Cyclic vomiting syndrome in pediatric patients

Steve Wartenberg: Welcome back to our ongoing series on cyclic vomiting syndrome with Dr. V. I'm Steve Wartenberg and this is Dr. Thangam Venkatesen. Today's topic is all about the differences between CVS in adults, which is what we've been focusing on in previous episodes, and CVS in younger patients, and how to transition the treatment and care of these adolescents as they become adults. We have a special guest and expert in this area, Dr. Desale Yacob, a pediatric gastroenterologist at Nationwide Children's Hospital. Thanks for joining us, Des.

Desale Yacob, MD: It's great to be here, and thank you for having me.

Steve Wartenberg: Give us an idea of how you two came to collaborate together.

Desale Yacob, MD: Our group has been interested in cyclic vomiting syndrome, and historically, the studies and the initial work in pediatric CVS was done at Nationwide Children's Hospital. Back then, we used to be Columbus Children's Hospital. So Dr. Billy was here and he started his work on CVS and we have always followed his research and what he was doing, even when he was gone from Columbus and was in Milwaukee, and Dr. Venkatesen happens to also be there and she did a lot of the work, most of the work on CVS when it pertains to adult patients. So when we found out that you were heading this way, we were very excited because that meant we will have a collaborator on the other side or in the adult GI. So then we connected and her husband happens to be a pediatric gastroenterologist, so he is-

Steve Wartenberg: At Nationwide?

Desale Yacob, MD: At Nationwide Children's Hospital, so it made it much easier, and I have already had the opportunity to push this forward.

Steve Wartenberg: Now, like I said, we've been talking mostly about adult CVS, so what are some of the differences and maybe even similarities that you see?

Desale Yacob, MD: Most patients start having these episodes early on, in the first 10 years, and they continue to suffer from cyclic vomiting syndrome. Some of them may outgrow it and may stop having the cyclic vomiting syndrome, but a lot of them go on to have cyclic vomiting syndrome as adults, so the presentation and the impact on their daily function in life is very similar. So there is a lot of similarities. The same syndromes, the same problem. It just happens that in pediatrics, they're going to be missing school days, they're going to be missing birthdays or the ability to socialize and hang out with their friends, versus an adult, they're unable to go and work and do all the other things that adults do. So it's the same problem, it just happens to impact different age groups.

Steve Wartenberg: Yeah, growing up can be tough enough when you don't have these medical issues. That's pretty tough for a kid to go through this.

Desale Yacob, MD: And even when you think about it, cyclic vomiting syndrome by the definition is something that is cyclical. It happens every so often. It could happen every four weeks, every two months, every six months. For every time that they have an episode, they're out for a few days. It's not just a one-time episode of throwing up. It's something that starts and could go on for four or five, six days, and that means being out of commission for that long. So it's very impactful and it's very debilitating when it comes to its impact on the child.

Thangam Venkatesen, MD: Like Des says, initially, though it was taught to be a pediatric disorder, it's very clear now that it can present as early as age two, and I do have patients who will be called adult onset.

Steve Wartenberg: A twelve-year-old becomes a 15, 16, 18 year old. That's where you two would meet and talk about it or how will that work?

Desale Yacob, MD: The transition actually starts when you first meet them, and it starts by the fact that you are educating them on their problem, they're educating them on the importance of taking their medications, the names of their medications, and they're actually the ones that will educate their providers to some degree because if they know a lot about their problem, they are able to advocate for themselves and they're able to bring up exactly what has been happening with them and what they need. But then this collaboration, when someone is just as invested in the care of children with cyclic vomiting syndrome, you have that peace and you're able to reach out, make that phone call, which we have done multiple times. "I have this eighteen-year-old who has cyclic vomiting syndrome. I would love for him to come see you," and it's like, "Yeah, I could see him this week, kind of deal. So that is priceless, and you don't really find it everywhere. I think we are fortunate that we have this collaborative system here.

So one of the things, I'm sure you're thinking the same thing.

Thangam Venkatesen, MD: Yeah.

Desale Yacob, MD: One of the things that is really important in caring for children with cyclic vomiting syndrome is that you put together a letter, a letter that says, "So-and-so has cyclic vomiting syndrome, was diagnosed at this age and they are on these medications. They have been worked up and these things have been rolled out. If they show up in your emergency room, please do these following things." So if they have that letter, they could take it anywhere.

Steve Wartenberg: An actual paper letter or an electronic one?

Desale Yacob, MD: An actual paper letter, because our electronic system may not communicate with the electronic system in Nebraska where this young man is going to school.

Thangam Venkatesen, MD: I think we're very fortunate that we have a very strong pediatric GI, neuro GI program at Nationwide, and so in some ways, it's easier for us to make this transition in Columbus. And certainly, adolescents as they become adults, there are multiple challenges. The education piece is very important, and so I think the transition can be challenging, and certainly, I think very close collaboration on both sides is very important, and I think the patient can feel reassured that, "Hey, I do have this other person who's communicating with somebody on the other side." Again, as far as education and training, we cross over, and maybe Des, I'll let you talk a little bit about what's going on with that.

Desale Yacob, MD: Yeah, I think the first thing that happened when you came to Columbus was that we were both invited to give a talk on cyclic vomiting syndrome, the ANMS. The ANMS is American Neurogastro and Motility Society, so they have their annual conference. Those educational opportunities are meant to educate our colleagues.

Steve Wartenberg: These are colleagues who are GI specialist, but not necessarily CVS specialists.

Desale Yacob, MD: Exactly. Just because you're a pediatric gastroenterologist or a gastroenterologist does not mean you have the depth of knowledge about cyclic vomiting syndrome.

Steve Wartenberg:
Okay. Well, thank you both. This has been great, and thank you for watching and stay tuned for more episodes on what you need to know about CVS.
 
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