Differentiating Cyclic From Chronic Vomiting Patterns in Children: Quantitative Criteria and Diagnostic Implications

Abstract

Objective. To establish criteria to differentiate two patterns of vomiting and to identify the predominant diagnoses for each one. Methods. All children 2 to 18 years of age referred to a pediatric gastroenterology service who presented with recurrent vomiting (three episodes of vomiting within a 3-month period) as a primary complaint from 1985 to 1991 were retrospectively reviewed (n = 106). The vomiting pattern (emeses per hour and episodes per month), diagnostic studies, and therapeutic responses were compared by Mann-Whitney U and x2 tests. Results. Based on the criteria of peak intensity (four or more emeses per hour) and frequency (nine or fewer episodes per month), two subgroups were differentiated: children with a cyclic pattern (n = 34), who vomited at a higher peak intensity (12.6 ± 1.6 vs 1.5 ± 0.1 emeses per hour) but at a lower frequency (1.9 ± 4.8 vs 36.6 ± 0.3 episodes per month) than those with a chronic pattern (n = 72). Among children with a cyclic pattern, nongastrointestinal (65%) causes, especially abdominal migraine, predominated over gastrointestinal ones (12%), whereas among those with a chronic pattern, gastrointestinal disorders (76%), especially peptic and infectious disorders, predominated over nongastrointestinal ones (10%). Conclusions. On the basis of quantitative historical criteria, children with recurrent vomiting can be classified into two subgroups that seem to be clinically and etiologically distinct. Abdominal migraine was the dominant diagnosis in those with cyclic vomiting, whereas peptic and infectious gastrointestinal disorders predominated in those with chronic vomiting. This differentiation between cyclic and chronic patterns of vomiting may be a useful diagnostic clue to the clinician.