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Cyclic Vomiting Syndrome (CVS)

Introduction:

Cyclic vomiting syndrome is a medical problem which describes episodes of unexplained, overwhelmingly intense spells of nausea and vomiting -- with or without abdominal pain. The vomiting is often rapid, frequent, and intense often needing emergency room intervention.

In the past, it has been best characterized and recognized in children, but is now also recognized to occur in adults.

These patterns of vomiting have an abrupt on-set, lasting for hours to several days, and just as quickly ending followed by symptom free intervals of weeks to months.

Cyclic vomiting syndrome (CVS) may overlap with other digestive disorders like delayed gastric emptying, or gastroparesis. As well, it may occur in diabetics and diabetics with gastroparesis.

A strong family history of migraine headaches is a common finding.

A clinical feature perhaps shared by classical migraine sufferers and cyclic vomiting syndrome is a dysfunction of the sympathetic nervous system -- or what has been identified as an abnormality of adrenergic function. For some, this may help identify better medical treatment approaches.

Terms:

Migraine, abdominal migraine, dyspepsia, and cyclic vomiting syndrome all may have overlapping features. Since it is unclear as to the biological mechanisms which underlie the source of these symptoms, patients are categorized -- and therefore diagnosed -- based upon their predominating symptoms and lack of any other identifiable medical cause (like tumors, metabolic disorders, etc) for which to explain their symptoms.

The feature of abdominal migraine is an abrupt on-set of severe abdominal pain -- this symptom is the most disturbing for the patient (may also have symptoms of nausea and migraine) lasting for several hours or days, followed by an abrupt disappearance of symptoms. Of interest – a condition called Hereditary Angioedema (HAE) may be mistakenly diagnosed as abdominal migraine. Ruling out HAE is a good idea -- treatments are very different for the two conditions. HAE is a genetic problem that makes the body unable to produce certain necessary chemicals. Lack of these chemicals causes swelling that can happen anywhere in the body. When swelling happens in the abdomen, it causes nausea, pain and vomiting just like an abdominal migraine. A simple blood test will find most cases of HAE.

People who suffer with chronic dyspepsia -- or gastroparetic symptoms of: nausea, vomiting, and retching may also have interspersed spells of very intense nausea and vomiting, therefore showing clinical features of CVS and gastroparesis.

Other characteristics of CVS:

• No specific trigger can be identified -- yet, for some females -- a clear pattern may be seen following the menstrual cycle.

• May awaken in the middle of the night with vomiting.

The beginning phase of an "attack" may be heralded by:

• Mild nausea

• Feeling of weakness

• Colicy feeling -- an urgent feeling to move bowels

• Sweating or chills

• Abdominal pain or pressure

In the vomiting phase of an attack features may include:

• Overwhelming nausea and vomiting -- intense, rapid and frequent

• Impairment of consciousness, and concentration, with irritability

• Low grade fever

• Rapid heart rate

• Headache

• Severe abdominal pain

• Strong thirst

• Sensitive to noises and light

• Paleness

As the spell passes, then features may include:

• A return of hunger and ability to keep food down

• Energy level returns

It is important that medical intervention be initiated early. This helps to decrease the duration of an attack. Medical treatment is aimed at controlling symptoms.

Diagnosis

Is based upon the characteristic abrupt cycles of nausea and vomiting, and no underlying medical cause can be found.

Other diseases which may cause cycling of nausea and vomiting:

• Brain tumors

• Intermittent twisting of the bowel

• An obstruction of the urinary outflow from one of the kidneys (obstructive uropathy)

• Mitochondrial disorders

There are other diseases too which may mimic CVS. More information on this and treatments please visit the Cyclic Vomiting Syndrome Association