{"doi":"10.1111/nmo.15015","title":"Advancements in Our Understanding and Management of Cyclic Vomiting Syndrome and Cannabinoid Hyperemesis","abstract":"We are pleased to introduce this special supplement featuring a series of articles on cyclic vomiting syndrome (CVS) and cannabinoid hyperemesis syndrome (CHS), following the Third International Symposium on CVS and CHS held in Columbus, Ohio, USA, November 4–5, 2022. Nearly 25 years after the second CVS Symposium, which was held in Milwaukee, Wisconsin in April 1998, significant advancements have been made in understanding these enigmatic disorders of gut–brain interaction. Progress spans potential mechanisms, therapeutic strategies, and identification of gaps in knowledge and future research priorities. Notably, this symposium reflected a remarkable shift in its faculty demographics: in 1998, only 5% were women and 14% were minorities, whereas in 2022, women comprised 54% of faculty, and minorities comprised 31%, with representation from both senior and junior investigators across diverse disciplines. CVS and its more recently recognized counterpart, CHS, continue to challenge clinicians and researchers alike. To address these challenges, the symposium brought together a multidisciplinary team of adult and pediatric clinicians, translational scientists, and basic researchers from gastroenterology, neurology, and psychology. First, an article by Chandra Wilson, actor (Dr Bailey of Gray's Anatomy), caregiver and advocate for CVS patients highlights her daughter's struggles with CVS. Kathleen Adams, Founder and Emeritus President, then discusses her daughter's journey with CVS, and more recently the identification of a new gene defect and a condition called Jansen de Vries Syndrome (JdVS), a rare genetic condition that contributes to some of her daughter's symptoms. CVS is redescribed as to its essential clinical characteristics, including its subphenotypes and comorbidities, from the patient perspective, and recent epidemiology confirming that it is as common in adults as in children. Several articles are devoted to the pathophysiologic mechanisms. Our keynote speaker, Steve Porges, proposed the polyvagal platform that he developed and discussed the role of vagal parasympathetic regulation of the sympathetic system as a prime suspect in the pathophysiology of disorders of gut–brain interaction (DGBI) and possibly CVS. CHS is examined through the lens of two endocannabinoid receptor physiologists, with a potential rat model for vomiting (gaping behavior), along with the epidemiology of growing cannabis usage, the clinical entity and its treatment, and addressing the question of whether CHS is a subset of CVS. Potential confounding disorders were reviewed, including gastroparesis and functional nausea. The novel emesis mediator growth differentiation factor-15 and the use of functional MRI and transcranial magnetic stimulation to map relevant gut-brain pathways are also discussed. Comorbid sleep disturbances, interactions between stress and the gut, and use of novel vagal metrics (vagal efficiency) to measure vagal dysregulation are described. Migraine and antimigraine therapies are extensively reviewed by neurologists with a spotlight on new therapies that target calcitonin gene-related peptides or their corresponding receptors. The final set of articles focuses on a review of the adult (2019) and pediatric CVS guideline (under revision, 2024) recommendations, acute management in the emergency department, new data on the prevention of hospitalizations, and user-friendly visual action plans. The need for the development of validated tools and patient-reported outcome measures is also discussed. Promising use of novel percutaneous vagal neuromodulation and stress reduction therapies, such as heartfulness meditation practice in DGBI and CVS, is reviewed. Finally, a synopsis of the final brainstorming session focused on gaps in knowledge, research priorities, and the need for substantial funding from both public (NIH) and other external entities to drive the field forward is presented. As with our Second International Symposium, it","journal":"Neurogastroenterology & Motility","year":2025,"id":561528,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9593,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":728675,"name":"Thangam Venkatesan","orcid":"0000-0002-8095-7456","position":1,"is_corresponding":false},{"id":1414479,"name":"B U.K. Li","orcid":"0000-0003-0355-3201","position":0,"is_corresponding":true}],"reference_count":0,"raw_metadata":null,"created_at":"2026-07-19T02:55:58.259104Z","pmid":"39901659","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}