第470例——反复发作性呕吐

The 470th case: recurrent vomiting

周期性呕吐综合征常合并精神心理障碍,是症状诱发、加重的因素,显著影响患者的生活质量和治疗效果,同时使患者频繁就医、反复进行不必要的检查,造成医疗资源浪费。本例患者20岁女性,自婴幼儿期起反复发作性呕吐,间断给予对症支持治疗效果不佳,经消化内科和心理医学科协同诊治,加用抗抑郁药后症状能够维持缓解。内科医师应注意早期识别功能性胃肠病包括周期性呕吐综合征患者合并的精神心理问题,对难治性患者转诊至心理医学科并启动抗焦虑抑郁治疗。

Patients with cyclic vomiting syndrome usually have comorbid psychological disorders, the trigger and aggravating factors of gastrointestinal symptoms. It may decrease the quality of life and the response to the conventional therapies, bring the patients to seek medical care frequently and perform unnecessary examinations, result in the waste of medical resources. We reported a 20-year-old woman with complaint of recurrent vomiting since infant, and less response to symptomatic and supportive treatment. Her vomiting relieved with antidepressant after consultation with gastroenterological specialist and psychologist. Physicians should pay more attention to recognize the comorbid psychological disorders in patients with functional gastrointestinal disorders (FGIDs), including cyclic vomiting syndrome. It is important to refer the patients with refractory symptoms to the psychologists for further professional evaluation and antidepressants.