Abstract：
BACKGROUND: An increasing number of studies have explored the clinical features, epidemiology, pathophysiology, and management of cyclic vomiting syndrome (CVS). CVS is common in adults and children and negatively impacts patients, families, and the healthcare system. A related condition, cannabinoid hyperemesis syndrome (CHS), has been a focus of interest in the lay press and published literature.
OBJECTIVE: Clinical presentations of CVS have been defined by small series and expert opinion, but recent prospective studies are refining our understanding of the spectrum of emetic episodes and the breadth of comorbid conditions. Large cross-sectional population analyses are clarifying CVS prevalence and factors related to age, ethnicity, and geographic region. CVS pathophysiology is multifactorial with contributions from migraines, dysautonomia, endogenous cannabinoids, mitochondrial dysfunction, genetic abnormalities, and rapid gastric emptying. CVS treatment relies on antiemetics and antimigraine therapies to abort acute episodes coupled with prophylactic regimens employing neuromodulators and antiepileptics. CHS represents a challenge partly because of difficulties in achieving sustained cannabis abstinence. Benefits of other therapies in CHS remain poorly defined. Several areas warrant further scrutiny including better identification of CVS triggers and characterization of different CVS subsets including those with frequent severe episodes, refined description of epidemiology to allow targeting of populations predisposed to CVS development, rigorous definition of pathogenic factors to provide a foundation for exploratory studies of novel therapies, and conduct of controlled trials by multicenter collaborations to confirm benefits of existing and new therapies in development. Progress in these areas will be facilitated by generous governmental and industry support.
OBJECTIVE: Clinical presentations of CVS have been defined by small series and expert opinion, but recent prospective studies are refining our understanding of the spectrum of emetic episodes and the breadth of comorbid conditions. Large cross-sectional population analyses are clarifying CVS prevalence and factors related to age, ethnicity, and geographic region. CVS pathophysiology is multifactorial with contributions from migraines, dysautonomia, endogenous cannabinoids, mitochondrial dysfunction, genetic abnormalities, and rapid gastric emptying. CVS treatment relies on antiemetics and antimigraine therapies to abort acute episodes coupled with prophylactic regimens employing neuromodulators and antiepileptics. CHS represents a challenge partly because of difficulties in achieving sustained cannabis abstinence. Benefits of other therapies in CHS remain poorly defined. Several areas warrant further scrutiny including better identification of CVS triggers and characterization of different CVS subsets including those with frequent severe episodes, refined description of epidemiology to allow targeting of populations predisposed to CVS development, rigorous definition of pathogenic factors to provide a foundation for exploratory studies of novel therapies, and conduct of controlled trials by multicenter collaborations to confirm benefits of existing and new therapies in development. Progress in these areas will be facilitated by generous governmental and industry support.
摘要：
背景：越来越多的研究探索了临床特征，流行病学,病理生理学,和周期性呕吐综合征（CVS）的管理。CVS在成人和儿童中很常见，对患者产生负面影响，家庭,和医疗保健系统。一个相关的情况，大麻素剧吐综合征（CHS），一直是非专业媒体和出版文献的兴趣焦点。
目的：CVS的临床表现已由小系列和专家意见定义，但是最近的前瞻性研究正在完善我们对呕吐发作的范围和合并症的广度的理解。大规模的横断面人群分析澄清了CVS患病率和与年龄相关的因素，种族,和地理区域。CVS病理生理学是多因素的，有偏头痛的作用，自主神经失调,内源性大麻素，线粒体功能障碍，遗传异常，和快速的胃排空。CVS治疗依靠止吐药和抗偏头痛疗法来中止急性发作，并结合使用神经调节剂和抗癫痫药的预防方案。CHS是一项挑战，部分原因是难以实现持续的大麻禁欲。CHS中其他疗法的益处仍然不明确。几个领域需要进一步审查，包括更好地识别CVS触发因素和表征不同的CVS子集，包括那些频繁的严重发作，流行病学的精细描述，以允许针对倾向于CVS发展的人群，严格定义致病因素，为新疗法的探索性研究提供基础，并通过多中心合作进行对照试验，以确认现有和新疗法在开发中的益处。政府和工业界的慷慨支持将促进这些领域的进展。
目的：CVS的临床表现已由小系列和专家意见定义，但是最近的前瞻性研究正在完善我们对呕吐发作的范围和合并症的广度的理解。大规模的横断面人群分析澄清了CVS患病率和与年龄相关的因素，种族,和地理区域。CVS病理生理学是多因素的，有偏头痛的作用，自主神经失调,内源性大麻素，线粒体功能障碍，遗传异常，和快速的胃排空。CVS治疗依靠止吐药和抗偏头痛疗法来中止急性发作，并结合使用神经调节剂和抗癫痫药的预防方案。CHS是一项挑战，部分原因是难以实现持续的大麻禁欲。CHS中其他疗法的益处仍然不明确。几个领域需要进一步审查，包括更好地识别CVS触发因素和表征不同的CVS子集，包括那些频繁的严重发作，流行病学的精细描述，以允许针对倾向于CVS发展的人群，严格定义致病因素，为新疗法的探索性研究提供基础，并通过多中心合作进行对照试验，以确认现有和新疗法在开发中的益处。政府和工业界的慷慨支持将促进这些领域的进展。
