appendectomy, cholecystectomy and Nissen fundoplica-tion. Others have been labeled with psychiatric disorders including bulimia and psychogenic vomiting, and have been hospitalized on psychiatric wards, and a few parents have been suspected of Munchausen-by-proxy.39

Complications can also occur from the frequent and often severe episodes of vomiting that occur with CVS. Dehydration and electrolyte disturbances are common and intravenous rehydration is required in 58% of patients, which can be compared to less than 1% in rotavirus infection. Hematemesis can occur towards the end of attacks and is usually related to prolapse gastropathy or Mallory-Weiss tears.11 Although not common, frequent vomiting can lead to secondary peptic injury. Aspiration and growth failure fortunately seem to be uncommon occurrences.

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