Diseases

Cyclic vomiting syndrome is hard to diagnose because no tests -- such as a blood test or X-ray -- can establish a diagnosis of cyclic vomiting syndrome. A doctor must look at symptoms and medical history to rule out other common diseases or disorders that can cause nausea and vomiting. Making a diagnosis takes time because the doctor also needs to identify a pattern or cycle to the vomiting. For example, the patient who has had at least five separate episodes of vomiting or at least three separate episodes over six months for children or one year for adults, that have had attacks similar to previous episodes (for example, they started the same time of day, last same time span and have the same intensity), makes the diagnosis of CVS more likely.However, it is not unusual to have laboratory tests such as CT, ultrasound or MRI of the abdomen, magnetic resonance enterography, endoscopy, upper GI series of X-rays, gastrointestinal motility tests, food allergy tests, and others performed to help the physician be sure that diseases with similar symptoms are not causing the problems.

Treatment varies, but people with cyclic vomiting syndrome generally improve after learning to control their symptoms. People with cyclic vomiting syndrome are advised to get plenty of rest and sleep and to take medications that prevent a vomiting episode, stop one in progress, speed up recovery, or relieve associated symptoms.Treatment of vomiting phase: Once a vomiting episode begins, treatment usually requires the person to stay in bed and sleep in a dark, quiet room. Severe nausea and vomiting may require hospitalization and intravenous fluids to prevent dehydration. Sedatives may help if the nausea continues.Treatment during prodromal phase: Sometimes, during the prodromal phase, it is possible to stop an episode from happening. People with nausea or abdominal pain before an episode can ask their doctor about taking ondansetron (Zofran) or lorazepam (Ativan) for nausea or ibuprofen (Advil, Motrin) for pain. Other medications that may be helpful are ranitidine (Zantac) or omeprazole (Prilosec), which help calm the stomach by lowering the amount of acid it makes.Treatment during recovery phase: During this phase it's very important to drink water and replace lost electrolytes. Electrolytes are salts the body needs to function and stay healthy. Symptoms during the recovery phase can vary. Some people find their appetite returns to normal immediately, while others need to begin by drinking clear liquids and then move slowly to solid food.Frequent and long-lasting episode treatment: People whose episodes are frequent and long-lasting may be treated during the symptom-free intervals in an effort to prevent or ease future episodes. Medications that help people with migraine headaches, such as propranolol (Inderal), cyproheptadine (Periactin), and amitriptyline (Elavil), are sometimes used during this phase, but they do not work for everyone. Taking the medicine daily for one to two months may be necessary before one can tell if it helps.Symptom-free phase: The symptom-free interval phase is a good time to eliminate anything known to trigger an episode. For example, if episodes are brought on by stress or excitement, a symptom-free interval phase is the time to find ways to reduce stress and stay calm. Behavioral therapy may help reduce attacks by reducing stress and anxiety.Sinus and allergy causes: If sinus problems or allergies cause episodes, those conditions should be treated early to reduce the chance for a CVS attack.Migraine treatment: During an episode, anti-migraine drugs such as sumatriptan (Imitrex) may be prescribed to stop symptoms of migraine headache. The safety and efficacy of these medications has not been established in children under 18 years of age.

In most cases of cyclic vomiting syndrome, affected people have no known history of the disorder in their family, but many CVS-affected individuals have a family history of related conditions, such as migraines, in their mothers and other maternal relatives. This family history suggests an inheritance pattern known as maternal inheritance or mitochondrial inheritance, which applies to genes contained in mitochondrial DNA. Disorders with mitochondrial inheritance can appear in every generation of a family and can affect both males and females. However, because mitochondria can be passed from one generation to the next only through egg cells (not through sperm cells), only females pass mitochondrial conditions to their children. In addition, most researchers suggest that CVS development may require other factors to help trigger genetic component.

Most investigators who study CVS suggest there are ways to prevent or reduce the number of CVS attacks. Ways to prevent and/or reduce attacks include the following:

• Get adequate sleep.
• Seek help to prevent stress and anxiety.
• Treat infections and/or allergies early.
• Avoid any triggers of CVS, especially related to foods.
• During the well phase, eat a balanced diet with regular meals.
• Utilize appropriate medications prescribed by a physician to reduce CVS symptoms.

Although home remedies have not been well studied, anecdotal reports suggest at least three remedies may help some patients. They are biofeedback to reduce stress, L-carnitine that helps turn fat into energy, and coenzyme Q10, a substance that aids mitochondrial dysfunction.Reports of diets that help reduce the frequency of reoccurrence of CVS attacks include gluten-free diets, a Paleo diet (diet based on foods eaten by early humans such as fish, meat, vegetables, and fruit without dairy or green products), and GAPS diet (complicated diet plan designed for individuals with gastrointestinal immune problems). Parents and individuals should check with their physician before utilizing any of these home remedies or diets to avoid any potential side effects or deterioration in the child's or adult's condition.

If the condition is not treated, attacks typically occur four to 12 times per year. Between episodes, vomiting is absent, and nausea is either absent or much reduced. Many affected people experience other symptoms during and between episodes, including pain, digestive disorders such as gastroesophageal reflux (GERD) and irritable bowel syndrome (IBS), and fainting spells (syncope). In addition, complications of CVS can also include dehydration, electrolyte abnormalities, damage to the esophagus, and tooth decay due to the acid in vomit. People with cyclic vomiting syndrome are also more likely than people without the disorder to experience depression, anxiety, and panic disorder. It is unclear how these health conditions are related to nausea and vomiting.

Although the exact causes of cyclic vomiting syndrome have yet to be determined, researchers have proposed several factors that may contribute to the disorder. These factors include changes in brain function, hormonal abnormalities, and gastrointestinal problems. Many researchers believe that cyclic vomiting syndrome is a migraine-like condition, which suggests that it is related to changes in signaling between nerve cells (neurons) in certain areas of the brain.Some cases of cyclic vomiting syndrome may be related to genetic changes in mitochondrial DNA. Mitochondria are structures within cells that convert the energy from food into a form that cells can use. Although most DNA is packaged in chromosomes within the nucleus, mitochondria also have a small amount of their own DNA (known as mitochondrial DNA, mDNA, or mtDNA).Several changes in mitochondrial DNA have been associated with cyclic vomiting syndrome. Some of these changes alter single DNA building blocks (nucleotides), whereas others rearrange larger segments of mitochondrial DNA. These changes likely impair the ability of mitochondria to produce energy. Defects in energy production may lead to symptoms during periods when the body requires more energy, such as when the immune system is fighting an infection. It remains unclear how changes in mitochondrial function are related to recurrent episodes of nausea and vomiting.

Cyclic vomiting syndrome is a disorder that causes recurrent episodes of nausea, vomiting, and tiredness (lethargy) that are also termed as “paroxysmal and stereotypic”. This condition is diagnosed most often in young children, but it can affect people of any age. It was first described by Samuel Gee in 1882; the etiology and pathophysiology is unknown but researchers suggest genetic component may play a significant role in this syndrome. CVS is characterized by episodes of rapid vomiting followed with periods of completely normal health - clinicians suggest this off and on again stereotypic vomiting pattern that usually consists of four phases is the diagnostic feature of the syndrome.

Cyclic vomiting syndrome is generally considered to be a variant of migraines, which are severe headaches often associated with pain, nausea, vomiting, and extreme sensitivity to light and sound. Many people with cyclic vomiting syndrome have a family history of migraines, and attacks of nausea and vomiting may be replaced by migraine headaches as an affected person gets older.

• CVS
• Cyclical vomiting
• Cyclical vomiting syndrome
• Periodic vomiting

Most people with cyclic vomiting syndrome have normal intelligence, although some affected people have experienced developmental delay or intellectual disability, muscle weakness (myopathy), and/or seizures. People with these additional features are said to have cyclic vomiting syndrome plus.The prognosis for CVS varies. Patients with complications and weak responses to treatment have a fair prognosis while others may respond well and have a good prognosis. In general, CVS lasts about two and a half to five and a half years, resolving late childhood or early adolescence. Some patients go on to develop migraine headaches, and a few patients have CVS extend into adulthood. Patients with a diagnosis of cyclic vomiting syndrome plus have a prognosis usually ranging from fair to poor.

In addition to the patient's primary-care physician or pediatrician, gastroenterologists (doctors who specialize in disorders of the digestive system) are usually consulted. In addition, critical-care specialists (adult or pediatric) may need to be consulted if complications develop.

The exact prevalence of cyclic vomiting syndrome is unknown; estimates range from 3.15 to 2,000 per 100,000 children. The condition is diagnosed less commonly in adults, although recent studies suggest that the condition could be as common in adults as in children.