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Medscape
04-06-2025
- Health
- Medscape
Management of Pediatric Cyclic Vomiting Syndrome (NASPGHAN, 2025)
Editorial Note: These are some of the highlights of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference. Guidelines on pediatric cyclic vomiting syndrome (CVS) were published in April 2025 by the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition in the Journal of Pediatric Gastroenterology and Nutrition .[1] Abortive Treatment Antimigraine agents, such as triptans and nonsteroidal anti-inflammatory drugs, are strongly recommended for treating acute episodes of pediatric CVS in patients who have a personal or family history of migraine. Other options for treating acute CVS episodes in children and adolescents are 5-hydroxytryptamine 3 and neurokinin 1 (NK-1) receptor antagonists. Administration of intravenous fluids is suggested for patients who do not respond to outpatient abortive therapy. Prophylactic Treatment To prevent CVS episodes, suggested nonpharmacologic approaches are trigger avoidance and the use of dietary supplements, such as coenzyme Q10, riboflavin, and magnesium. Medications that are suggested for prophylaxis include beta-blockers and NK-1 and 5-hydroxytryptamine 2A receptor antagonists. Tricyclic antidepressants may be considered for patients with frequent and severe symptoms. Because of their adverse effects, anticonvulsants are generally not recommended for prophylaxis and should be reserved for patients who have refractory CVS. For more information, please go to Cyclic Vomiting Syndrome.
Medscape
04-06-2025
- Health
- Medscape
Fitness Levels Impaired in Patients With Paediatric IBD
Patients with paediatric inflammatory bowel disease (IBD) exhibited lower cardiorespiratory and neuromuscular fitness than healthy matched control participants. Higher body mass index (BMI) for children and adolescents was negatively associated with cardiorespiratory fitness, while the use of any biologic medication was positively associated. METHODOLOGY: This cross-sectional case-control study assessed cardiorespiratory and neuromuscular fitness in patients with paediatric IBD aged 6-17 years. This study included 73 patients with paediatric IBD (mean age, 13 years; 56.2% girls; 31 with Crohn's disease [CD]; 42 with ulcerative colitis [UC] and IBD unidentified) from two tertiary centres in Finland and 73 age- and sex-matched healthy control children from an ongoing study and registry. Clinical disease activity was determined using the Pediatric Ulcerative Colitis Activity Index for UC and using the Pediatric Crohn's Disease Activity Index for CD along with the Physician's Global Assessment, and physical activity was evaluated using a questionnaire covering various activities over the past 12 months. Cardiorespiratory fitness was measured with a maximal exercise test on a cycle ergometer. Peak oxygen uptake (VO2peak) and maximal workload (Wmax) divided by body weight were considered as measures of cardiorespiratory fitness. Neuromuscular fitness was also assessed using various tests. TAKEAWAY: All patients with CD were in remission or had mild disease activity, whereas 69% of patients with UC were in remission and only one had a severe disease. Patients with paediatric IBD had significantly lower cardiorespiratory fitness, with lower Wmax/kg ( P = .007) and VO2peak/kg ( P < .001) than control participants. = .007) and VO2peak/kg ( < .001) than control participants. Neuromuscular fitness was also reduced in patients with paediatric IBD, with lower performance than control participants in sit-up, long jump, and hand grip strength tests ( P = .001 for all). = .001 for all). In the multivariate analysis, higher age‐ and sex‐adjusted BMI for children and adolescents was associated with lower Wmax/kg and VO2peak/kg ( P < .001 for both), while the use of any biologic medication was linked to higher Wmax/kg ( P = .025) and VO2peak/kg ( P = .006). IN PRACTICE: "Lower physical fitness has been associated with poorer disease control, impaired quality of life, and increased risk of cardiovascular diseases in PIBD [paediatric IBD]. This emphasizes the importance of assessing and improving physical fitness in these patients as a part of their multidisciplinary treatment," the authors wrote. SOURCE: This study was led by Saija Kantanen, Tampere University Hospital, Tampere, Finland. It was published online on May 30, 2025, in the Journal of Pediatric Gastroenterology and Nutrition . LIMITATIONS: Some data from the control group were collected previously, and changes in physical activity levels over time may have affected the results. Additionally, the duration of the disease in patients was short, and the design was cross-sectional. DISCLOSURES: This study was supported by the Foundation for Pediatric Research; the State Funding for University-level Health Research, Tampere University Hospital, and Wellbeing Services County of Pirkanmaa; the Päivikki and Sakari Sohlberg Foundation; and the Finnish Foundation for Cardiovascular Research. The authors declared having no relevant conflicts of interest.
