Cyclic Vomiting Syndrome Treatment

What is cyclic vomiting syndrome?

Cyclic vomiting syndrome is defined by severe vomiting episodes which have no clear root. The episodes may last for days or hours and can be accompanied by periods of symptom-free time. Episodes are similar, meaning they start at the same time of day, last the same length of time, and occur with the same symptoms and intensity.

The condition is seen across all age groups; however, it usually is seen in children between 3-7 years old. While it is more prevalent in children, the amount of adults suffering from the disease is growing. 

The disorder is challenging to identify because vomiting can be one of the symptoms of many conditions. Treatment usually requires lifestyle modifications to prevent the events that trigger vomiting episodes. The use of medications, such as anti-nausea or migraine treatments, can reduce symptoms.

Causes

The cause behind the syndrome of cyclic vomiting is not known. The possible causes could be genetic problems with digestion, hormonal imbalances, and nervous system problems. Specific bouts of vomiting may be triggered by: 

• Colds, allergies, or sinus problems
• Emotional stress or excitement, especially in children
• Anxiety or panic attacks, especially in adults 
• Certain beverages and foods include caffeine, alcohol, chocolate or even cheese consumption 
• Consuming too much, eating before bedtime or fasting
• Hot weather
• Physical exhaustion
• Exercising too much
• Menstruation
• Motion sickness
• The identification of the main triggers that cause vomiting episodes could help with the management of the symptoms of the condition.

Symptoms

It is believed that the symptoms associated with cyclic nausea syndrome typically start in the morning. The symptoms and signs include: 

• Three or more repeat episodes of vomiting which begin at the same time and last for the same duration of time  
• Variable intervals of general health and with no nausea in between episodes 
• Excessive sweating and nausea before the episode begin. Other symptoms and signs during the vomiting phase could include: 
• Abdominal pain
• Diarrhea
• Dizziness
• Sensitivity to light
• Headache
• Retching or gagging

How can cyclic vomiting syndrome be diagnosed?

CVS diagnosis is difficult since most of the symptoms associated with it resemble other conditions. To confirm the diagnosis, the doctor will advise the patient to undergo a couple of tests. They are listed below:

1. Laboratory tests: They include complete blood count, thyroid tests, liver function tests, ESR, urine analysis, β-hCG, etc.
2. Motility tests: This test is done to monitor the movement of food through the digestive system and check for digestive disorders.
3. Imaging tests: They include upper GI (gastrointestinal) endoscopy, Ultrasonography, and CT scan. These tests are done to check for any digestive system blockages or any signs of other digestive disorders.
4. Physical examination and medical history of the patient.

How is cyclic vomiting syndrome treated?

The following management strategy can be used in treating cyclic vomiting syndrome.

1. Avoidance of factors that trigger the CVS
2. Prophylactic and abortive medications: The doctor might advise a few medications to prevent CVS or medications that decrease their frequency. They are listed below:

• Prophylactic medications include- cyproheptadine, amitriptyline, propranolol, anti-convulsants, and erythromycin [1].
• Medications used for aborting episodes include- promethazine, ondansetron, triptans, and prochlorperazine.

3.  Supportive pharmacologic therapy- Supportive therapy is administered when both prophylactic and abortive therapy fails. 

4.  Other treatment includes pain relief medications, anti-depressants, anti-convulsants, medications that suppress stomach acid, anti-migraine medicines, and medicines that can decrease the patient’s anxiety.

5.  IV fluids- It is given to replace the fluids and electrolytes lost due to vomiting. 

What are the complications of cyclic vomiting syndrome?

The complications of cyclic vomiting syndrome are:

1. Severe dehydration
2. Tooth decay
3. Injury to the food pipe (Mallory Weiss tear)
4. Esophagitis (inflammation of the esophagus)
5. Gastritis 

Prevention

Cyclic vomiting syndrome can be prevented by following these steps. They are mentioned below:

1. Getting adequate sleep
2. Avoid triggering food items such as caffeine, chocolate, cheese, alcohol, etc.
3. Eating a small quantity of meals at regular intervals. 
4. Treat sinus problems
5. Reduce stress and anxiety 
6. Consult the doctor and take medications as advised by the doctor.

FAQ

References

1. https://emedicine.medscape.com/article/933135-treatment#d11
2. https://www.ncbi.nlm.nih.gov/books/NBK500018/