cyclic vomiting syndrome (CVS)

Introduction

Cycles of severe nausea & vomiting that last for hours or even days & alternate with longer periods of no symptoms.

Etiology

• idiopathic
• may be a form of abdominal migraine
  • patients may develop migraine as adult

Epidemiology

• occurs mostly in children between the ages of 3 & 7
  • 2% of children in 1 study
• can affect adults, too

Genetics

• family history of migraine is common

Clinical manifestations

• cycles of severe nausea & vomiting
  • episodes usually last anywhere from 1 to 5 days, though they can last for up to 10 days
  • alternate with longer periods of no symptoms
  • vomiting or retching as often as 6-12 times/hour
• each episode is similar to the previous ones
  • tend to start at about the same time of day
    • at night or first thing in the morning
  • last the same length of time
  • present the same symptoms at the same level of intensity
• in adults, episodes tend to occur less often than they do in children, but they last longer
• 4 phases
  • prodrome
    • often marked by abdominal pain,
    • can last from just a few minutes to several hours
    • sometimes there is no prodrome
  • episode (nausea & vomiting)
  • recovery
    • nausea & vomiting stop
    • healthy color, appetite, & energy return
  • symptom-free interval
• most people can identify a specific condition or event that triggered an episode.
  • most common trigger is an infection
  • emotional stress or excitement
  • certain foods (such as chocolate or cheese)
  • eating too much
  • eating just before going to bed
  • hot weather
  • physical exhaustion
  • menstruation
  • motion sickness
• photosensitivity
• headache
• fever
• dizziness
• diarrhea
• drinking water usually leads to more vomiting, though the water can dilute the acid in the vomit, making the episode a little less painful

Laboratory

• cannabinoid in urine

Complications

• dehydration
• electrolyte imbalance
• peptic esophagitis
• hematemesis
• Mallory-Weiss tear
• tooth decay

Differential diagnosis

• cannabinoid hyperemesis syndrome

Management

• CVS cannot be cured
• rest; sleep
• migraine prophylaxis helps some
• severe nausea & vomiting may require hospitalization & intravenous fluids to prevent dehydration
• abstinence from cannabis rarely resolves symptoms or leads to a diagnosis of cannabinoid hyperemesis syndrome

More general terms

• syndrome
• vomiting

Patient information

cyclic vomiting syndrome patient information