Cyclic Vomiting Syndrome (CVS)

What is Cyclic Vomiting Syndrome?

Cyclic vomiting syndrome (CVS) is a disorder with repeated episodes of severe nausea and vomiting that alternate with symptom free periods. It occurs in children and adults.

What are the signs and symptoms of CVS?

The symptom episodes tend to follow the same pattern in each person with CVS over time. There are typically four phases:

  • The first phase is relatively symptom-free. It occurs between vomiting episodes and usually lasts weeks to months.
  • During the second phase the coming on of an episode is felt. There is nausea, but oral medicines may still be taken. This phase lasts minutes to hours.
  • In the third phase there is intense nausea and vomiting, and an inability to eat, drink, or take medicines without vomiting. Other symptoms may include belly pain, hot sweats, cold chills, headache, sensitivity to light and sounds, and diarrhea. The person may be drowsy and withdrawn. This phase lasts from hours to days.
  • In the fourth phase, recovery begins with the settling down of symptoms and ends with going back to a normal diet and a return to the relatively symptom-free period.

In CVS, the pattern of these episodes repeats over a long-term, with 3 or more episodes a year.

How do I know if I have Cyclic Vomiting Syndrome?

A doctor can diagnose Cyclic Vomiting Syndrome (CVS) based on a thorough history, physical exam, and the symptoms. There is no test for CVS. Tests may be done to rule out other conditions. A viral infection may at first be suspected. Repeated trips to emergency rooms are not uncommon, especially until a diagnosis is made. Many people with CVS also report migraine headaches or a family history of migraines.

What causes Cyclic Vomiting Syndrome?

The cause of CVS is not yet known. Scientists are looking at genetic, hormonal, and other factors that may contribute to the symptoms.

How is CVS treated?

In general, treatment includes avoiding potential triggering factors, taking medicines to prevent episodes or reduce symptoms, and getting supportive care during episodes.

Triggering factors like stress, anxiety, or certain foods will vary between persons. Try to identify and avoid triggers.

Drug treatments may be divided into short-term treatment of the vomiting episodes and long-term treatment to try to prevent the episodes. In the short term, antiemetic agents can reduce nausea and vomiting. Antianxiety and antimigraine medications may also help. Long term, a tricyclic antidepressant can help prevent nausea and vomiting. Other medicines may also be used as preventive therapies.

Continual vomiting can cause other problems, which need to be treated as well. Examples include loss of fluids (dehydration), electrolyte imbalance, and irritation of the esophagus (food tube).

A letter from your doctor that describes your Cyclic Vomiting Syndrome diagnosis and the right treatment for you is often helpful to have on hand. Having a planned, quick, effective treatment helps put care into action early if emergency treatment is needed. It also helps reduce worry. Planned support and early action help improve the treatment of CVS.

Learn more about Cyclic Vomiting Syndrome from Dr. Thangam Venkatesan

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