Cyclic Vomiting Syndrome
- 1 Cyclic Vomiting Syndrome Definition
- 2 Cyclic Vomiting Syndrome Epidemiology
- 3 Cyclic Vomiting Syndrome Symptoms
- 4 Cyclic Vomiting Syndrome Risk Factors
- 5 Cyclic Vomiting Syndrome Etiology
- 6 Cyclic Vomiting Syndrome Diagnosis
- 7 Cyclic Vomiting Syndrome Diagnostic Criteria
- 8 Cyclic Vomiting Syndrome Differential Diagnosis
- 9 Cyclic Vomiting Syndrome Treatment
- 10 Cyclic Vomiting Syndrome Complications
- 11 Cyclic Vomiting Syndrome Prevention
- 12 Cyclic Vomiting Syndrome Prognosis
- 13 Can Cyclic Vomiting Syndrome Kill You?
- 14 Cyclic Vomiting Syndrome Support Groups
- 15 Cyclic Vomiting Syndrome ICD9 Code
Cyclic Vomiting Syndrome Definition
Cyclic Vomiting Syndrome (CVS) is a functional vomiting disorder characterized by cycles or episodes of acute nausea and vomiting that persists for several days or hours and alternate with asymptomatic episodes .
It is also called:
- Abdominal Migraine 
- Periodic Syndrome
- Childhood Cyclic Vomiting
- Cyclical Vomiting Syndrome
- Chronic Vomiting in Childhood
Cyclic Vomiting Syndrome Epidemiology
The exact prevalence and incidence of CVS is unknown. In a region in central Ohio with mainly white population, the prevalence of CVS in kids was found to be 0.04% .
Cyclic Vomiting Syndrome Symptoms
The signs and symptoms include:
It may be characterized by either severe vomiting occurring several times every hour and lasting for less than a week, or 3 or more distinct episodes of vomiting without any apparent cause in the last 1 year.
It is typically characterized by fever, diarrhea, abdominal pain, dizziness and sensitivity to light.
The intervals between vomiting episodes are usually asymptomatic. However, some patients may suffer from the following problems between episodes:
- Abdominal pain
- Limb pain
- Mild to moderate nausea
Constant vomiting can result in severe dehydration which can be fatal for sufferers. The symptoms include:
- Less urination
Cyclic Vomiting Syndrome Risk Factors
The risk factors include:
Children with a family history of migraines are found to suffer from CVS when they get older. The relationship between CVS and migraines is not clear.
Long-term marijuana use
Chronic usage of marijuana (cannabis sativa) has also been linked with the development of CVS.
Cyclic Vomiting Syndrome Etiology
The exact causes of CVS are not known. The trigger factors for vomiting episodes are:
- Hot weather
- Motion sickness
- Physical exhaustion
- Foods, such as cheese or chocolate
- Colds, allergies or sinus problems
- Overeating or eating just before going to bed
- Panic attacks or anxiety, particularly in adults
- Excitement or emotional stress, especially in children
Identifying the trigger factors for CVS may help manage its symptoms.
Cyclic Vomiting Syndrome and Genetics
Heredity (mitochondrial inheritance) is supposed to play a role in CVS development, as the disease is found to have a possible relationship with migraine. Single-base pair and rearrangements in mitochondrial DNA have been linked with these attributes.
Cyclic Vomiting Syndrome Diagnosis
Diagnosis can be difficult for CVS. Diagnostic procedure usually involves:
- Asking about the symptoms
- Consideration of medical history
- Physical examination
Diagnostic tests may involve:
- MRI scans, to detect brain tumor and other central nervous system disorders
- Imaging studies (like CT scan, endoscopy, magnetic resonance imaging), to detect digestive system obstructions and other disorders
- Lab tests, to detect metabolic disorders and thyroid conditions
- Motility tests, to detect digestive disorders and monitor food movement through the digestive system
However, there are no specific tests for CVS.
Cyclic Vomiting Syndrome Diagnostic Criteria
The essential diagnostic criteria for CVS include:
- A history of 3 or more periods of unremitting vomiting and severe nausea, and pain (in some cases), that lasts for a few hours, days or even weeks or months
- Intervening asymptomatic intervals, which persist for weeks to months
- Exclusion of gastrointestinal, metabolic, or biochemical or structural disease of CNS (central nervous system)
Cyclic Vomiting Syndrome Differential Diagnosis
In order to avoid misdiagnosis, the differential diagnosis should include isolating the signs of CVS from those of:
- Gastrointestinal (GI) disorders (Gastroesophageal reflux disease, Inflammatory bowel disease etc.)
- Neurologic disorders (Abdominal migraine, Migraine headaches etc.)
- Renal disorders (such as Nephrolithiasis)
- Metabolic disorders (Mitochondriopathy, Urea cycle defects etc.)
- Endocrine disorders (Addison disease, Pheochromocytoma etc.)
Cyclic Vomiting Syndrome Treatment
There is no cure for CVS. Treatment aims at controlling the symptoms. Medications prescribed include:
- Anti-nausea drugs
- Drugs that suppress stomach acid
Drugs used to manage migraine problems can sometimes prevent or stop cyclic vomiting episodes. The medicines may be recommended for frequent and chronic episodes.
Acute cases of dehydration may need treatment in hospital.
Cyclic Vomiting Syndrome and Behavioral Therapy
As per research, around half of all CVS sufferers have anxiety or depression. It is unclear to what extent anxiety and depression can result from, or cause, cyclic vomiting. Behavioral therapy (involving techniques and exercises) may be recommended for children suffering from anxiety or depression.
Cyclic Vomiting Syndrome Home Remedies
Home remedies for CVs include measures like:
- Getting enough sleep
- Resting in a quiet place in between vomiting bouts
- Drinking enough water to restore electrolyte balance
- Eating solid foods only after feeling better
- Reducing stress
- Eating small meals
Cyclic Vomiting Syndrome – Alternative Medicines and Cure
- L-carnitine (natural substance that assists in fat-to-energy conversion)
- Coenzyme Q10 (ubiquinone), which helps in basic cellular functions
Stress, which can trigger vomiting bouts, can be managed by Biofeedback training.
However, none of these have been studied well.
Cyclic Vomiting Syndrome Complications
The complications for CVS include:
- Tooth enamel decay, caused by acid in vomit
- Dehydration, caused by loss of water due to excessive vomiting
- Injury to the esophagus, caused by stomach acid
Cyclic Vomiting Syndrome Prevention
Avoiding trigger factors can reduce the frequency of vomiting bouts. Prevention can also include lifestyle modification measures like:
- Getting proper sleep
- Avoiding trigger foods (chocolate, cheese etc)
- Eating small meals and snacks daily at regular intervals
Cyclic Vomiting Syndrome Prognosis
CVS persists for an average span of 2- 2.5 years. It resolves in late childhood or during early teen years. A few patients continue to exhibit symptoms even when they turn into adults.
Can Cyclic Vomiting Syndrome Kill You?
There is little evidence of mortality associated with CVS. However, acute cases of fluid loss can cause potentially fatal salt imbalances. During a CVS episode, blood pressure increases dangerously (hypertension). Severe dehydration due to CVS, that goes untreated, can also cause death.
Cyclic Vomiting Syndrome Support Groups
Patients can get information and assistance from various support groups and online forums. These include (5):
National Organization for Rare Disorders
55 Kenosia Avenue
P.O. Box 1968
Danbury, CT 06813–1968
Phone: 1–800–999–6673 or 203–744–0100
Email: [email protected]
Cyclic Vomiting Syndrome Association
2819 West Highland Boulevard
Milwaukee, WI 53208
Email: [email protected]
Cyclic Vomiting Syndrome ICD9 Code
The ICD9 Code for CVS is 536.2 .