Cyclic Vomiting Syndrome
- An idiopathic chronic functional GI disorder characterized by discrete, recurrent, stereotypical paroxysmal episodes of high-intensity nausea and vomiting lasting hours to days
- Cyclic vomiting syndrome (CVS) plus two or more neuromuscular disorders in association
- Catamenial CVS: associated with menstrual cycle
- Note: Cannabis hyperemesis syndrome (CHS) is distinct from CVS.
- CVS has four distinct phases:
- Interepisodic: symptom-free period
- Prodromal: minutes to hours of nausea with or without abdominal pain
- Vomiting: hours to days
- 3 per 100,000 annually in children
- Limited data in adults
- 0.04–2% in general population
- 1–2% in children (2)
- Female > male (55:45)
- More common in children; mean age of diagnosis is 35 years in adults and ages 3 to 7 in children.
- Average of 3 years from symptom onset to diagnosis
Etiology and Pathophysiology
- Strong link between CVS and migraine: similar symptoms, frequent family history of migraines, and effectiveness of antimigraine therapy
- One proposed mechanism:
- Heightened neuronal excitability owing to enhanced ion permeability, mitochondrial deficits, or hormonal state → increased susceptibility to physical or psychological trigger → release of corticotropin-releasing factor (CRF) → vomiting
- Vomiting perpetuated by altered brainstem regulation → sustained vomiting
- Possible maternal inheritance, based on family history of migraines and link to mitochondrial DNA (mtDNA) mutations
- Multiple theories:
- GI motility dysfunction
- Food allergy or intolerance
- Likely matrilineal inheritance, especially with childhood onset
- A3243G or other mtDNA mutations including mitochondrial dysfunction
- Ion channel mutations
- Several polymorphisms have been identified. 165119T more common in children with CVS
- Family history of migraine headaches
- Depression and/or anxiety
- Chronic cannabis use
- Possibly food allergies
- Hypothalamic-pituitary-adrenal axis dysfunction
- No primary prevention measures exist.
- Secondary prevention of attacks relies on multidisciplinary approach to trigger avoidance, comorbidity treatment, and prophylactic medication use.
Commonly Associated Conditions
- Irritable bowel syndrome (67%)
- Headaches (52%)
- Motion sickness (46%)
- Migraines (11–40%)
- Seizure disorder (5.6%)
- Cannabis use
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Domino, Frank J., et al., editors. "Cyclic Vomiting Syndrome." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2020. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816162/all/Cyclic_Vomiting_Syndrome.
Cyclic Vomiting Syndrome. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2020. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816162/all/Cyclic_Vomiting_Syndrome. Accessed June 10, 2023.
Cyclic Vomiting Syndrome. (2020). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (27th ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816162/all/Cyclic_Vomiting_Syndrome
Cyclic Vomiting Syndrome [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2020. [cited 2023 June 10]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816162/all/Cyclic_Vomiting_Syndrome.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Cyclic Vomiting Syndrome ID - 816162 ED - Domino,Frank J, ED - Baldor,Robert A, ED - Golding,Jeremy, ED - Stephens,Mark B, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816162/all/Cyclic_Vomiting_Syndrome PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -