{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T18:07:51Z","timestamp":1780337271042,"version":"3.54.1"},"reference-count":36,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,2,27]],"date-time":"2025-02-27T00:00:00Z","timestamp":1740614400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Neurogastroenterology Motil"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Central neuromodulators, specifically tricyclic antidepressants (TCAs), are prescribed as prophylactic treatment for cyclical vomiting syndrome (CVS). It is unclear whether opioids and\/or cannabis affect the treatment response to neuromodulators. The aims of this study were to assess: (i) the prevalence of opioid and cannabis use among outpatients with CVS, (ii) clinical characteristics associated with opioid\/cannabis use and response to a three\u2010tiered neuromodulator treatment algorithm, and (iii) the effect of opioid\/cannabis cessation on response to the treatment algorithm.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methodology<\/jats:title><jats:p>Data from consecutive patients newly diagnosed with Rome IV CVS at a single tertiary care neurogastroenterology outpatient clinic (January 2016\u2013June 2024) were retrospectively collected. Patients were advised to stop consuming opioids and\/or cannabis and commenced a low\u2010dose TCA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Sixty\u2010one (46\/75) percent of outpatients with CVS responded to the three\u2010tiered treatment algorithm. Among responders, 42 (91%) patients responded to TCA alone (1st line therapy), 3 (7%) patients responded to TCA and selective serotonin reuptake inhibitor or serotonin norepinephrine\u00a0reuptake inhibitor (2nd line therapy), and 1 (2%) patient required topiramate (3rd line therapy). The mean [SD] dosage of TCA among responders was 26.5 [18.3] mg. Twenty\u2010five (33%) patients consumed opioids, 14 (19%) took cannabis, and five (7%) consumed both opioids and cannabis. While opioid cessation was associated with clinical response to the treatment algorithm (<jats:italic>p<\/jats:italic>\u2009=\u20090.03), opioid intake at the initial consultation was not (<jats:italic>p<\/jats:italic>\u2009=\u20090.2). Irritable bowel syndrome was independently associated with significantly greater odds (OR [95% CI]) of opioid consumption at baseline (6.59 [1.49\u201329.24], <jats:italic>p<\/jats:italic>\u2009=\u20090.01). Heartburn was independently associated with lower odds of response to the treatment algorithm\u00a0(0.2 [0.05\u20130.65], <jats:italic>p<\/jats:italic>\u2009=\u20090.006).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Low\u2010dose neuromodulators, along with opioid and cannabis cessation, may be important strategies in the management of CVS.<\/jats:p><\/jats:sec>","DOI":"10.1111\/nmo.70007","type":"journal-article","created":{"date-parts":[[2025,3,12]],"date-time":"2025-03-12T06:12:05Z","timestamp":1741759925000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Impact of Opioid and Cannabis Use on Low\u2010Dose Amitriptyline Efficacy in Cyclical Vomiting Syndrome: A Real\u2010World Study in the United Kingdom"],"prefix":"10.1111","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0859-6470","authenticated-orcid":false,"given":"Mohsin F.","family":"Butt","sequence":"first","affiliation":[{"name":"NIHR Nottingham Biomedical Research Centre Nottingham University Hospitals NHS Trust and the University of Nottingham  Nottingham UK"},{"name":"Nottingham Digestive Diseases Centre, Translational Medical Sciences, School of Medicine University of Nottingham  Nottingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Cefalo","sequence":"additional","affiliation":[{"name":"NIHR Nottingham Biomedical Research Centre Nottingham University Hospitals NHS Trust and the University of Nottingham  Nottingham UK"},{"name":"Nottingham Digestive Diseases Centre, Translational Medical Sciences, School of Medicine University of Nottingham  Nottingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-9267-9471","authenticated-orcid":false,"given":"Caterina","family":"Sbarigia","sequence":"additional","affiliation":[{"name":"NIHR Nottingham Biomedical Research Centre Nottingham University Hospitals NHS Trust and the University of Nottingham  Nottingham UK"},{"name":"Nottingham Digestive Diseases Centre, Translational Medical Sciences, School of Medicine University of Nottingham  Nottingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1794-2569","authenticated-orcid":false,"given":"Arkadeep","family":"Dhali","sequence":"additional","affiliation":[{"name":"Academic Department of Gastroenterology Sheffield Teaching Hospitals NHS Foundation Trust  Sheffield UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2957-4684","authenticated-orcid":false,"given":"Maura","family":"Corsetti","sequence":"additional","affiliation":[{"name":"NIHR Nottingham Biomedical Research Centre Nottingham University Hospitals NHS Trust and the University of Nottingham  Nottingham UK"},{"name":"Nottingham Digestive Diseases Centre, Translational Medical Sciences, School of Medicine University of Nottingham  Nottingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,2,27]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2016.02.011"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2018.05.020"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-230X-14-181"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-2982.2008.01793.x"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.13606"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2982.2010.01577.x"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2982.2011.01679.x"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.12843"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.14159"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.13607"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.13245"},{"issue":"6","key":"e_1_2_10_13_1","first-page":"963","article-title":"Health Care Resource Use and Associated Costs of Cyclic Vomiting Syndrome in the United States","volume":"1","author":"Chen Y. 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