Cardiac vagal regulation is impeded in children with cyclic vomiting syndrome
Abstract
Introduction The pathophysiology underlying cyclic vomiting syndrome (CVS) remains undefined. Scant data and distinct clinical features point to altered autonomic nervous system function. Autonomic signaling can be noninvasively assessed through cardiac indices of parasympathetic vagal regulation, which is reduced in children with disorders of gut-brain interaction. We aimed to examine dynamic cardiac vagal regulation in children with CVS compared with that in healthy controls (HC). Methods A total of 31 children with CVS evaluated in a tertiary care CVS center and 66 HC (ages 8-18 years) underwent cardiac autonomic function assessment. Electrocardiogram recordings were conducted during 3-minute sit/stand/sit posture challenges. The electrocardiogram-derived variables heart period, respiratory sinus arrhythmia (RSA), and vagal efficiency (VE) were analyzed using linear regression and mixed-effects modeling. Results After exclusion of medication confounders, 23 patients with CVS were included in analyses. Both groups were comparable in age, gender, and body mass index. Compared with HC, children with CVS had shorter heart period (standardized mean difference range: 1.15-1.22, all P values Discussion Children with CVS have suboptimal parasympathetic autonomic regulation compared with HC, indexed by reduced RSA and VE, even during their interepisodic well phase. Abnormal vagal modulation may underlie CVS pathophysiology, comorbidities, and triggers. Assessing VE during posture s…
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Gut symptoms may be a product of a dampened ventral vagal circuit resulting in vulnerability to the dorsal vagal circuit being recruited in defense.
“Potentially, gut symptoms may be a product of a dampened ventral vagal circuit that resulted in a vulnerability to the dorsal vagal circuit being recruited in defense [68,81,82].”
From The vagal paradox: A polyvagal solution (2023) · cites this paper as [81]
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Self-citation
- Authors
- Kolacz, J., Kovacic, K., Dang, L., Li, B. U. K., Lewis, G. F., & Porges, S. W.
- Affiliations
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA;
- Medical College of Wisconsin (US)
- The Ohio State University Wexner Medical Center (US)
- Indiana University Bloomington (US)
- University of North Carolina at Chapel Hill (US)
- Corresponding author
- Kovacic, Katja
- Venue
- American Journal of Gastroenterology
- Published
- 2023-01-30
- Volume
- 118
- Issue
- 7
- Pages
- 1268-1275
- ISSN
- 0002-9270 (ISSN-L)
- 1572-0241
- OpenAlex
- W4318574214
- Cited by
- 25
- References
- 48
- Citations by year
- 2026: 5 · 2025: 7 · 2024: 8 · 2023: 5
- FWCI
- 4.91
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The American Journal of Gastroenterology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Life Sciences › Neuroscience › Neurology › Vagus Nerve Stimulation Research
- Keywords
- cyclic vomiting syndrome, respiratory sinus arrhythmia, heart period, children, gut-brain axis, autonomic nervous system
- MeSH terms
- Arrhythmia, Sinus, Autonomic Nervous System, Child, Heart, Heart Rate, Humans, Vagus Nerve, Vomiting
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