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