North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition 2025 guidelines on the diagnosis of cyclic vomiting syndrome in children

OBJECTIVES: Cyclic vomiting syndrome (CVS) is characterized by distinct clinical features and symptom overlap with migraine disorders. Cannabinoid hyperemesis syndrome (CHS) is a related condition with similar symptom expression. Due to a lack of diagnostic biomarkers, there is a need for optimal symptom-based diagnostic criteria. These evidence-based guidelines from the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) were formulated to assist clinicians in the diagnosis of pediatric CVS. METHODS: The NASPGHAN council approved a multidisciplinary content expert panel. The panel prioritized a set of clinical questions and outcomes. The recommendations were developed based on a systematic review that applied the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. To formulate the recommendations and suggested diagnostic algorithm, the panel linked decisions to current evidence and utilized the Delphi Method for expert consensus when available literature was insufficient. A systematic review of available research evidence informed the summary on pediatric CHS. A separate document provides GRADE-based treatment guidelines for pediatric CVS. RESULTS: The panel voted and agreed on one prioritized recommendation on the utility of diagnostic screening tests for pediatric CVS and updated the past consensus-based diagnostic algorithm. A consensus-based clinical approach to the diagnosis of pediatric CHS as a related but separate entity is also provided. CONCLUSIONS: The panel recommends screening serum and urine laboratory testing and an upper gastrointestinal radiographic series for all patients with symptoms suggestive of CVS. The panel concluded that there is low yield and cost-effectiveness of other diagnostic screening tests. A set of recommended diagnostic criteria for CVS was formulated based on the characteristics of vomiting attack frequency, duration, and associated symptoms.