Cyclic vomiting syndrome

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at August 3, 2016
StartDiseasesCyclic vomiting syndrome

Cyclic vomiting syndrome is a disorder in which a person goes through cycles of vomiting without any known or apparent cause. Episodes can last from hours to days and can be accompanied by severe abdominal pain and nausea. Patients can often become bedridden and unable to attend school or perform work or social duties. It is also known as periodic syndrome, abdominal migraine, and childhood cyclic vomiting or CVS.

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Definition & Facts

Cyclic vomiting syndrome can appear at any age though most often occurs in childhood. Children can outgrow it but most of them go on to develop migraines. Episodes can last anywhere from a few hours to a few days.

Cyclic vomiting syndrome can mimic the same symptoms as other illnesses but its difference is characterized by the vomiting having no definitive cause. Research has shown that there is a connection between CVS and migraines.

There are four phases of CVS: prodrome phase, vomiting phase, recovery phase and the well phase. Episodes can occur at the same time of day or at any time at all. A person can suffer for days, weeks, months and even decades at a time with periods of wellness in between that can last for months or even years.

Hospitalization may be required to receive intravenous fluids for dehydration. Bloody vomit or blood in stool may occur as severe vomiting can cause a tear in the lower esophageal tract known as a Mallory-Weiss tear. If a person sees blood in their vomit or stool they should immediately seek medical attention. CVS can be disruptive and terrifying to patients and to their families and friends.

Symptoms & Complaints

As the person cycles through the four phases of CVS, their symptoms will vary in their intensity. The prodrome phase is where the person feels an episode coming on. Symptoms can be excessive sweating, nausea, retching, and extreme pallor.

The vomiting phase consists of vomiting, nausea and retching accompanied or not by severe abdominal pain. Even after the stomach has been emptied the person may still continue to dry heave. The person may be unable to walk or talk and can appear to be comatose or unconscious.

The recovery phase is when the nausea subsides and the vomiting and retching stop. The well phase is when the person is between episodes and free of symptoms. People may experience other symptoms such as fever, dizziness, diarrhea, sensitivity to light and sound, gagging and loss of appetite.

Causes

Researchers have not yet found a definitive cause for CVS but they have found a correlation between migraines and CVS. There are many possible causes including emotional stress due to anxiety, depression, panic attacks or panic disorder.

Overexcitement due to upcoming events such as birthday parties, the first day of school, vacations and holidays can bring on episodes in children. Infections, menstruation, hot weather, overeating, eating too quickly or eating right before bedtime, and physical overexertion can lead to an attack.

Some foods such as chocolate and cheese and food additives like caffeine, nitrites and MSG can be triggers. Bodily functions such as the way food moves through the digestive system, problems with autonomic nervous system function (the system that control involuntary bodily functions such as breathing and heart rate), and hormonal imbalances have been found to be possible causes.

Two other possible suspects are gastroparesis - a disorder that causes the movement of food from the stomach to the small intestine to slow or stop, and gastroenteritis – also called the stomach flu and which involves inflammation of the stomach lining, small intestine, and large intestine.

Diagnosis & Tests

CVS can mimic the symptoms of other diseases causing a misdiagnosis. As of now, there is no standardized test to identify CVS. Once the most possible causes like stomach flu and food poisoning have been ruled out, the physician can perform tests like an upper GI endoscopy or a gastric emptying test.

If there are no gastric disturbances the physician then can move on to check for dietary habits or neurological disorders by ordering MRIs and computed tomography (CT) scans. Blood tests can be done to check for hormonal imbalances. Clinical urine tests can be given to rule out kidney disease or infections.

Tests for psychological disturbances may be done as mental disorders such as anxiety and panic disorder can cause frequent nausea and vomiting. The health care provider will take a family history and medical history and do a physical examination. The physician will start to suspect cyclic vomiting syndrome if they see patterns or cycles of vomiting. The patterns will vary between adults and children.

Treatment & Therapy

Patients with cyclic vomiting syndrome need plenty of rest and fluids as they can become dehydrated to the point of being life-threatening if not treated promptly. Health care providers may refer the patient to a gastroenterologist for further treatment.

A series of medications may be prescribed to treat all four phases of CVS. Ondansetron or lorazepam can be prescribed for nausea. Ranitidine, lansoprazole, and omeprazole can be taken to control the production of stomach acid. Medications for anxiety, ibuprofen for stomach pain and sumatriptan for migraines can be prescribed as well.

Getting plenty of rest in a dark, quiet room is recommended. IV treatments may be required for a period of time to replace lost fluids and electrolytes. IV nutrition may be needed if an episode lasts for several days.

After the nausea and vomiting have passed, the person can begin drinking clear fluids before moving on slowly to other liquids and solid foods. Some people may find that their appetite quickly returns to normal and resume their regular diet.

Prevention & Prophylaxis

Staying well rested, avoiding any trigger foods, and treating any triggering allergies or sinus infection can help the person avoid future attacks. Psychotherapy can help reduce stress and anxiety.

Eating a well-balanced diet and avoiding overeating or eating just before bedtime can help prevent future episodes.

A physician may prescribe the medications amitriptyline, propranolol, and cyproheptadin to adults and children while they are symptom-free to lessen the severity and frequency of episodes. It may take months to evaluate whether the medications help to prevent episodes.