Disease: Cyclic Vomiting Syndrome (CVS)

    Cyclic vomiting syndrome facts*

    *Cyclic vomiting syndrome facts medical author: Charles Patrick Davis, MD, PhD

    • Cyclic vomiting syndrome is a disorder that causes recurrent episodes of nausea, vomiting, and tiredness (lethargy) most often in children but may occur in all age groups.
    • Symptoms of cyclic vomiting syndrome are repeated attacks of intense nausea, vomiting, and lethargy that last anywhere from an hour to 10 days; other symptoms may include pale skin, abdominal pain, diarrhea, headache, and an increased sensitivity to light or to sound.
    • The most common situations that cause cyclic vomiting syndrome are emotional excitement and infections; other triggers can include periods without eating, temperature extremes, lack of sleep, overexertion, allergies, ingesting certain foods or alcohol, and menstruation.
    • Cyclic vomiting syndrome has four phases: symptom-free, prodrome, vomiting, and recovery.
    • Cyclic vomiting syndrome is diagnosed by the patient's history and symptoms.
    • Treatment is done by the patient learning to avoid the causes or triggers of the disorder; however, during the prodrome, vomiting and recovery phases, medications are often used to treat the symptoms (for example, anti-nausea medications, NSAIDs, anti-migraine medications, fluid replenishment and others).
    • Complications may include pain, reflux, fainting, depression, panic disorder, and irritable bowel syndrome.
    • Cyclic vomiting syndrome is generally considered to be a variant of migraines by researchers.
    • "Cyclic vomiting syndrome plus" is considered a diagnosis when a patients also exhibit symptoms of developmental delay or intellectual disability, muscle weakness (myopathy), and/or seizures.
    • The disorder has a wide range of reported prevalence, about 4 to 2000 per 100,000 children; but seems to occur less frequently in adults although the data is not clear.
    • Researchers suggest several factors may contribute to the disorder: brain function disorder, hormonal abnormalities, GI problems, migraine-like conditions, and changes in mitochondrial DNA.
    • Some people may inherit the changes in mitochondrial DNA that may cause the disorder.

    What is cyclic vomiting syndrome?

    Cyclic vomiting syndrome is a disorder that causes recurrent episodes of nausea, vomiting, and tiredness (lethargy). This condition is diagnosed most often in young children, but it can affect people of any age.

    What are the symptoms of cyclic vomiting syndrome?

    Cyclic vomiting syndrome is characterized by attacks of intense nausea, vomiting, and lethargy that last anywhere from an hour to 10 days. An affected person may vomit several times per hour, potentially leading to a dangerous loss of fluids (dehydration). Additional symptoms can include unusually pale skin (pallor), abdominal pain, diarrhea, headache, and an increased sensitivity to light (photophobia) or to sound (phonophobia). In most affected people, the signs and symptoms of each attack are quite similar. These attacks can be debilitating, making it difficult for an affected person to go to work or school.

    What triggers cyclic vomiting syndrome?

    Episodes of nausea and vomiting can be triggered by several different factors. The most common triggers are emotional excitement and infections. Other triggers can include periods without eating (fasting), temperature extremes, lack of sleep, overexertion, allergies, ingesting certain foods or alcohol, and menstruation.

    What are the four phases of cyclic vomiting syndrome?

    Cyclic vomiting syndrome has four phases:

    Symptom-free interval phase. This phase is the period between episodes when no symptoms are present.

    Prodrome phase. This phase signals that an episode of nausea and vomiting is about to begin. Often marked by nausea - with or without abdominal pain - this phase can last from just a few minutes to several hours. Sometimes, taking medicine early in the phase can stop an episode in progress. However, sometimes there is no warning; a person may simply wake up in the morning and begin vomiting.

    Vomiting phase. This phase consists of nausea and vomiting; an inability to eat, drink, or take medicines without vomiting; paleness; drowsiness; and exhaustion.

    Recovery phase. This phase begins when the nausea and vomiting stop. Healthy color, appetite, and energy return.

    How is cyclic vomiting syndrome diagnosed?

    Cyclic vomiting syndrome is hard to diagnose because no tests - such as a blood test or X-ray - can establish a diagnosis of cyclic vomiting syndrome. A doctor must look at symptoms and medical history to rule out other common diseases or disorders that can cause nausea and vomiting. Making a diagnosis takes time because the doctor also needs to identify a pattern or cycle to the vomiting.

    How is cyclic vomiting syndrome treated?

    Treatment varies, but people with cyclic vomiting syndrome generally improve after learning to control their symptoms. People with cyclic vomiting syndrome are advised to get plenty of rest and sleep and to take medications that prevent a vomiting episode, stop one in progress, speed up recovery, or relieve associated symptoms.

    Once a vomiting episode begins, treatment usually requires the person to stay in bed and sleep in a dark, quiet room. Severe nausea and vomiting may require hospitalization and intravenous fluids to prevent dehydration. Sedatives may help if the nausea continues.

    Sometimes, during the prodrome phase, it is possible to stop an episode from happening. For example, people with nausea or abdominal pain before an episode can ask their doctor about taking ondansetron (Zofran) or lorazepam (Ativan) for nausea or ibuprofen (Advil, Motrin) for pain. Other medications that may be helpful are ranitidine (Zantac) or omeprazole (Prilosec), which help calm the stomach by lowering the amount of acid it makes.

    During the recovery phase, drinking water and replacing lost electrolytes are important. Electrolytes are salts the body needs to function and stay healthy. Symptoms during the recovery phase can vary. Some people find their appetite returns to normal immediately, while others need to begin by drinking clear liquids and then move slowly to solid food.

    People whose episodes are frequent and long-lasting may be treated during the symptom-free intervals in an effort to prevent or ease future episodes. Medications that help people with migraine headaches, such as propranolol (Inderal), cyproheptadine (Periactin), and amitriptyline (Elavil), are sometimes used during this phase, but they do not work for everyone. Taking the medicine daily for 1 to 2 months may be necessary before one can tell if it helps.

    The symptom-free interval phase is a good time to eliminate anything known to trigger an episode. For example, if episodes are brought on by stress or excitement, a symptom-free interval phase is the time to find ways to reduce stress and stay calm. If sinus problems or allergies cause episodes, those conditions should be treated.

    During an episode, anti-migraine drugs such as sumatriptan (Imitrex) may be prescribed to stop symptoms of migraine headache. However, these agents have not been studied for use in children.

    What are the complications if cyclic vomiting syndrome is not treated?

    If the condition is not treated, attacks typically occur four to 12 times per year. Between episodes, vomiting is absent, and nausea is either absent or much reduced. However, many affected people experience other symptoms during and between episodes, including pain, digestive disorders such as gastroesophageal reflux and irritable bowel syndrome, and fainting spells (syncope). People with cyclic vomiting syndrome are also more likely than people without the disorder to experience depression, anxiety, and panic disorder. It is unclear how these health conditions are related to nausea and vomiting.

    What is the relationship between cyclic vomiting syndrome and migraines?

    Cyclic vomiting syndrome is generally considered to be a variant of migraines, which are severe headaches often associated with pain, nausea, vomiting, and extreme sensitivity to light and sound. Many people with cyclic vomiting syndrome have a family history of migraines, and attacks of nausea and vomiting may be replaced by migraine headaches as an affected person gets older.

    What other features and conditions accompany cyclic vomiting syndrome?

    Most people with cyclic vomiting syndrome have normal intelligence, although some affected people have experienced developmental delay or intellectual disability, muscle weakness (myopathy), and/or seizures. People with these additional features are said to have cyclic vomiting syndrome plus.

    How common is cyclic vomiting syndrome?

    The exact prevalence of cyclic vomiting syndrome is unknown; estimates range from 4 to 2,000 per 100,000 children. The condition is diagnosed less commonly in adults, although recent studies suggest that the condition could be as common in adults as in children.

    What are the genetic changes related to cyclic vomiting syndrome?

    Although the exact causes of cyclic vomiting syndrome have yet to be determined, researchers have proposed several factors that may contribute to the disorder. These factors include changes in brain function, hormonal abnormalities, and gastrointestinal problems. Many researchers believe that cyclic vomiting syndrome is a migraine-like condition, which suggests that it is related to changes in signaling between nerve cells (neurons) in certain areas of the brain.

    Some cases of cyclic vomiting syndrome may be related to genetic changes in mitochondrial DNA. Mitochondria are structures within cells that convert the energy from food into a form that cells can use. Although most DNA is packaged in chromosomes within the nucleus, mitochondria also have a small amount of their own DNA (known as mitochondrial DNA or mtDNA).

    Several changes in mitochondrial DNA have been associated with cyclic vomiting syndrome. Some of these changes alter single DNA building blocks (nucleotides), whereas others rearrange larger segments of mitochondrial DNA. These changes likely impair the ability of mitochondria to produce energy. Defects in energy production may lead to symptoms during periods when the body requires more energy, such as when the immune system is fighting an infection. However, it remains unclear how changes in mitochondrial function are related to recurrent episodes of nausea and vomiting.

    What are the symptoms of cyclic vomiting syndrome?

    Cyclic vomiting syndrome is characterized by attacks of intense nausea, vomiting, and lethargy that last anywhere from an hour to 10 days. An affected person may vomit several times per hour, potentially leading to a dangerous loss of fluids (dehydration). Additional symptoms can include unusually pale skin (pallor), abdominal pain, diarrhea, headache, and an increased sensitivity to light (photophobia) or to sound (phonophobia). In most affected people, the signs and symptoms of each attack are quite similar. These attacks can be debilitating, making it difficult for an affected person to go to work or school.

    What triggers cyclic vomiting syndrome?

    Episodes of nausea and vomiting can be triggered by several different factors. The most common triggers are emotional excitement and infections. Other triggers can include periods without eating (fasting), temperature extremes, lack of sleep, overexertion, allergies, ingesting certain foods or alcohol, and menstruation.

    What are the four phases of cyclic vomiting syndrome?

    Cyclic vomiting syndrome has four phases:

    Symptom-free interval phase. This phase is the period between episodes when no symptoms are present.

    Prodrome phase. This phase signals that an episode of nausea and vomiting is about to begin. Often marked by nausea - with or without abdominal pain - this phase can last from just a few minutes to several hours. Sometimes, taking medicine early in the phase can stop an episode in progress. However, sometimes there is no warning; a person may simply wake up in the morning and begin vomiting.

    Vomiting phase. This phase consists of nausea and vomiting; an inability to eat, drink, or take medicines without vomiting; paleness; drowsiness; and exhaustion.

    Recovery phase. This phase begins when the nausea and vomiting stop. Healthy color, appetite, and energy return.

    How is cyclic vomiting syndrome diagnosed?

    Cyclic vomiting syndrome is hard to diagnose because no tests - such as a blood test or X-ray - can establish a diagnosis of cyclic vomiting syndrome. A doctor must look at symptoms and medical history to rule out other common diseases or disorders that can cause nausea and vomiting. Making a diagnosis takes time because the doctor also needs to identify a pattern or cycle to the vomiting.

    How is cyclic vomiting syndrome treated?

    Treatment varies, but people with cyclic vomiting syndrome generally improve after learning to control their symptoms. People with cyclic vomiting syndrome are advised to get plenty of rest and sleep and to take medications that prevent a vomiting episode, stop one in progress, speed up recovery, or relieve associated symptoms.

    Once a vomiting episode begins, treatment usually requires the person to stay in bed and sleep in a dark, quiet room. Severe nausea and vomiting may require hospitalization and intravenous fluids to prevent dehydration. Sedatives may help if the nausea continues.

    Sometimes, during the prodrome phase, it is possible to stop an episode from happening. For example, people with nausea or abdominal pain before an episode can ask their doctor about taking ondansetron (Zofran) or lorazepam (Ativan) for nausea or ibuprofen (Advil, Motrin) for pain. Other medications that may be helpful are ranitidine (Zantac) or omeprazole (Prilosec), which help calm the stomach by lowering the amount of acid it makes.

    During the recovery phase, drinking water and replacing lost electrolytes are important. Electrolytes are salts the body needs to function and stay healthy. Symptoms during the recovery phase can vary. Some people find their appetite returns to normal immediately, while others need to begin by drinking clear liquids and then move slowly to solid food.

    People whose episodes are frequent and long-lasting may be treated during the symptom-free intervals in an effort to prevent or ease future episodes. Medications that help people with migraine headaches, such as propranolol (Inderal), cyproheptadine (Periactin), and amitriptyline (Elavil), are sometimes used during this phase, but they do not work for everyone. Taking the medicine daily for 1 to 2 months may be necessary before one can tell if it helps.

    The symptom-free interval phase is a good time to eliminate anything known to trigger an episode. For example, if episodes are brought on by stress or excitement, a symptom-free interval phase is the time to find ways to reduce stress and stay calm. If sinus problems or allergies cause episodes, those conditions should be treated.

    During an episode, anti-migraine drugs such as sumatriptan (Imitrex) may be prescribed to stop symptoms of migraine headache. However, these agents have not been studied for use in children.

    What are the complications if cyclic vomiting syndrome is not treated?

    If the condition is not treated, attacks typically occur four to 12 times per year. Between episodes, vomiting is absent, and nausea is either absent or much reduced. However, many affected people experience other symptoms during and between episodes, including pain, digestive disorders such as gastroesophageal reflux and irritable bowel syndrome, and fainting spells (syncope). People with cyclic vomiting syndrome are also more likely than people without the disorder to experience depression, anxiety, and panic disorder. It is unclear how these health conditions are related to nausea and vomiting.

    What is the relationship between cyclic vomiting syndrome and migraines?

    Cyclic vomiting syndrome is generally considered to be a variant of migraines, which are severe headaches often associated with pain, nausea, vomiting, and extreme sensitivity to light and sound. Many people with cyclic vomiting syndrome have a family history of migraines, and attacks of nausea and vomiting may be replaced by migraine headaches as an affected person gets older.

    What other features and conditions accompany cyclic vomiting syndrome?

    Most people with cyclic vomiting syndrome have normal intelligence, although some affected people have experienced developmental delay or intellectual disability, muscle weakness (myopathy), and/or seizures. People with these additional features are said to have cyclic vomiting syndrome plus.

    How common is cyclic vomiting syndrome?

    The exact prevalence of cyclic vomiting syndrome is unknown; estimates range from 4 to 2,000 per 100,000 children. The condition is diagnosed less commonly in adults, although recent studies suggest that the condition could be as common in adults as in children.

    What are the genetic changes related to cyclic vomiting syndrome?

    Although the exact causes of cyclic vomiting syndrome have yet to be determined, researchers have proposed several factors that may contribute to the disorder. These factors include changes in brain function, hormonal abnormalities, and gastrointestinal problems. Many researchers believe that cyclic vomiting syndrome is a migraine-like condition, which suggests that it is related to changes in signaling between nerve cells (neurons) in certain areas of the brain.

    Some cases of cyclic vomiting syndrome may be related to genetic changes in mitochondrial DNA. Mitochondria are structures within cells that convert the energy from food into a form that cells can use. Although most DNA is packaged in chromosomes within the nucleus, mitochondria also have a small amount of their own DNA (known as mitochondrial DNA or mtDNA).

    Several changes in mitochondrial DNA have been associated with cyclic vomiting syndrome. Some of these changes alter single DNA building blocks (nucleotides), whereas others rearrange larger segments of mitochondrial DNA. These changes likely impair the ability of mitochondria to produce energy. Defects in energy production may lead to symptoms during periods when the body requires more energy, such as when the immune system is fighting an infection. However, it remains unclear how changes in mitochondrial function are related to recurrent episodes of nausea and vomiting.

    Source: http://www.rxlist.com

    Episodes of nausea and vomiting can be triggered by several different factors. The most common triggers are emotional excitement and infections. Other triggers can include periods without eating (fasting), temperature extremes, lack of sleep, overexertion, allergies, ingesting certain foods or alcohol, and menstruation.

    Source: http://www.rxlist.com

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