Treatment, diagnosis, symptoms and causes

Cyclic vomiting syndrome (CVS) is a rare disorder that primarily affects children. It causes episodes of severe vomiting and nausea that can last from several hours to several days. Lifestyle changes and medication can help.

The severe vomiting episodes seen in cyclic vomiting syndrome may have no apparent cause. They can occur 4 to 12 times per year.

In this article, we describe CVS treatments and effects on the body, as well as the causes, prevention strategies, etc.

There is no cure for CVS, but there are several ways to prevent and manage the symptoms. A treatment plan may involve:

Medication

A doctor may prescribe one or more of the following drugs:

  • antidepressants, such as amitriptyline (Elavil) can help prevent episodes and relieve pain
  • antiemetics, medicines for nausea and vomiting
  • medicines to control stomach acid, including omeprazole (Prilosec)
  • migraine medications, including sumatriptan (Imitrex) and propranolol (Inderal), possibly off-label

Finding the right dosage, the right drug, or the right combination of drugs can take some time.

Hospital treatment

People with severe nausea and vomiting may require hospitalization, especially if they develop dehydration or other complications.

In the hospital, the person may be given intravenous – IV – drugs, fluids and nutrients.

Lifestyle changes

Adjusting the lifestyle can significantly benefit people with CVS. Taking the following steps can help:

  • drink lots of fluids.
  • eat regularly, without skipping meals
  • exercise regularly
  • get enough sleep, especially during an episode of vomiting
  • rest and sleep in a dark, quiet room
  • manage triggers, including stress and excitement
  • take medication as prescribed
  • receive regular support from health professionals

Diet

During and after episodes of vomiting, it is important to stay hydrated. Throughout the episodes, take regular sips of fluids, which should ideally contain a electrolyte mixture.

Anyone who feels well enough to resume their normal diet immediately after an episode should do so. Others may need to start with a liquid diet.

After returning to a regular diet, it is important to eat regularly, without skipping meals.

It can also help avoid:

  • Juice
  • cheese
  • Chocolate
  • caffeine

It can be difficult to diagnose CVS, and a doctor usually first rules out other causes of vomiting.

The process begins with a complete medical history. The doctor will also ask about the symptoms and perform a physical exam.

They can then request one or more of the following: tests:

  • imaging studies of the digestive system, such as an ultrasound or endoscopy
  • blood or urine tests to look for infection or metabolic conditions
  • a CT scan or MRI of the head to look for lesions or tumors
  • other tests to check for digestive problems

A doctor can diagnose CVS based on the following Criteria:

  • The person has at least two periods of severe nausea and sudden vomiting that persist for several hours or days over a 6 month period.
  • The episodes are similar every time.
  • The episodes occur weeks or months apart and the person feels healthy between the episodes.
  • The symptoms are not the result of another medical condition.

In addition to severe and recurring episodes of nausea and vomiting, CVS can cause:

Between episodes of nausea or vomiting, a person may live:

People with CVS are also more likely to get:

Cyclic vomiting syndrome is more common in children than in adults, although increasing numbers of adults are diagnosed with CVS.

Adults and children may experience the condition differently, the National Organization for Rare Diseases report. For example:

  • In adults, episodes tend to occur less frequently, but they can persist longer – up to 8 days at a time.
  • The most common trigger in children is excitement, such as birthdays or holidays, while anxiety or panic attacks can be stronger triggers in adults.

It can be difficult to manage CVS in school children. Research indicates that children with CVS miss about 20 days of school per year.

Due to regularity episodes, caregivers may be able to roughly predict when a seizure will occur. During seizures, it is important to encourage rest and hydration.

The exact cause of CVS is unknown, but the following may be involved:

A lot people with CVS have autonomic nervous system abnormalities. This system controls blood pressure, digestion, and other involuntary functions.

Triggers

Having a regular routine of eating and getting good sleep can reduce the frequency and severity of seizures. Learning to deal with other triggers, including stress and excitement, is also helpful.

Factors that trigger episodes of nausea and vomiting in people with CVS may include:

  • alcohol
  • the allergies
  • anxiety or panic, especially in adults
  • caffeine
  • certain foods, such as cheese and chocolate
  • the food additive monosodium glutamate, known as MSG
  • emotional arousal, especially in children
  • extreme temperatures
  • spend too much time without eating
  • illness, such as a cold or the flu
  • infections
  • lack of sleep
  • menstruation
  • travel sickness
  • stress
  • eat too much
  • overwork, such as exercising too much

Risk factors

Factors that increase the chances of developing CVS include:

  • a staff or family history migraine
  • a family history of other conditions, such as IBS
  • sensitivity by light or by sound
  • age, as children ages 3 to 7 are most likely to develop CVS
  • be a woman

CVS can lead to other health problems, such as:

  • dehydration, excessive vomiting
  • tooth decay, as stomach acid can erode the enamel
  • damage to the esophagus, the tube that connects your mouth and stomach
  • gastroparesis or inability of the stomach to empty completely in the usual way
  • mood disorders, such as anxiety, depression, or panic disorder

CVS is generally does not endanger life, but some complications, such as depression, can increase the risk of death.

According to some research, approximately a third of adult CVS patients experience disability as a result of the condition.

Some people with CVS are unable to walking or talking during episodes. A person may need to stay in bed throughout an episode or may even appear unconscious or comatose.

As a result, some people with CVS may be eligible for disability benefits, depending on where they live and the severity of their condition.

CVS is also associated with other disorders which can be classified as disabilities, including:

A lot researchers consider CVS to be a form of migraine, and a person with it can also experience migraines.

Most children get too big for CVS around the time of puberty, but about 75% of children with the disease develop migraines as they age.

CVS seems to be closely linked to abdominal migraine, a condition characterized by episodes of cramping and pain in the stomach.

Medicines for migraine can relieve CVS symptoms whether or not a person experiences a headache. Find out more about migraine medications.

Anyone with symptoms of CVS should receive medical attention.

People who already have a diagnosis should contact a doctor if they live:

  • incapacitating nausea
  • severe diarrhea
  • severe vomiting
  • vomiting that does not respond to medications
  • severe dehydration
  • reduced appetite
  • weightloss

It is not possible to prevent the occurrence of CVS, but a person can take the following not to reduce the frequency and severity of episodes.

  • Identify specific triggers and avoid exposing yourself to them.
  • Continue to take the prescribed medications even if you feel well.
  • Get quality sleep regularly.
  • Treat any allergies, sinus problems, or other illnesses or infections immediately.
  • Practice ways to manage stress and anxiety.
  • Eat regular meals.
  • Keep in touch with the doctor and discuss prevention methods and any changes in symptoms.

CVS is a rare disorder that involves recurring episodes of vomiting and nausea. It is rare and usually affects children aged 3 to 7 years.

The condition is most likely a form of migraine. While most children come out of CVS around the time of puberty, many continue to experience migraines.

Medication and lifestyle changes can help manage symptoms and reduce the frequency and severity of future episodes.

Anyone with symptoms of CVS should receive medical attention.


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Daniel Lange

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