Autonomic nerve function in adult patients with cyclic vomiting syndrome.
Level 4 - case-series / case-control
Uncontrolled case series of adult patients with cyclic vomiting syndrome
PubMed 21323793 · doi:10.1111/j.1365-2982.2011.01679.x
What was done
Autonomic nerve function and gastric emptying were evaluated in 22 adults (18 female, mean age 35 ± 11 years) meeting Rome III criteria for cyclic vomiting syndrome (CVS). Sympathetic function was assessed via postural changes in heart rate and blood pressure, along with sympathetic skin responses in the hand and foot. Parasympathetic function was measured via heart rate response to deep breathing, Valsalva maneuver, and postural indices. Gastric emptying was evaluated using a 4-hour standard isotope-labeled meal test.
What was found
Of 21 patients who completed testing, 9 (43%) had autonomic abnormalities (21 total abnormalities detected) and 12 had normal results. Sympathetic dysfunction was observed in 7 patients (absent skin response in foot and/or hand); orthostatic tachycardia occurred in 2 patients (mean heart rate increase 39 beats/min) and blood pressure decline in 3 patients (mean drop 30/14 mmHg). Parasympathetic dysfunction occurred in 6 patients (abnormal deep breathing response, expiration/inspiration index <1.25). Rapid gastric emptying occurred in 12 patients (57%), but abnormal autonomic function frequency did not differ significantly between rapid and non-rapid emptying subgroups.
Why it matters
This study provides evidence that autonomic dysfunction—primarily sympathetic—is present in a substantial portion of adult CVS patients, suggesting shared pathophysiologic features with pediatric CVS.
Limits
The study is a single-center case series of only 22 patients with no healthy control group. The abstract does not specify whether testing occurred during active vomiting episodes or interictal periods, nor does it account for potential confounding medications.
Cited by
- supports The autonomic nervous system is dysregulated in patients suffering from gastrointestinal disorders such as chronic vomiting syndromes.