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Cyclic Vomiting Syndrome: Symptoms, Causes & Treatment

Cyclic vomiting syndrome (CVS) is a disorder, causing recurring episodes of vomiting, lethargy and nausea. It is a functional gastrointestinal disorder and the attacks are sudden and repeat constantly. The attacks or the episodes can last from a few hours [1] to several days. Cyclic vomiting syndrome affects all age groups, although children between ages 3 to 7 are the most affected ones. It is commonly found in children, but the current statistics reveal a hike in the number of adults with cyclic vomiting syndrome.

Cyclic vomiting syndrome image

Cyclic vomiting syndrome is difficult to diagnose because of vomiting being a common symptom of various disorders. The symptoms [2] of cyclic vomiting syndrome can become too severe that it restricts your day to day activities such as going to work or school. Episodes of vomiting, lethargy, and nausea can occur at random or regular intervals. Cyclic vomiting syndrome is considered as a different version of a migraine and abdominal migraine, due to the similarities in its symptoms such as nausea, vomiting, severe headaches associated with pain, and extreme sensitivity to sound [3] and light.

The disorder and its frequency are not widely known to the public due to the lack of medical attention. By the 2000s, researchers believed that it was due to the commonality of the symptoms that cyclic vomiting syndrome goes undiagnosed.

Symptoms Of Cyclic Vomiting Syndrome

The attacks of intense nausea, lethargy and vomiting are the major signs of cyclic vomiting syndrome. The symptoms can last for a period [4] of one hour to 10 days, which can result in massive loss of fluids from your body resulting in dehydration, pallor, abdominal pain etc. The symptoms of cyclic vomiting syndrome are mostly similar.

An individual affected by the rare disorder may show one or more of the following signs.

Symptoms of cyclic vomiting syndrome

Phases Of Cyclic Vomiting Syndrome

An episode of the cyclic vomiting syndrome disorder has four [5] distinct stages.

1. Prodrome phase

This phase acts as the indicator or the warning, where an individual understands that an episode of vomiting and nausea is about [6] to begin. The prodrome phase may cause abdominal pain, and can last for just a few minutes to several hours. It will also cause your skin to appear pale. In adults, the prodrome phase can result in panic attacks [7] or anxiety.

2. Vomiting or episode phase

Consisting of nausea, vomiting and [8] retching, this phase causes the individual to be unresponsive. During the vomiting phase, you will not be able to drink, eat or even take medicines without instantly vomiting it out. It causes you to feel drowsy, exhausted or dizzy. The vomiting can occur 5 to 6 times in an hour and can last up to a period of 10 days.

3. Recovery phase

During this phase, the vomiting and the retching will stop. The skin begins to regain its colour and you regain the appetite and energy. The recovery can be gradual[9] or immediate.

4. Symptom-free interval or well phase

In this phase, there will be no symptoms. It is actually the period between the episodes.

Causes Of Cyclic Vomiting Syndrome

Researchers have proposed various factors to be the contributing factors causing cyclic vomiting syndrome. The main causes of cyclic vomiting syndrome [10] are linked to the symptoms of a migraine. It can be triggered by various factors, with the most common and possible causes being digestion difficulties, hormone imbalances, nervous system issues, infections etc.

  • Anxiety or panic attacks, especially in adults
  • Emotional stress or excitement, especially in children
  • Overeating, eating right before going to bed or fasting
  • Hot weather
  • Physical exhaustion or too much exercising
  • Menstruation
  • Motion sickness [11]
  • Foods, such as caffeine, chocolate, cheese, and food containing monosodium glutamate (MSG)
  • Colds, allergies or sinus problems[12]
  • Sleep deprivation.

Diagnosis Of Cyclic Vomiting Syndrome

The identification of the problem is deemed to be a bit arduous, due to the very common symptoms the disorder encompass.

To conduct the diagnosis, your doctor will ask about your medical history and a physical exam will follow. The doctor will also [13] ask about the pattern of the symptoms experienced. Then, the doctor may recommend the following methods.

1. Motility tests

This test will be done to monitor the movement of food through your digestive system. Motility tests will find out if there are any digestion-related disorders.

2. Imaging studies

Procedures such as endoscopy, ultrasound [14] or a CT scan will be conducted to check for any form of blockages in your digestive system. It will also check for other related digestive conditions as well.

3. Laboratory tests

This will be done to check the possibility of any thyroid problem or any metabolic conditions.

Treatment Of Cyclic Vomiting Syndrome

Various studies have been conducted to find a proper method of treatment for the condition of cyclic vomiting syndrome. The treatment for cyclic vomiting syndrome focuses on controlling the signs and symptoms. And varies from one individual to the other. Studies [15] have revealed the effectiveness of using migraine medications in some cases of cyclic vomiting syndrome. The treatment involves

  • anti-nausea drugs such as ondansetron
  • antidepressants
  • anti-seizure medications
  • pain-relieving medications such as ibuprofen
  • medications that suppress stomach acids such as ranitidine, lansoprazole or omeprazole
  • migraine treatments such as sumatriptan and propranolol.

In some severe cases with dehydration, IV fluids will be used to balance the body fluids.

Complications

Cyclic vomiting syndrome can cause various complications within your body.

1. Tooth decay

The constant and continuous vomiting caused by cyclic vomiting syndrome can result in developing tooth decay, as the acid in the vomit may corrode the tooth [16] enamel.

2. Injury to oesophagus

The stomach acid that develops [17] with the vomit can cause internal irritations. It can damage the oesophagus, causing it to bleed.

3. Dehydration

Excessive and continuous vomiting can cause your body to release fluids, even the necessary ones. The loss of water can result in dehydration and sometimes it can [18] be severe.

Risk Factors

  • Chronic use of Cannabis sativa or marijuana is linked to cyclic vomiting syndrome. It is often used by individuals to treat the symptoms. The constant [19] use can lead to a condition called cannabis hyperemesis syndrome, that causes continuous vomiting.
  • Migraines and cyclic vomiting syndrome have been associated with each other. However, there is a bit of ambiguity[20] in the connection. Individuals who suffer from cyclic vomiting syndrome have been found out to have a family history of migraines.

Diet To Follow

It is best that you follow a diet that is well-balanced and nutritious. Skipping meals should not even be an option and incorporate liquids that contain electrolytes and glucose such as, broths, caffeine-free soft drinks, fruit juices, sports drinks, and oral rehydration solutions, such as Pedialyte. Gluten-free diets, a paleo diet based on foods such as fish, meat, vegetables, and fruit without dairy or green products are advised.

Avoid consuming foods such as chocolate, cheese, and foods with monosodium glutamate (MSG) and alcohol.

Prevention

An individual suffering from cyclic vomiting syndrome will be aware of the triggers that cause it. The best method to prevent the onset of the vomiting and nausea is by avoiding the triggering elements.

  • Getting enough [21] sleep.
  • Treating any persisting allergies or sinus problems.
  • Taking steps to manage anxiety and stress.
  • During the symptom-free interval or well phase, eat a balanced diet with regular meals.
  • Utilize the medications prescribed by a physician.

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View Article References
  1. [1] Davis, A., & Bryant, J. H. (2018). Cyclic Vomiting Syndrome. In StatPearls [Internet]. StatPearls Publishing.
  2. [2] Talley, N. J., & Napthali, K. E. (2015). Cyclical vomiting syndrome. In Functional and Motility Disorders of the Gastrointestinal Tract (pp. 101-110). Springer, New York, NY.
  3. [3] Adamiak, T. R., & Jensen, M. J. (2015). Cyclic vomiting syndrome. South Dakota Medicine, 68(1).
  4. [4] Abell, T. L., Adams, K. A., Boles, R. G., Bousvaros, A., Chong, S. K. F., Fleisher, D. R., ... & Linder, S. L. (2008). Cyclic vomiting syndrome in adults. Neurogastroenterology & Motility, 20(4), 269-284.
  5. [5] Prakash, C., & Clouse, R. E. (1999). Cyclic vomiting syndrome in adults: clinical features and response to tricyclic antidepressants. The American journal of gastroenterology, 94(10), 2855.
  6. [6] Bhandari, S., Jha, P., Thakur, A., Kar, A., Gerdes, H., & Venkatesan, T. (2018). Cyclic vomiting syndrome: epidemiology, diagnosis, and treatment. Clinical Autonomic Research, 1-7.
  7. [7] Shearer, J., Luthra, P., & Ford, A. C. (2018). Cyclic vomiting syndrome: a case series and review of the literature. Frontline gastroenterology, 9(1), 2-9.
  8. [8] Venkatesan, T., Zadvornova, Y., Raff, H., & Hillard, C. J. (2016). Endocannabinoid‐related lipids are increased during an episode of cyclic vomiting syndrome. Neurogastroenterology & Motility, 28(9), 1409-1418.
  9. [9] Hayes, W. J., VanGilder, D., Berendse, J., Lemon, M. D., & Kappes, J. A. (2018). Cyclic vomiting syndrome: diagnostic approach and current management strategies. Clinical and Experimental Gastroenterology, 11, 77.
  10. [10] Rashed, H., Abell, T. L., Familoni, B. O., & Cardoso, S. (1999). Autonomic function in cyclic vomiting syndrome and classic migraine. Digestive diseases and sciences, 44(8 Suppl), 74S-78S.
  11. [11] Sagar, R. C., Sood, R., Gracie, D. J., Gold, M. J., To, N., Law, G. R., & Ford, A. C. (2018). Cyclic vomiting syndrome is a prevalent and under‐recognized condition in the gastroenterology outpatient clinic. Neurogastroenterology & Motility, 30(1), e13174.
  12. [12] Li, B. U., & Misiewicz, L. (2003). Cyclic vomiting syndrome: a brain–gut disorder. Gastroenterology Clinics, 32(3), 997-1019.
  13. [13] Fleisher, D. R., & Matar, M. (1993). The cyclic vomiting syndrome: a report of 71 cases and literature review. Journal of pediatric gastroenterology and nutrition, 17(4), 361-369.
  14. [14] Blumentrath, C. G., Dohrmann, B., & Ewald, N. (2017). Cannabinoid hyperemesis and the cyclic vomiting syndrome in adults: recognition, diagnosis, acute and long-term treatment. GMS German Medical Science, 15.
  15. [15] Irwin, S., Barmherzig, R., & Gelfand, A. (2017). Recurrent gastrointestinal disturbance: abdominal migraine and cyclic vomiting syndrome. Current neurology and neuroscience reports, 17(3), 21.
  16. [16] Mettu, S., Animireddy, D., Kanumuri, P. K., & Muppa, R. (2016). Symptomatic management of a child with cyclic vomiting syndrome. BMJ case reports, 2016.
  17. [17] Stanghellini, V., Chan, F. K., Hasler, W. L., Malagelada, J. R., Suzuki, H., Tack, J., & Talley, N. J. (2016). Gastroduodenal disorders. Gastroenterology, 150(6), 1380-1392.
  18. [18] Li, B. U. K., Murray, R. D., Heitlinger, L. A., Robbins, J. L., & Hayes, J. R. (1999). Is cyclic vomiting syndrome related to migraine?. The Journal of pediatrics, 134(5), 567-572.
  19. [19] Sontineni, S. P., Chaudhary, S., Sontineni, V., & Lanspa, S. J. (2009). Cannabinoid hyperemesis syndrome: clinical diagnosis of an underrecognised manifestation of chronic cannabis abuse. World journal of gastroenterology: WJG, 15(10), 1264.
  20. [20] Eisen, E. A. (2014, March). Cyclic Vomiting Syndrome and Migraine Headache Treated Successfully with Mirtazapine: A Case Report and Review of the Literature. In Clinical Vignette Symposium 2014.
  21. [21] Tache, Y. (1999). Cyclic vomiting syndrome: the corticotropin-releasing-factor hypothesis. Digestive diseases and sciences, 44(8 Suppl), 79S-86S.

Story first published: Monday, December 10, 2018, 16:38 [IST]
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