Cyclic vomiting syndrome (NORD)
Definitions & Key takeaways
Cyclic vomiting syndrome (CVS) is a disorder characterized by recurrent, sudden episodes of severe nausea and vomiting. These episodes can last for hours, days, or weeks and are not associated with other illnesses or injuries. Between episodes, people with CVS feel entirely normal.
The cause of CVS is unknown, but it may be related to problems with the autonomic nervous system or changes in the levels of certain chemicals in the blood. Some people with CVS have a family history of the condition. CVS usually starts in childhood, mainly affecting children between the age of 3 to 7 years. It often resolves by adolescents, but it may persist in some individuals until adulthood.
Cyclic vomiting syndrome, or CVS for short, is a disorder characterized by recurrent or cyclic episodes of severe nausea and vomiting.
CVS can occur at any age, but is typically more common and severe in children.Episodes of nausea and vomiting may last for a few hours to several days.
They generally have sudden onset, resolve for a period of time, and are similar each time. In some people, especially adults, nausea and vomiting may continue between episodes,but the intensity is far less severe than during episodes.
Episodes may occur a few times a year or as frequently as several times a month. Episodes may return like clockwork, and monthly episodes are common.
Children may experience bouts of projectile vomiting as frequently as four or more times per hour, which can potentially lead to dehydration and electrolyte imbalances, involving sodium and potassium.
Episodes can also be associated with severe abdominal pain, retching, and diarrhea, as well as decreased appetite and weight loss.
In severe cases, an individual can become incapacitated and unable to walk or talk until the episode resolves. The exact cause of CVS is still unknown, but it seems to have many contributing factors.
The nervous system is thought to play a role. Nerves deliver messages throughout the body, including between the brain and gut, to coordinate functions.Most individuals with CVS have migraines or a family history of migraines.
In fact, CVS is sometimes called “abdominal migraine”.Gastrointestinal motility may also have a role. The gastrointestinal tract has a layer of smooth muscles, which normally help push food, liquid, and gas from the esophagus down to the rectum.
In some individuals with CVS, gastrointestinal motility doesn’t function properly, which is known as dysmotility. Dysmotility may also occur between vomiting episodes, resulting in conditions like gastroesophageal reflux, gastroparesis, and irritable bowel.
Other factors contributing to CVS may include changes or mutations in mitochondrial genes, as well as abnormal function of the autonomic nervous system called dysautonomia, and an overactive response to stress.In addition to migraine headache and gut dysmotility, several other conditions are common in people with CVS, including additional pain syndromes, chronic fatigue, postural tachycardia syndrome, anxiety, depression, and attention deficit hyperactivity disorder.
In addition, some factors are recognized as potential triggers that may precipitate an episode. These include physical exhaustion, lack of sleep, increased stress, anxiety, and panic attacks.
Other triggers include consuming certain foods or alcohol, as well as experiencing motion sickness, infections like colds, incoming weather fronts, and menstruation.
Diagnosis of CVS is typically based on the history and presenting signs and symptoms, after other potential conditions and causes have been ruled out.Treatment of CVS is primarily focused on prevention or management of the episodes and associated symptoms.
The most effective treatment varies between individuals. Preventative measures include identifying and avoiding triggers.
In addition, some individuals may benefit from anti-migraine medications, such as amitriptyline or triptans; autonomic nervous system treatments like propranolol; and mitochondrial-targeted cofactors, such as coenzyme Q10, or L-carnitine.Management of episodes can include medications to suppress nausea and vomiting, like ondansetron or granisetron; as well as anti-migraine medications to treat pain.
In some patients, non-steroidal anti-inflammatory drugs, or NSAIDs, can be used to manage pain. In addition, infusing intravenous sugar solutions or consuming sugary drinks like soda and juices may stop or lessen the severity of the episode.
Intravenous fluids may be needed to reverse or prevent dehydration. Finally, if prevention and management of the episode fail, individuals should try to rest in a quiet and dimly lit room, and in some people, sedatives like lorazepam can be used to help induce sleep.
Cyclic vomiting syndrome is a disorder characterized by recurrent or cyclic episodes of severe nausea and vomiting, which can be associated with severe abdominal pain, retching, and diarrhea, as well as migraine-like symptoms.
These episodes can last for a few hours to days, may occur several times a year, and can cause dehydration and electrolyte imbalances.
While the exact cause is not known, there seem to be several contributing factors and triggers. Diagnosis is made based on the history and presenting signs and symptoms, and treatment is focused on prevention or management
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