American Board of Internal Medicine (ABIM) Certification Practice Exam

What treatment is typically recommended for cyclic vomiting syndrome?

1. Beta-blockers

2. Tricyclic antidepressants

3. Antibiotics

4. Antihistamines

The correct answer is: Tricyclic antidepressants

Cyclic vomiting syndrome (CVS) is characterized by recurrent episodes of severe nausea and vomiting that can last for hours to days, often with symptom-free intervals in between. The management of CVS can be challenging, but tricyclic antidepressants have emerged as a commonly recommended treatment option. Tricyclic antidepressants, such as amitriptyline, have properties that help manage nausea and vomiting, likely due to their ability to modulate neurotransmitters in the central nervous system. They can help decrease the frequency and severity of vomiting episodes in patients with CVS by altering the gastric motility and reducing pain, which can be associated with the episodes. In individuals with CVS, the use of tricyclics is particularly beneficial because they may also address any underlying anxiety or mood disorders that are often present in these patients, contributing to their overall well-being and reducing the psychological burden associated with recurrent vomiting. Other treatment options, such as beta-blockers and antihistamines, may provide some benefit in select cases or for specific triggers, but tricyclic antidepressants are the mainstay therapy due to their direct impact on the symptomatology of cyclic vomiting syndrome. Antibiotics are not indicated in this context, as CVS is not an infectious process requiring