CVSA members could also be more likely to have a more severe course than others with CVS, although, arguably it is this very subset of CI-1033 clinical trial patients that needs to be

targeted as they utilize enormous health care resources. It is even possible that some respondents do not actually have CVS, but we believe this is unlikely as non-CVS patients would have little Inhibitors,research,lifescience,medical incentive to visit the CVSA Web site and participate in the survey. Also, since this survey only included patients with CVS who had visited an ED, we were unable to ascertain what proportion of CVS patients use the ED or the factors that lead to frequent ED use among patients with CVS. However in the author’s own cohort of over a hundred patients with CVS, 13% of patients presented to the ED > 12 times a year (unpublished data). In an effort to protect the personal health information of these patients we did not attempt to obtain

geographic location. We are unable to comment about other factors Inhibitors,research,lifescience,medical that may be important with regard to ED use among CVS patients such as seasonality or whether these patients were cared for in academic or non-academic centers. Conclusions We conclude that the experience of CVS patients Inhibitors,research,lifescience,medical with acute episodes treated in the ED is suboptimal, with delays in recognition and referral, and infrequent use of patient-specific treatment protocols. Because patients with CVS often present to the ED during acute episodes, ED providers should be familiar with their potential role in this condition: consideration of CVS as a diagnosis in any patient with a history of repeated high-intensity vomiting episodes; Inhibitors,research,lifescience,medical supportive

care with hydration, dextrose containing fluids, and anti-emetic therapy; and initiation of appropriate referrals from the ED to gastroenterologists or specialists with expertise in this disorder. Inhibitors,research,lifescience,medical Care for CVS patients may be improved through education of emergency physicians and staff about this condition and its management. Abbreviations CVS: cyclic vomiting syndrome; ED: emergency department; CVSA: Cyclic Vomiting Syndrome Association Competing interests The authors declare that they have no competing interests. Authors’ contributions TV: Study concept and design, Acquisition of the data, Analysis and interpretation of the data, Drafting of the manuscript, Critical revision of the manuscript. ST: Study concept and Tolmetin design, Drafting of the manuscript, Critical revision of the manuscript, Study supervision. TB, JM, KB and KA: Study concept and design, Critical revision of the manuscript, Drafting of the manuscript. WJH: Study concept and design, Critical revision of the manuscript. NK: Study design, Critical revision of the manuscript. BL:Study concept and design, Administrative, technical, or material support, Critical revision of the manuscript.