North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition 2025 guidelines for management of cyclic vomiting syndrome in children
Bibliographic record
Abstract
Abstract Background Cyclic vomiting syndrome (CVS) is a disorder recognized for its unique intensity of vomiting attacks and inordinate impact on quality of life. There is considerable symptom overlap with migraine. Due to the lack of evidence‐based treatment algorithms, current management strategies vary. Objective These evidence‐based guidelines were formulated to replace prior expert consensus recommendations and to assist patients and clinicians in the management of pediatric CVS. Methods Guidelines were developed by a multidisciplinary panel of experts and a patient representative who prioritized questions relevant to medical providers and patients. The guidelines were developed based on systematic reviews with assessment of certainty of the evidence, following the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach, including indirect evidence from pediatric migraine headache literature to strengthen the recommendations in areas with limited evidence. The panel used GRADE Evidence‐to‐Decision frameworks to formulate recommendations, which were subject to public comment. Results The panel formulated 16 recommendations on the management of pediatric CVS using nonpharmacological and pharmacological approaches. Recommendations were subdivided into abortive (acute) and prophylactic (preventive) interventions. Conclusions A strong recommendation was formulated for the use of anti‐migraine agents in aborting CVS episodes in patients with a personal or family history of migraine. Conditional recommendations for abortive CVS therapies included the use of oral and intravenous (IV) 5‐hydroxytryptamine 3 (5‐HT3) and neurokinin 1 (NK‐1) receptor antagonists and early presentation when requiring IV intervention. Conditional recommendations for prophylactic CVS therapies included nonpharmacological treatments such as trigger avoidance, supplements, and various biobehavioral and neuromodulation interventions. Conditional recommendations for prophylactic pharmacological therapies included the use of beta‐blockers, NK‐1 and 5‐hydroxytryptamine 2A (5‐HT2A) receptor antagonists, and tricyclic antidepressants. The panel cautioned regarding potential side effects with several pharmacological agents and the use of anti‐convulsants only in refractory CVS. Systematic Review Registration PROSPERO 2022 CRD42022310108; available at: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022310108 .
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.015 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.004 | 0.003 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.004 |
| Insufficient payload (model declined to judge) | 0.013 | 0.005 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".