Cyclic vomiting syndrome

What is cyclic vomiting syndrome?
Cyclic vomiting syndrome is an unexplained disorder of children and adults that was first described by Dr. S. Gee in 1882. The condition is characterized by recurrent, prolonged attacks of severe nausea, vomiting and prostration with no apparent cause. Vomiting occurs at frequent intervals (5-10 times an hour at the peak) for hours to 10 days (1-4 most commonly). The episodes tend to be similar to each other in symptoms and duration and are self-limited. The person returns to their normal health between episodes.

Occurrence
Cyclic vomiting syndrome typically begins in infancy through adulthood between ages 3-7. It can persist for months to decades. Episodes can recur between several times a month to several times a year. Females are affected slightly more than males. The person may be prone to motion sickness, and there is often a family history of migraine. There is a high likelihood that episodes will develop into migraine headaches in adolescence.

Symptoms
Episodes may begin at any time, but often start during early morning hours. There is relentless nausea with repeated bouts of vomiting or retching. The person is pale, listless and resists talking. They often drool or spit and have an extreme thirst. They may experience intense abdominal pain and less often headache, low-grade fever and diarrhea. Prolonged vomiting may cause mild bleeding from irritation of the esophagus. One mother aptly described her child’s state as a “conscious coma”. The symptoms are frightening to the person and family and can be life-threatening if delayed treatment leads to dehydration.

Diagnosis
Cyclic vomiting syndrome has been difficult to diagnose because it is infrequently seen and is commonly misdiagnosed as stomach flu or food poisoning. There are as yet no blood tests, x-rays or other specific procedures used to diagnose the disorder. The diagnosis is made by careful review of the patient’s history, physical examination and lab studies to rule out other diseases that may cause vomiting similar to cyclic vomiting syndrome.

Triggers
Although some patients know of nothing that triggers attacks, many can identify specific circumstances that seem to bring on their episodes. Colds, flus and other infections, intense excitement (birthdays, holidays, vacations) and emotional stress are the most frequently reported triggers. Specific foods or anesthetics may also play a role.

Treatment
Treatment is generally supportive with much importance placed on early intervention. A dark quiet environment is critical for sleep. Hospitalizations and IV fluid replacement may be necessary. Medication trials sometimes succeed in finding something to prevent, shorten or abort the episodes. It is important to work with a physician who does his/her best to understand cyclic vomiting syndrome and is supportive.

Long-term treatment
The foundation of long-term management involves a responsive collaborative doctor-patient-family relationship, sensitive to stresses caused by the illness and to triggers such as feelings and attitudes that may pre-dispose to attacks. Consistent, accessible physician care by a care coordinator who understands and communicates the nature of cyclic vomiting syndrome, regardless of specialty, is vital to the family’s well-being. Connections with the Cyclic Vomiting Syndrome Association, a family and professional network, does a great deal toward healing a family that has been in doubt and despair for years.

This information was developed by the Cyclic Vomiting Syndrome Association and is herewith used with permission.

Cyclic Vomiting Syndrome Association. Cyclic Vomiting Syndrome. Available at: https://www.cvsaonline.org/what-is-cvs/. Accessed April 24, 2023.

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