The following information may help to address your question:
What is cyclic vomiting syndrome?
Cyclic vomiting syndrome
) is a condition characterized by recurrent, prolonged episodes of severe nausea and vomiting
. Episodes of vomiting may last hours or days. Other signs and symptoms during episodes may include intense sweating, paleness, weakness and fatigue, abdominal pain, diarrhea, fever, dizziness, and headache. Most people with CVS are symptom-free in between episodes, but some people have milder symptoms.
The condition can begin at any age, but it most often begins in childhood.
A subset of people with CVS also have neurologic or neuromuscular disorders
; the condition in these cases is referred to as "CVS plus."
The underlying cause of CVS is unknown. Data suggest there is a strong genetic component for CVS in children, involving changes (mutations
) in mitochondrial DNA
Researchers believe that the condition primarily affects the brain, causing abnormalities in how the brain and gut interact.
Many people with CVS report "triggers" for episodes, such as excitement, stress, infections, eating certain foods, and menstruation.
People with a family history
of migraines may be more likely to develop CVS.
Treatment strategies for controlling symptoms may include avoiding triggers, medications to prevent or relieve nausea, tricyclic antidepressants, anti-migraine medications, and supplements called coenzyme Q-10
While some people with CVS outgrow the condition within a few years, others continue to have episodes through adulthood.
Children who outgrow CVS may go on to develop migraines.
Last updated: 10/16/2017
What are the characteristics of adult cyclic vomiting syndrome?
Cyclic vomiting syndrome causes severe vomiting, nausea and gagging — sometimes as often as 12 times an hour.
In adults, episodes tend to occur less often than they do in children, but they last longer.
Episodes in children generally last only a day or two, but adults can have symptoms for almost a week. Adults tend to have episodes about every 3 months, while children have episodes every 2-4 weeks.
Other common symptoms include pallor and exhaustion. Some people also become sensitive to light and may develop:
- Abdominal pain
A healthcare provider may suspect cyclic vomiting syndrome adults when the following is present for at least 3 with onset at least 6 months ago:
- Each episode of cyclic vomiting syndrome is usually similar to the previous one (same time of day, same length of time) lasting for less than one week
- Three or more separate episodes in the past year
- Absence of nausea or vomiting between episodes
Based on several studies of adult patients with cyclic vomiting syndrome, the most uniform feature of adult patients with cyclic vomiting syndrome was the stereotypical nature of the nausea, vomiting, and abdominal pain with intermittent symptom free periods. The abdominal pain appears to be more pronounced in the adult patients than in pediatric patients.
Furthermore, the events or situations that trigger episodes in adults cannot always be pinpointed as easily as they can in children.
Last updated: 10/18/2017
How might cyclic vomiting syndrome be treated?
Treatment of cyclic vomiting syndrome (CVS) aims to prevent episodes (prophylactic
therapy), stop episodes (abortive therapy), and provide supportive care while symptoms are present (supportive therapy). There is no specific treatment that has been proven effective in controlled trials, but several therapies based on observation and experience (empiric therapies) have been effective in case series
. Treatment options for each person may depend on the person's age, whether there is a family history of migraines, the severity of episodes, and how often episodes occur.
People with CVS should consult with their doctor about a personalized treatment plan.
- Avoiding triggers of episodes (e.g. certain foods, physical exhaustion, sleep deprivation, or psychological stress).
- Various medications (usually for patients with more than one episode per month). Examples include cyproheptadine, amitriptyline (a tricyclic antidepressant), various anti-convulsants, propranolol, and erythromycin. There is consensus among experts that amitriptyline should be used as the first treatment for children over 5 years old, and cyproheptadine for children under 5 years old. Approximately 80% of those with a family history of migraines respond well to anti-migraine medications.
- Supplements called coenzyme Q-10 and L-carnitine. Retrospective studies have shown these to be very effective.
Abortive therapy options include various anti-migraine and anti-nausea medications such as ondansetron, promethazine, prochlorperazine, and a group of drugs used for migraines called triptans (e.g. sumatriptan).
is needed when both prophylactic and abortive therapies are unsuccessful. Supportive care is an extremely important aspect of treatment while a person is having symptoms. This may involve:
- Oral fluids if possible.
- IV fluids if needed.
- Sedatives or pain medications to allow for sleep and a break from severe nausea.
Last updated: 10/17/2017
What is the long-term outlook for people with cyclic vomiting syndrome?
The long-term outlook for people with cyclic vomiting syndrome varies from person to person. Many children with CVS "outgrow" the condition by late childhood or early adolescence, but some continue to have symptoms through adulthood.
It has been reported that many children with CVS go on to develop migraine headaches by late childhood.
Some of these children experience a phase of abdominal migraines
In adults with CVS, the course of the condition and how long it lasts have not been well-studied. There is substantial morbidity associated with CVS in adults, possibly due to lack of awareness and long delays in diagnosis.
Although people with CVS are symptom-free about 90% of the time, the condition can be quite disabling.
Children with CVS may miss many days of school and may need home tutoring or home schooling. Because of increased likelihood of episodes during times of stress or excitement, CVS may interfere with birthdays, holidays, and vacations.
Last updated: 10/18/2017
How can we connect with other adult patients with cyclic vomiting syndrome?
You can connect with other patients and families of patients with cyclic vomiting syndrome through supporting organizations. Click here
to view a list of supporting organizations and contact information.
Last updated: 6/8/2016
We hope this information is helpful. We strongly recommend you discuss this information with your doctor. If you still have questions, please
GARD Information Specialist
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