What is the role of imaging studies in the workup of cyclic vomiting syndrome?

Updated: Oct 31, 2018
  • Author: Thangam Venkatesan, MD; Chief Editor: Carmen Cuffari, MD  more...
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Answer

Imaging studies may be indicated as follows.

In evaluation for GI diseases, upper GI (UGI) radiography with small-bowel follow-through (SBFT), esophagogastroduodenoscopy (EGD), abdominal ultrasonography (US), or computed tomography (CT) and gastric-emptying scanning may provide definitive information. [48] In evaluation for neurologic or otolaryngologic diseases, sinus CT or brain MRI should be considered. CT scans may not adequately visualize the subtentorial region. Obstructive renal disease can be revealed with renal ultrasonography or CT imaging.

With a broad array of possible diagnoses and possible diagnostic approaches, an extensive evaluation may appear cumbersome. Olson and Li reported that UGI radiography followed by empiric antimigraine therapy for 2 months is the most cost-effective approach ($1600) for the initial treatment of recurrent episodic vomiting in children ($3020 for extensive diagnostic evaluation, and $1830 for empiric treatment alone). [49]

Until prospective trials are conducted, the authors’ current approach generally includes initial blood and urine screens, including metabolic screening and UGI radiography at initial presentation.

The presence of specific symptoms such as hematemesis, bilious vomiting, persistent headache, flank pain, acidosis, or uncharacteristically severe or atypical vomiting episodes should raise the clinician’s index of suspicion of an underlying disorder and should warrant a prompt and more extensive or repeat evaluation. [49] The 4 tests with the highest yield are endoscopy, sinus radiography or CT imaging, small-bowel radiography, and head CT or MRI. [48]


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