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cyclic vomiting syndrome (CVS)

Cycles of severe nausea & vomiting that last for hours or even days & alternate with longer periods of no symptoms. Etiology: 1) idiopathic 2) may be a form of abdominal migraine - patients may develop migraine as adult Epidemiology: 1) occurs mostly in children between the ages of 3 & 7 - 2% of children in 1 study 2) can affect adults, too Genetics: - family history of migraine is common Clinical manifestations: 1) cycles of severe nausea & vomiting a) episodes usually last anywhere from 1 to 5 days, though they can last for up to 10 days b) alternate with longer periods of no symptoms c) vomiting or retching as often as 6-12 times/hour 2) each episode is similar to the previous ones a) tend to start at about the same time of day - at night or first thing in the morning b) last the same length of time c) present the same symptoms at the same level of intensity 3) in adults, episodes tend to occur less often than they do in children, but they last longer 4) 4 phases a) prodrome - often marked by abdominal pain, - can last from just a few minutes to several hours - sometimes there is no prodrome b) episode (nausea & vomiting) c) recovery - nausea & vomiting stop - healthy color, appetite, & energy return d) symptom-free interval 5) most people can identify a specific condition or event that triggered an episode. a) most common trigger is an infection b) emotional stress or excitement c) certain foods (such as chocolate or cheese) d) eating too much e) eating just before going to bed f) hot weather g) physical exhaustion h) menstruation i) motion sickness 6) photosensitivity 8) headache 9) fever 10) dizziness 11) diarrhea 12) drinking water usually leads to more vomiting, though the water can dilute the acid in the vomit, making the episode a little less painful Laboratory: - cannabinoid in urine Differential diagnosis: - cannabinoid hyperemesis syndrome Complications: 1) dehydration 2) electrolyte imbalance 3) peptic esophagitis 4) hematemesis 5) Mallory-Weiss tear 6) tooth decay Management: 1) CVS cannot be cured 2) rest; sleep 3) migraine prophylaxis helps some 4) severe nausea & vomiting may require hospitalization & intravenous fluids to prevent dehydration 5) abstinence from cannabis rarely resolves symptoms or leads to a diagnosis of cannabinoid hyperemesis syndrome [1]

General

syndrome vomiting

References

  1. Venkatesan T, Hillard CJ, Rein LE et al. Patterns of cannabis use in patients with cyclic vomiting syndrome. Clin Gastroenterol Hepatol 2019 Jul 25; PMID: 31352091 https://www.cghjournal.org/article/S1542-3565(19)30783-9/pdf
  2. Levinthal DJ, Staller K, Venkatesan T. AGA Clinical Practice Update on Diagnosis and Management of Cyclic Vomiting Syndrome: Commentary. Gastroenterology. 2024 Jul 10:S0016-5085(24)05025-X PMID: 39023502 https://www.gastrojournal.org/article/S0016-5085(24)05025-X/fulltext
  3. Chen YJ, Princic N, Winer I et al
  4. Richmond C, Williams J, Thavamani A, Levinthal DJ, Venkatesan T. Cyclic Vomiting SyndromeEpidemiology, Comorbidities, and Treatment of Cyclic Vomiting Syndrome in the United States. Am J Gastroenterol. 2024 May 1;119(5):965-976. PMID: 38088366 PMCID: PMC11062608 Free PMC article. https://www.niddk.nih.gov/health-information/digestive-diseases/cyclic-vomiting-syndrome