cyclic vomiting syndrome (CVS)
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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
- tend to start at about the same time of day
- in adults, episodes tend to occur less often than they do in children, but they last longer
- 4 phases
- 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
Complications
Differential diagnosis
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[1]
More general terms
References
- ↑ Jump up to: 1.0 1.1 Venkatesan T, Hillard CJ, Rein LE et al. Patterns of cannabis use in patients with cyclic vomiting syndrome. Clin Gastroenterol Hepatol 2019 Jul 25; PMID: https://www.ncbi.nlm.nih.gov/pubmed/31352091 https://www.cghjournal.org/article/S1542-3565(19)30783-9/pdf
- ↑ Levinthal DJ, Staller K, Venkatesan T. AGA Clinical Practice Update on Diagnosis and Management of Cyclic Vomiting Syndrome: Commentary. Gastroenterology. 2024 Jul 10:S0016-5085(24)05025-X PMID: https://www.ncbi.nlm.nih.gov/pubmed/39023502 https://www.gastrojournal.org/article/S0016-5085(24)05025-X/fulltext
- ↑ Chen YJ, Princic N, Winer I et al
- ↑ Richmond C, Williams J, Thavamani A, Levinthal DJ, Venkatesan T. Cyclic Vomiting SyndromeEpidemiology, Comorbidities, and Treatment of Cyclic Vomiting Syndrome in the United States. Am J Gastroenterol. 2024 May 1;119(5):965-976. PMID: https://www.ncbi.nlm.nih.gov/pubmed/38088366 PMCID: PMC11062608 Free PMC article. https://www.niddk.nih.gov/health-information/digestive-diseases/cyclic-vomiting-syndrome