Cyclic Vomiting Syndrome

Cyclic Vomiting Syndrome Definition

Cyclic Vomiting Syndrome (CVS) is a functional vomiting disorder characterized by cycles or episodes of acute nausea and vomiting that persists for several days or hours and alternate with asymptomatic episodes [¹].

It is also called:

• Abdominal Migraine [²]
• Periodic Syndrome
• Childhood Cyclic Vomiting
• Cyclical Vomiting Syndrome
• Chronic Vomiting in Childhood

Cyclic Vomiting Syndrome Epidemiology

The exact prevalence and incidence of CVS is unknown. In a region in central Ohio with mainly white population, the prevalence of CVS in kids was found to be 0.04% [⁴].

Cyclic Vomiting Syndrome Symptoms

The signs and symptoms include:

Cyclic vomiting

It may be characterized by either severe vomiting occurring several times every hour and lasting for less than a week, or 3 or more distinct episodes of vomiting without any apparent cause in the last 1 year.

Vomiting episode

It is typically characterized by fever, diarrhea, abdominal pain, dizziness and sensitivity to light.

The intervals between vomiting episodes are usually asymptomatic. However, some patients may suffer from the following problems between episodes:

• Abdominal pain
• Limb pain
• Anxiety
• Depression
• Mild to moderate nausea

Dehydration

Constant vomiting can result in severe dehydration which can be fatal for sufferers. The symptoms include:

• Paleness
• Thirst
• Less urination
• Listlessness
• Exhaustion

Cyclic Vomiting Syndrome Risk Factors

The risk factors include:

Having migraines

Children with a family history of migraines are found to suffer from CVS when they get older. The relationship between CVS and migraines is not clear.

Long-term marijuana use

Chronic usage of marijuana (cannabis sativa) has also been linked with the development of CVS.

Cyclic Vomiting Syndrome Etiology

The exact causes of CVS are not known. The trigger factors for vomiting episodes are:

• Hot weather
• Menstruation
• Motion sickness
• Physical exhaustion
• Foods, such as cheese or chocolate
• Colds, allergies or sinus problems
• Overeating or eating just before going to bed
• Panic attacks or anxiety, particularly in adults
• Excitement or emotional stress, especially in children

Identifying the trigger factors for CVS may help manage its symptoms.

Cyclic Vomiting Syndrome and Genetics

Heredity (mitochondrial inheritance) is supposed to play a role in CVS development, as the disease is found to have a possible relationship with migraine. Single-base pair and rearrangements in mitochondrial DNA have been linked with these attributes.

Cyclic Vomiting Syndrome Diagnosis

Diagnosis can be difficult for CVS. Diagnostic procedure usually involves:

• Asking about the symptoms
• Consideration of medical history
• Physical examination

Diagnostic tests may involve:

• MRI scans, to detect brain tumor and other central nervous system disorders
• Imaging studies (like CT scan, endoscopy, magnetic resonance imaging), to detect digestive system obstructions and other disorders
• Lab tests, to detect metabolic disorders and thyroid conditions
• Motility tests, to detect digestive disorders and monitor food movement through the digestive system

However, there are no specific tests for CVS.

Cyclic Vomiting Syndrome Diagnostic Criteria

The essential diagnostic criteria for CVS include:

• A history of 3 or more periods of unremitting vomiting and severe nausea, and pain (in some cases), that lasts for a few hours, days or even weeks or months
• Intervening asymptomatic intervals, which persist for weeks to months
• Exclusion of gastrointestinal, metabolic, or biochemical or structural disease of CNS (central nervous system)

Cyclic Vomiting Syndrome Differential Diagnosis

In order to avoid misdiagnosis, the differential diagnosis should include isolating the signs of CVS from those of:

• Gastrointestinal (GI) disorders (Gastroesophageal reflux disease, Inflammatory bowel disease etc.)
• Neurologic disorders (Abdominal migraine, Migraine headaches etc.)
• Renal disorders (such as Nephrolithiasis)
• Metabolic disorders (Mitochondriopathy, Urea cycle defects etc.)
• Endocrine disorders (Addison disease, Pheochromocytoma etc.)

Cyclic Vomiting Syndrome Treatment

There is no cure for CVS. Treatment aims at controlling the symptoms. Medications prescribed include:

• Anti-nausea drugs
• Antidepressants
• Sedatives
• Drugs that suppress stomach acid

Drugs used to manage migraine problems can sometimes prevent or stop cyclic vomiting episodes. The medicines may be recommended for frequent and chronic episodes.

Acute cases of dehydration may need treatment in hospital.

Cyclic Vomiting Syndrome and Behavioral Therapy

As per research, around half of all CVS sufferers have anxiety or depression. It is unclear to what extent anxiety and depression can result from, or cause, cyclic vomiting. Behavioral therapy (involving techniques and exercises) may be recommended for children suffering from anxiety or depression.

Cyclic Vomiting Syndrome Home Remedies

Home remedies for CVs include measures like:

• Getting enough sleep
• Resting in a quiet place in between vomiting bouts
• Drinking enough water to restore electrolyte balance
• Eating solid foods only after feeling better
• Reducing stress
• Eating small meals

Cyclic Vomiting Syndrome – Alternative Medicines and Cure

These involve:

• L-carnitine (natural substance that assists in fat-to-energy conversion)
• Coenzyme Q10 (ubiquinone), which helps in basic cellular functions

Stress, which can trigger vomiting bouts, can be managed by Biofeedback training.

However, none of these have been studied well.

Cyclic Vomiting Syndrome Complications

The complications for CVS include:

• Tooth enamel decay, caused by acid in vomit
• Dehydration, caused by loss of water due to excessive vomiting
• Injury to the esophagus, caused by stomach acid

Cyclic Vomiting Syndrome Prevention

Avoiding trigger factors can reduce the frequency of vomiting bouts. Prevention can also include lifestyle modification measures like:

• Getting proper sleep
• Avoiding trigger foods (chocolate, cheese etc)
• Eating small meals and snacks daily at regular intervals

Cyclic Vomiting Syndrome Prognosis

CVS persists for an average span of 2- 2.5 years. It resolves in late childhood or during early teen years. A few patients continue to exhibit symptoms even when they turn into adults.

Can Cyclic Vomiting Syndrome Kill You?

There is little evidence of mortality associated with CVS. However, acute cases of fluid loss can cause potentially fatal salt imbalances. During a CVS episode, blood pressure increases dangerously (hypertension). Severe dehydration due to CVS, that goes untreated, can also cause death.

Cyclic Vomiting Syndrome Support Groups

Patients can get information and assistance from various support groups and online forums. These include (⁵):

National Organization for Rare Disorders

55 Kenosia Avenue

P.O. Box 1968

Danbury, CT 06813–1968

Phone: 1–800–999–6673 or 203–744–0100

Fax: 203–798–2291

Email: [email protected]

Internet: www.rarediseases.org

Cyclic Vomiting Syndrome Association

2819 West Highland Boulevard

Milwaukee, WI 53208

Phone: 414–342–7880

Fax: 414–342–8980

Email: [email protected]

Internet: www.cvsaonline.org

Cyclic Vomiting Syndrome ICD9 Code

The ICD9 Code for CVS is 536.2 [³].