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What is cyclic vomiting syndrome?

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About cyclic vomiting syndrome

Cyclic vomiting syndrome is one of the more unrecognized, misdiagnosed and mysterious childhood diseases. Children with CVS experience severe, recurring vomiting episodes but remain completely symptom-free for weeks or even months between the episodes. Over the course of 24 to 48 hours, a child could have more than 30 vomits and a few can vomit hundreds of times per episode.

A child’s vomiting could lead to dehydration and a visit to the emergency room, where doctors commonly mistake CVS for gastroenteritis (irritation or infection of the stomach and intestines), food poisoning, or gastroesophageal reflux disease. One characteristic that distinguishes CVS is that the vomiting bouts usually follow a specific pattern — they often start at the same time of day (early morning), have the same symptoms and last the same amount of time.

Cyclic vomiting syndrome is closely associated with abdominal migraines, and about 80 percent of children with CVS will also have abdominal migraines.

What causes cyclic vomiting syndrome?

The specific causes of CVS are unknown, but researchers believe the problem resides in the brain, which is home to the body’s vomiting center. With the stomach flu or a bowel obstruction, a child will vomit until his or her stomach is empty. But with CVS, the child will continue to vomit or retch long after that point. Other factors include a heightened stress response, autonomic dysfunction and mitochondrial (energy) dysfunction.

How common is cyclic vomiting syndrome?

Some research suggests that this condition affects 2 percent of school-aged children.

What are the symptoms of cyclic vomiting syndrome?

Vomiting episodes often begin in the early morning, and you might find your child unresponsive, pale and curled in a fetal position. In addition to severe vomiting and nausea, a child with CVS could also experience:

Repeated vomiting can lead to serious dehydration. Signs of dehydration include thirst, exhaustion, decreased urination, paleness and listlessness. A child with any symptoms of dehydration should see a health care provider immediately.

Who is at risk of developing this condition?

CVS can begin at any age, but in children it typically begins between the ages of 3 and 7, with the peak age around 5. Sixty percent of those with CVS are female, and 70 to 80 percent have a family history of migraines.

Why is cyclic vomiting syndrome a concern?

Vomiting can cause severe dehydration that can be life threatening and lead to hospitalization. Cyclic vomiting attacks can last for days and be extremely debilitating for the child and disruptive to family life. On average, these children miss about three weeks of school annually due to their condition.

How is cyclic vomiting syndrome diagnosed/evaluated?

The doctor will thoroughly study your child’s medical history to see if the vomiting episodes fit the typical pattern for this condition. Increasingly, doctors are using the historical diagnostic criteria to make a tentative diagnosis of CVS rather than subjecting patients to all the available testing. However, doctors use selected tests to exclude some serious surgical disorders.

Diagnostic tests could include an upper GI series to rule out an anatomical reason for the symptoms, such as intestinal twisting or blockage, or an abdominal ultrasound to exclude kidney blockage or obstruction. Because the body’s vomiting center is based in the brain, occasionally your child’s doctor might use magnetic resonance imaging to look for a growth or blockage in the brain, though that is very rarely the cause of cyclic vomiting. The doctor might also use endoscopy to look for inflammation caused by food allergies or bacterial infection of stomach, as well as blood tests to check for metabolic, liver and pancreatic disorders. Autonomic testing can confirm postural orthostatic tachycardia syndrome (POTS), a condition that sometimes occurs with CVS and that causes lightheadedness upon standing.

If no specific cause for the vomiting is found, the diagnosis is most likely CVS.

What is the treatment for cyclic vomiting syndrome?

Your child’s doctor might prescribe anti-migraine medications for prevention, as well as anti-vomiting medications. When a child is in the emergency room or hospitalized during an episode, doctors might add IV hydration and sedation.

What happens after treatment?

Your child’s doctor will continue to monitor your child’s symptoms and adjust treatment as necessary.

When should you contact a physician?

Pediatricians should consider the possibility of CVS in children who experience:

  • Recurrent vomiting episodes that start with severe vomiting — several times per hour — and last less than one week
  • Three or more separate episodes of vomiting in the past six months of five total
  • No nausea or vomiting between episodes

What is the long-term outlook for cyclic vomiting syndrome?

Most children will outgrow CVS around puberty, but about 75 percent will likely develop migraine headaches later in life.

How do I live with cyclic vomiting syndrome?

It’s important to track and understand the triggers for your child’s vomiting episodes. Triggers can include illness, stress/excitement, fatigue or certain foods, such as chocolate or cheese. Nearly 60 percent of school-aged children with CVS meet the criteria for an anxiety disorder, and cognitive behavior therapy can help your child stay calm and reduce stress, which in turn can have a positive effect on your child’s CVS symptoms.

Learn more and find additional parent and patient resources through the Cyclic Vomiting Syndrome Association.

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