Improvement on Persistent Vomiting after Administration of Amitriptyline: Case Report from Limited Resources Setting in East Nusa Tenggara, Indonesia

Background: Cyclic vomiting syndrome (CVS) is a functional gastrointestinal disorder (FGID), characterized by recurring episodes of intense vomiting accompanied by nausea and headache followed by asymptomatic period between the episodes. It remains under-recognized despite its known prevalence, which is 1.9% in school-age children worldwide. In Indonesia, neither the prevalence nor the incidence of cyclic vomiting syndrome has been reported.

Objective: To emphasize the challenges of diagnosing persistent vomiting in children living in rural area.

Methods: This is a case report of pediatric cyclic vomiting syndrome in a local, limited resource private hospital in Manggarai Regency, East Nusa Tenggara, Indonesia. A 10-year-old girl was admitted due to her sixth episode of vomiting over the past six weeks. She was hospitalized a few times due to her episodes of vomiting and was diagnosed with gastroesophageal reflux disease (GERD) earlier. Her episodes were characterized by vomiting every 30-60 minutes at first, gradually declining over 3-4 days, and recurring in about 6-7 days. All the available tests results were unremarkable. The diagnosis was established based on the criteria of The International Classification of Headache Disorder 2004 (ICHD-II), excluding possible etiologies using the only available resources in our location, and resolution of symptoms after administration of amitriptyline. She was discharged with continuous amitriptyline for 2 weeks and went into remission.

Conclusion: CVS should always be considered in repeated vomiting in children. When recurrent vomiting is suspected as CVS in limited resources settings, diagnostic therapy should immediately be performed. Recognition of this disorder is important to establish prompt diagnosis and convenient intervention, thus improving the quality of life of the children.