Cyclic Vomiting Syndrome


Cyclic Vomiting Syndrome also called CVS is a condition typified by recurring vomiting spells that makes the affected individual lethargic. CVS continues to be of unknown etiology as medical specialists, and healthcare experts have not still been able to determine what exactly causes or triggers the syndrome. Though CVS usually affects children aged 3-7, adults too are susceptible to the disorder.

Samuel Jones Gee, a British pediatrician, was the first physician to throw light on CVS in 1882. Medical scientists are of the opinion that genetics could be behind the syndrome. Individuals with cyclic vomiting syndrome return to normalcy and continue remaining so once the episodic vomiting subsides.Cyclic Vomiting Syndrome pictures

Stages of Cyclic Vomiting Syndrome

Cyclic vomiting syndrome comprises four integral phases or stages:-

  • Asymptomatic interval phase: The gap between two subsequent episodes is normally asymptomatic implying that the affected person does not display any CVS symptoms.
  • Prodromal stage: Prodromal phase signals the onset of an episode that queasiness succeeded by emesis will soon follow. Pain in the abdomen accompanied by nausea is typical in this phase which could prevail for 5-6 minutes or may last for several hours. However, abdominal pain may not always be present.

If the individual feels the symptoms strongly, he or she can take medications for arresting the condition from progressing. But often vomiting could start abruptly without any indication.

  • Vomiting phase: Vomiting is frequent during this phase, and the person can neither take medicines nor eat or drink as long as the episode lasts. Recurrent vomiting leads to exhaustion and drowsiness and makes the person appear pale.
  • Recovery phase: As nausea along with vomiting ebbs, the individual starts feeling energetic and appetite is reinstated.

Cyclic Vomiting Syndrome Symptoms and Signs

A CVS episode could last for just an hour or could stretch to more than a week. The individual could vomit several times in an hour leading to acute dehydration owing to excessive fluid loss. The person could also experience abdominal pain, headache, and diarrhea accompanied by heightened sensitivity to sound and light (phonophobia and photophobia). The symptoms do not vary much in the majority of those who are affected by CVS which includes:

  • Retching (recurrent vomiting)
  • Abdominal pain
  • Dry vomit
  • Dizziness
  • Fatigue
  • Motion sickness, dizziness or vertigo
  • Oliguria (reduced urine output)
  • Thirst
  • Fever

Almost all the symptoms above overlap or match with numerous other diseases and disorders. However, it is the 4 phases of CVS alternating between periods of aggravation and remission of symptoms that enable pediatricians and physicians to conveniently diagnose the disease.

Cyclic Vomiting Syndrome Causes & Trigger Factors

Many causative factors and triggers could set in motion a CVS episode. Common causes include:

  • Infections like tooth decay or sinusitis
  • Sudden and unpredictable excitement, anxiety or nervousness

Less common triggers involve:

  • Periods of fasting
  • Sleep deficiency
  • Working and living in environments where the ambient temperature fluctuates between extremely hot and intensely cold
  • Allergies
  • Excessive stress or overstrain
  • A migraine headache (note that a migraine has the potential of not only triggering CVS but could also develop at a later stage after the individuals recover from the syndrome)
  • Alcohol consumption
  • Menstruation
  • Overeating
  • Specific food items including but not limited to monosodium glutamate, cheese, and chocolate
  • mDNA or mitochondrial DNA (3010A and 16519T)
  • Symptoms of autonomic dysfunction and sympathetic nerve hypersensitivities like frequent diarrhea, undue saliva production, lethargy, and skin paleness
  • Physical and psychological stress

Medical specialists are not sure whether any particular or a set of factors trigger the disorder. However, the majority of professionals agree that a combination of genetic, environmental, neurological, and autonomic factors is responsible.

Complications (If left untreated)

If the affected person does not seek treatment, he or she could be experiencing 4-12 episodes annually. Retching tendencies and vomiting will be in remission in the interval between two episodes. Persons with CVS may also have to put up with the following complications:

  • GERD
  • Gastrointestinal/digestive disorders
  • Pain
  • Syncope (fainting episodes)
  • IBS
  • Electrolytic imbalance
  • Dehydration
  • Tooth decay
  • Esophageal damage
  • Anxiety
  • Depression

Prevalence/Incidence

CVS is predominant in children aged between 3-7 years, about 2000 out of every 1,00,000 are diagnosed with the condition per year. Though adults have been comparatively less susceptible than children since the condition was first identified, recent epidemiological data seem to suggest that the former could be equally at risk.

Cyclic Vomiting Syndrome Diagnosis

Correctly diagnosing CVS could be quite challenging even for a very experienced diagnostician or doctor. This is so because any normal or routine diagnostic test like an X-ray or blood assay can confirm the presence of the condition. The physician not only has to scrutinize the person’s medical history but also has to carefully observe the symptoms to discount other health issues or syndromes with similar complications.

Also, accurately identifying the disorder could be time-consuming since the gastroenterologist or pediatrician has to look out for a cyclic pattern of symptom activation followed by remission. Nevertheless, medical professionals carry out one or more of the following tests for confirmation:

  • Food allergy tests
  • Gastrointestinal motility assays
  • Upper GI X-rays (in series)
  • Endoscopy
  • MRE (magnetic resonance enterography)
  • Abdominal MRI or ultrasound
  • CT

Cyclic Vomiting Syndrome Treatment & Prevention

The severity of the syndrome determines the treatment option or plan that should be resorted to. Those suffering from CVS are normally aware of the triggers that activate the symptoms and therefore should follow the recommendations of the doctor. For instance, they should never miss out on taking the prescribed doses of medicines and also complete the full course.

In case of more than one episode in a month as well as experiencing several complications, the doctor could recommend immediate hospitalization. Your physician may prescribe propranolol, amitriptyline, topiramate or cyproheptadine. Making the following lifestyle changes could also go a long way in alleviating the symptoms as well as preventing their recurrence:

  • Consuming small carbohydrate-based meals at fixed times every day
  • Keeping away from food items that are regarded as potential triggers like chocolates and cheese
  • Getting plenty of sleep

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