Cyclical Vomiting Syndrome: A Systematic Review
Cyclical Vomiting Syndrome (CVS) is a rare condition that is characterized by recurrent episodes of severe vomiting, which are typically separated by symptom-free intervals lasting days to weeks. CVS is often misdiagnosed due to its similarity to other gastrointestinal conditions, such as gastroenteritis, or food allergies. As such, CVS is not well understood and the exact cause is unknown. This review outlines the current understanding of CVS, its diagnosis, and treatment options.
Classification
CVS is classified as a functional gastrointestinal disorder, in which symptoms arise from altered gut function, instead of an underlying structural abnormality. In the United States, CVS is also known as abdominal migraine.
Epidemiology
CVS is a rare condition, with an estimated prevalence of 0.2-2.7% in children and adolescents. The condition is more common in females and most individuals experience the first episode before the age of 10.
Clinical Features
The hallmark of CVS is recurrent episodes of severe vomiting that last from a few hours to several days. During an episode, affected individuals may also experience abdominal pain, nausea, headache, and fatigue. Symptoms typically resolve between episodes, and individuals may remain symptom free for weeks or months. CVS is also associated with other conditions, including migraine headaches, irritable bowel syndrome, and psychosocial stress.
Diagnosis
The diagnosis of CVS is based on clinical history and is typically made after other conditions, such as gastroenteritis, have been ruled out. To make a diagnosis, physicians may use criteria outlined by the International Classification of Headache Disorders, such as at least 5 episodes of nausea and/or vomiting in the past year, each lasting for at least an hour and separated by symptom-free intervals of at least 1 day.
Treatment
Due to the lack of knowledge surrounding CVS, treatment is largely based on clinical experience. Antiemetics are often used to reduce nausea and vomiting, and medications such as cyproheptadine may be prescribed to prevent episodes. Additionally, lifestyle modifications such as avoiding triggers, such as stress, can be helpful.
Conclusion
CVS is a rare condition characterized by recurrent episodes of severe vomiting. Diagnosis is based on clinical history and symptom management is typically based on lifestyle modifications and medications. Further research is necessary to better understand the cause and management of CVS.
References
Dai, D., & Chey, W. (2013). Cyclical vomiting syndrome. Gastroenterology Clinics of North America, 42(2), 399–410. https://doi.org/10.1016/j.gtc.2013.02.007
Morini, S., Fusco, L., Mencarelli, M. A., & Guidetti, V. (2017). Cyclic vomiting syndrome: An update on pharmacological management. Current Pharmaceutical Design, 23(29), 4491–4497. https://doi.org/10.2174/1381612823666170531100502
Thomas, R. J., & Hamilton, J. R. (2019). Cyclic vomiting syndrome: What family physicians need to know. American Family Physician, 100(5), 324–330.