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Cyclic vomiting syndrome or CVS for short is a disorder characterized by recurrent or cyclic episodes of severe nausea and vomiting. CVS can occur at any age but is typically more common and severe in children, episodes of nausea and vomiting may last for a few hours to several days they generally have sudden onset resolve for a period of time and are similar each time in some people, especially adults nausea and vomiting may continue between episodes but the intensity is far less severe than during episodes.

Episodes may occur a few times a year or as frequently as several times a month episodes may return like clockwork and monthly episodes are common they can occur at times of stress or be apparently random during an episode vomit can be biliously appearing green or yellow. Children may experience bouts of projectile vomiting as frequently as four or more times per hour which can potentially lead to dehydration and electrolyte imbalances involving sodium and potassium. Episodes can also be associated with severe abdominal pain retching and diarrhea as well as decreased appetite and weight loss.

Some individuals may also experience migraine-like symptoms like headaches and sensitivity to light and sound as well as fever dizziness a lack of energy and power,  in severe cases an individual can become incapacitated and unable to walk or talk until the episode resolves the exact cause of CVS is still unknown but it seems to have many contributing factors. The nervous system is thought to play a role nerves deliver messages throughout the body including between the brain and gut to coordinate functions, most individuals with CVS have migraines or a family history of migraines. In fact, CVS is sometimes called abdominal migraine, gastrointestinal motility may also have a role, the gastrointestinal tract has a layer of smooth muscles that normally help push food, liquid, and gas from the esophagus down to the rectum.

In some individuals with CVS gastrointestinal motility doesn't function properly which is known as dysmotility. Dysmotility may also occur between vomiting episodes resulting in conditions like gastroesophageal reflux, gastroparesis and irritable bowel other factors contributing to CVS may include changes or mutations in mitochondrial genes as well as the abnormal function of the autonomic nervous system called dysautonomia and an overactive response to stress. In addition to migraine headache and gut dysmotility, several other conditions are common in people with CVS including additional pain syndromes, chronic fatigue, postural tachycardia syndrome, anxiety, depression and attention deficit hyperactivity disorder. In addition, some factors are recognized as potential triggers that may precipitate an episode these include physical exhaustion, lack of sleep, increased stress anxiety, and panic attacks. Other triggers include consuming certain foods or alcohol as well as experiencing motion sickness infections like colds incoming weather fronts and menstruation.

           

Diagnosis of CVS is typically based on the history and presenting signs and symptoms after other potential conditions and causes have been ruled out. Treatment of CVS is primarily focused on prevention or management of the episodes and associated symptoms the most effective treatment varies between individual’s preventative measures including identifying and avoiding triggers, in addition, some individuals may benefit from anti-migraine medications such as amitriptyline or triptans, autonomic nervous system treatments like propranolol and mitochondrial-targeted cofactors such as coenzyme q10 or l-carnitine, management of episodes can include medications to suppress nausea and vomiting like on ondansetron or granisetron as well as anti-migraine medications to treat pain.

In some patients non-steroidal anti-inflammatory drugs or NSAIDs can be used to manage pain, in addition infusing intravenous sugar solutions or consuming sugary drinks like soda and juices may stop or lessen the severity of the episode, intravenous fluids may be needed to reverse or prevent dehydration finally if prevention and management of the episode fail, individuals should try to rest in a quiet and dimly lit room and in some people sedatives like lorazepam can be used to help induce sleep.  

Cyclic vomiting syndrome is a disorder characterized by recurrent or cyclic episodes of severe nausea and vomiting which can be associated with severe abdominal pain retching and diarrhea as well as migraine-like symptoms these episodes can last for a few hours to days may occur several times a year and can cause dehydration and electrolyte imbalances while the exact cause is not known there seem to be several contributing factors and triggers diagnosis is made based on the history and presenting signs and symptoms and treatment is focused on prevention or management of the episodes.

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