cyclic vomiting syndrome
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What is cyclic vomiting syndrome?
Cyclic vomiting syndrome (CVS) is a condition marked by sudden, repeated episodes of severe nausea and vomiting, with the cause of it being unknown. Episodes can last hours or days, followed by symptom-free periods.
CVS consists of four phases: prodrome, vomiting, recovery, and well. The prodrome phase includes nausea and sweating, often in the early morning. The vomiting phase can last hours or days, with frequent vomiting. Abdominal pain, diarrhea, dizziness, and other symptoms are common. Symptoms gradually decrease during the recovery phase and disappear during the well phase.
Diagnosis involves excluding conditions with similar symptoms through lab and imaging tests. Treatment focuses on symptoms and includes anti-nausea medications and, in severe cases, intravenous fluids to prevent dehydration. Preventative medications and supplements may be prescribed during the well phase to prevent future episodes.
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What are the main symptoms of cyclic vomiting syndrome?
Cyclic vomiting syndrome is marked by recurring episodes of severe nausea and vomiting, with symptom-free periods in between. Episodes follow a pattern of four phases: prodrome, vomiting, recovery, and well.
The prodrome phase starts with nausea and sweating, often in the early morning. The vomiting phase can last hours or days, with frequent vomiting. During this phase, people may experience abdominal pain, diarrhea, dizziness, headache, low-grade fever, sweating, light sensitivity, and thirst and may be unable to move or communicate. Symptoms gradually decrease during the recovery phase and disappear during the well phase.
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What causes cyclic vomiting syndrome?
Cyclic vomiting syndrome (CVS) is a condition marked by sudden, repeated episodes of severe nausea and vomiting, with symptom-free periods in between. The cause of CVS is unknown, but suspected contributing factors include genetic variants, digestive disorders, and altered stress reactions in the brain and endocrine system. In children, mitochondrial or neuroendocrine dysfunction has been linked to CVS, which is also associated with migraine.
Triggers for vomiting episodes include allergies, anxiety, emotional distress, fasting, infections, intense exercise, menstruation, temperature extremes, motion sickness, overeating, and panic attacks. Common dietary triggers include alcohol, caffeine, cheese, chocolate, and monosodium glutamate. Marijuana use can lead to a related condition, cannabinoid hyperemesis syndrome, which mimics CVS but lacks symptom-free periods.
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How do doctors diagnose cyclic vomiting syndrome?
Doctors diagnose cyclic vomiting syndrome (CVS) mainly by excluding other conditions presenting similar symptoms, such as acid reflux, appendicitis, or gastritis. They may also consider rarer conditions like intestinal malrotation or ureteropelvic obstruction.
To aid diagnosis, doctors use lab tests, including blood and urine analyses, and imaging techniques like ultrasound and MRI to examine the digestive and nervous systems. Endoscopy can provide a closer look at the esophagus, stomach, and small intestine.
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What treatments or lifestyle changes can help manage cyclic vomiting syndrome?
Cyclic vomiting syndrome is marked by severe nausea and vomiting episodes, with symptom-free periods in between. Diagnosing it involves excluding conditions like acid reflux or appendicitis through tests like blood and urine analysis, imaging, or endoscopy.
Treatment focuses on symptoms, especially during the prodrome phase, using antiemetics such as ondansetron or promethazine to ease nausea. Pain, nausea, stomach acid, and anxiety medications can help during the vomiting phase, and intravenous fluids may be needed for dehydration. To prevent future episodes during the well phase, amitriptyline, cyproheptadine, or propranolol may be prescribed. Coenzyme Q10 and l-carnitine supplements may also help. Common triggers include allergies, anxiety, emotional distress, and certain foods like caffeine or chocolate.
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cyclic vomiting syndrome, condition characterized by sudden repeated episodes of severe nausea and vomiting, the cause of which is unclear. The duration of each episode may vary, sometimes lasting several hours and other times lasting several days. There are also often periods of time when affected individuals have no symptoms.
Epidemiology and suspected causes
Cyclic vomiting syndrome affects individuals of all ages but often has an onset between ages three and seven. The condition tends to be slightly more common in women than in men. The prevalence of cyclic vomiting syndrome is not fully known. Research has indicated that in Canada, the United Kingdom, and the United States, about 2 percent of adults are affected. Various studies have found that the condition occurs in roughly 1.7 to 2.7 percent of school-age children.
The cause of cyclic vomiting syndrome is unknown. Factors suspected of contributing to the condition include genetic variants, digestive disorders, and altered stress reactions by the brain and endocrine system. In children, disorders that result in mitochondrial or neuroendocrine dysfunction have been linked to cyclic vomiting syndrome. The syndrome is also associated with migraine. In particular, young individuals and some adults who are affected often have a family history of migraine or develop worsening migraines with age.
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Bouts of vomiting are triggered by a range of factors. Some examples are allergies, anxiety, emotional distress, fasting, infections, intense exercise, menstruation, exposure to temperature extremes, motion sickness, overeating, and panic attacks. Alcohol, caffeine, cheese, chocolate, and monosodium glutamate are common dietary triggers. Persons who use marijuana may develop a closely related condition known as cannabinoid hyperemesis syndrome, which mimics the symptoms of chronic vomiting syndrome but lacks interim symptom-free periods.
Symptoms
Episodes of cyclic vomiting syndrome typically follow a pattern consisting of four phases, known as prodrome, vomiting, recovery, and well. The prodrome phase marks the onset of an episode and is characterized by nausea and sweating; this phase commonly strikes in the early morning. The vomiting phase, which may last several hours or days, is characterized by nausea and vomiting, sometimes several times within an hour. During this period individuals may be reluctant or unable to move or to communicate with others. Abdominal pain, diarrhea, dizziness, headache, low-grade fever, sweating, sensitivity to light, and thirst are commonly experienced. Symptoms gradually subside in the recovery phase and disappear entirely during the well phase.
Diagnosis and treatment
Cyclic vomiting syndrome is diagnosed primarily by ruling out other conditions with similar symptoms. Such conditions include acid reflux, appendicitis, gastritis, pancreatitis, and peptic ulcer. Volvulus or intestinal malrotation, in which part of the intestines becomes twisted, and ureteropelvic obstruction, in which the connection between the kidney and the bladder is blocked, sometimes also produce symptoms similar to those of cyclic vomiting syndrome. Laboratory tests, such as blood and urine tests, and imaging tests, such as ultrasound and magnetic resonance imaging (MRI) of the digestive and nervous systems, may be carried out to help diagnose cyclic vomiting syndrome. The esophagus, stomach, and small intestine may be more closely examined by endoscopy.
Treatment of cyclic vomiting syndrome focuses on symptoms and phase. During the prodrome phase, medications such as ondansetron or promethazine may be taken to ease nausea. In some instances, these medications are abortive, effectively preventing an episode from escalating further, though they are often ineffective in children. Although drugs taken orally generally are not tolerated during the vomiting phase, medications for pain and nausea and for reducing stomach acid and anxiety may be beneficial. In severe cases, intravenous fluids may be required to prevent dehydration.
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During the well phase, medications may be prescribed to help prevent future episodes; examples include amitriptyline, cyproheptadine, erythromycin, odansetron, and propranolol. The dietary supplements coenzyme Q10 and l-carnitine may also be useful in preventing episodes of vomiting. Preventive modalities are commonly recommended for individuals who experience at least one vomiting episode over a two-month period. Left untreated, frequent vomiting can damage the esophagus and teeth because of exposure to stomach acid.