Background and Aims Cyclic vomiting syndrome, a disorder of episodic nausea and vomiting similar to migraine headaches, can be associated with a number of underlying disorders including diabetes mellitus. The frequency and detailed characteristics of CVS in diabetic patients with GI symptoms is unknown. To our knowledge, this is the first study to address the subset of patients with cyclic vomiting syndrome in a population of diabetic gastroparetics and compare data on the two groups.
Methods We investigated 67 consecutive patients that presented to our office with the clinical diagnosis of diabetic gastroparesis. These patients were placed into two groups based on the presence or lack of cyclic symptoms. 38 patients carry both a diagnosis of diabetic gastroparesis and the presence of cyclic symptoms while the remaining 29 patients lack cyclic symptoms and were used as the control. Patients were stratified by demographic variables, duration of diabetes and gastroparesis illness, personal or family history of migraine headache, insulin dependence, total symptom score when symptomatic, and standardized gastric emptying study at 1, 2, and 4 hours.
Results 56% of our diabetic gastroparetic population had cyclic symptoms. The two groups were similar in regards to age, sex, duration of diabetes, duration of gastroparesis symptoms, insulin use, and total symptomatic score when symptomatic. There was statistical significance in the two groups that showed differences in the following: migraine headache (47.4% vs. 20.7%, p = .02), gastric emptying study at 1 hour (84.1% vs. 59.9%, p = .0187), and the repeated measures analysis of variance (area under the curve equivalent, p = .0302).
Conclusions The study suggests that a sizeable percentage of patients with diabetic gastroparesis have cyclic vomiting syndrome like episodes. These patients have a higher incidence of migraine headaches and a greater delay in gastric emptying than other diabetic gastroparetic patients. The existence of this cyclic vomiting syndrome subset and the question of this significant difference being either a manifestation of, or a response to, an underlying cause of diabetic gastroparesis may warrant further evaluation.
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