ATEENAGED girl with cystic fibrosis and diabetes mellitus presented with severe projectile vomiting that had lasted for 4 days. She complained of nausea, early satiety, and bloating. She was completely unable to tolerate solid foods but had some toleration for liquids. Her symptoms included nonradiating epigastric discomfort and a sensation of fullness. The vomitus did not contain blood or bile, and she had a history of regular bowel movements.
Her medical history was significant for chronic pancreatitis and a duodenal ulcer. The ulcer, detected by endoscopy 2 years earlier, responded to treatment with omeprazole. Two months prior to initial examination she was treated for Helicobacter pylori gastritis. Her insulin-dependent diabetes mellitus was adequately controlled, however, she had developed diabetic retinopathy with unilateral blindness. Her medications included pancreatin (Pancrezyme) tablets 3 times per day, 100 U insulin injection and 100 U insulin suspension per day, fat-soluble vitamins, and 20mg omeprazole 4