Document resource
Introduction Cyclical vomiting syndrome (CVS) is a disorder of gut-brain interaction characterised by recurrent episodes of nausea and vomiting, affecting approximately 1% of the general population in the United Kingdom. Guideline-recommended prophylactic therapies, including tricyclic antidepressants and topiramate, are endorsed by the American Neurogastroenterology and Motility Society and a UK protocol published by the University of Nottingham. This study compared prescription rates of guideline-recommended prophylactic medications among patients with CVS and assessed whether these rates differed between those treated at academic versus non-academic centres in the United States of America.Methods We conducted a retrospective cohort study using the TriNetX Research Network, a multicentre electronic health record database. Patients with CVS treated at academic and non-academic centres were compared with respect to prescription of at least one guideline-recommended first-line prophylactic medication (i.e., amitriptyline, nortriptyline, topiramate, and aprepitant). Patients with competing indications for these therapies were excluded: depression, bipolar disorder, epilepsy, malignancy, or those receiving chemotherapy or immunotherapy. Cohorts were propensity matched (1:1) for age, race, and ethnicity.Results After propensity score matching, 17, 800 individuals were included in the academic and non-academic centre groups ( table 1). There was no significant difference in the mean [SD] age (31.8 [20.2] vs 31.8 [19.3], P=0.90) or the distribution of females (56.6% vs 56.5%, P=0.9) in the academic versus the non-academic cohort. A significantly greater proportion of individuals in the academic cohort were of white race compared with the non-academic cohort (60.1% vs 58.7%, P=0.01). Among the 35,600 participants, 9.3% were prescribed at least one of the recommended prophylactic agents for CVS; a greater proportion of patients treated at academic centres received at least one prophylactic medication compared with those treated at non-academic centres (11.12% vs 7.49%; P=0.001) (table 1). Among the four prophylactic agents, amitriptyline was most commonly prescribed to patients with CVS (6.02%), followed by topiramate (1.83%), nortriptyline (1.62%), and aprepitant (1.16%).Conclusion Approximately one in ten patients with CVS receive prophylactic therapy, indicating underutilisation of guideline-recommended treatment, particularly in non-academic settings. These findings highlight the need for improved clinician awareness to optimise care delivery and outcomes.Abstract O59 Table 1Baseline characteristics and medicine usage in the propensity matched cohorts