Cyclic Vomiting Syndrome
Cyclic vomiting syndrome affects the upper GI tract, which includes the mouth, esophagus, stomach, small intestine, and duodenum.
Cyclic vomiting syndrome, sometimes referred to as CVS, is an increasingly recognized disorder with sudden, repeated attacks—also called episodes—of severe nausea, vomiting, and physical exhaustion that occur with no apparent cause. The episodes can last from a few hours to several days. Episodes can be so severe that a person has to stay in bed for days, unable to go to school or work. A person may need treatment at an emergency room or a hospital during episodes. After an episode, a person usually experiences symptom-free periods lasting a few weeks to several months. To people who have the disorder, as well as their family members and friends, cyclic vomiting syndrome can be disruptive and frightening.
The disorder can affect a person for months, years, or decades. Each episode of cyclic vomiting syndrome is usually similar to previous ones, meaning that episodes tend to start at the same time of day, last the same length of time, and occur with the same symptoms and level of intensity.
What is the gastrointestinal (GI) tract?
The GI tract is a series of hollow organs joined in a long, twisting tube from the mouth to the anus—the opening through which stool leaves the body. The body digests food using the movement of muscles in the GI tract, along with the release of hormones and enzymes. Cyclic vomiting syndrome affects the upper GI tract, which includes the mouth, esophagus, stomach, small intestine, and duodenum, the first part of the small intestine. The esophagus is the muscular tube that carries food and liquids from the mouth to the stomach. The stomach slowly pumps the food and liquids through the duodenum and into the rest of the small intestine, which absorbs nutrients from food particles. This process is automatic and people are usually not aware of it, though people sometimes feel food in their esophagus when they swallow something too large, try to eat too quickly, or drink hot or cold liquids.
What causes cyclic vomiting syndrome?
The cause of cyclic vomiting syndrome is unknown. However, some experts believe that some possible problems with bodily functions may contribute to the cause, such as the following:
- gastrointestinal motility—the way food moves through the digestive system
- central nervous system function—includes the brain, spinal cord, and nerves that control bodily responses
- autonomic nervous system function—nerves that control internal organs such as the heart
- hormone imbalances—hormones are a chemical produced in one part of the body and released into the blood to trigger or regulate particular bodily functions
- in children, an abnormal inherited gene may also contribute to the condition
Specific conditions or events may trigger an episode of cyclic vomiting:
- emotional stress, anxiety, or panic attacks—for example, in children, common triggers of anticipatory anxiety are school exams or events, birthday parties, holidays, family conflicts, or travel
- infections, such as a sinus infection, a respiratory infection, or the flu
- eating certain foods, such as chocolate or cheese, or additives such as caffeine, nitrites—commonly found in cured meats such as hot dogs—and monosodium glutamate, also called MSG
- hot weather
- menstrual periods
- motion sickness
- overeating, fasting, or eating right before bedtime
- physical exhaustion or too much exercise
What are the symptoms of cyclic vomiting syndrome?
The main symptoms of cyclic vomiting syndrome are severe nausea and sudden vomiting lasting hours to days. A person may also experience one or more of the following symptoms:
- retching, or making an attempt to vomit
- heaving or gagging
- lack of appetite
- abdominal pain
- sensitivity to light
Intensity of symptoms will vary as a person cycles through four distinct phases of an episode:
- Prodrome phase. During the prodrome phase, the person feels that an episode of nausea and vomiting is about to start. Often marked by intense sweating and nausea—with or without abdominal pain—this phase can last from a few minutes to several hours. The person may appear unusually pale.
- Vomiting phase. This phase consists of intense nausea, vomiting, and retching. Periods of vomiting and retching can last 20 to 30 minutes at a time. The person may be subdued and responsive, immobile and unresponsive, or writhing and moaning with intense abdominal pain. An episode can last from hours to days.
- Recovery phase. This phase begins when the vomiting and retching stop and the nausea subsides. Improvement of symptoms during the recovery phase can vary. Healthy color, appetite, and energy return gradually or right away.
Well phase. This phase occurs between episodes when no symptoms are present.
How is cyclic vomiting syndrome treated?
A health care provider may refer patients to a gastroenterologist for treatment.
People with cyclic vomiting syndrome should get plenty of rest and take medications to prevent a vomiting episode, stop an episode in progress, speed up recovery, or relieve associated symptoms.
The health care team tailors treatment to the symptoms experienced during each of the four cyclic vomiting syndrome phases:
- Prodrome phase treatment. The goal during the prodrome phase is to stop an episode before it progresses. Taking medication early in the phase can help stop an episode from moving to the vomiting phase or becoming severe; however, people do not always realize an episode is coming. For example, a person may wake up in the morning and begin vomiting. A health care provider may recommend the following medications for both children and adults:
- ondansetron (Zofran) or lorazepam (Ativan) for nausea
- ibuprofen for abdominal pain ranitidine (Zantac), lansoprazole (Prevacid), or omeprazole (Prilosec, Zegerid) to control stomach acid production
- sumatriptan (Imitrex)—prescribed as a nasal spray, an injection, or a pill that dissolves under the tongue—for migraines
- Vomiting phase treatment. Once vomiting begins, people should call or see a health care provider as soon as possible. Treatment usually requires the person to stay in bed and sleep in a dark, quiet room. A health care provider may recommend the following for both children and adults:
- medication for pain, nausea, and reducing stomach acid and anxiety
- anti-migraine medications such as sumatriptan to stop symptoms of a migraine or possibly stop an episode in progress
- hospitalization for severe nausea and vomiting
- IV fluids and medications to prevent dehydration and treat symptoms
- IV nutrition if an episode continues for several days
- Recovery phase treatment. During the recovery phase, drinking and eating will replace lost electrolytes. A person may need IV fluids for a period of time. Some people find their appetite returns to normal right away, while others start by drinking clear liquids and then moving slowly to other liquids and solid food. A health care provider may prescribe medications during the recovery phase and well phase to prevent future episodes.
- Well phase treatment. During the well phase, a health care provider may use medications to treat people whose episodes are frequent and long lasting in an effort to prevent or ease future episodes. A person may need to take a medication daily for 1 to 2 months before evaluating whether it helps prevent episodes. A health care provider may prescribe the following medications for both children and adults during the well phase to prevent cyclic vomiting syndrome episodes, lessen their severity, and reduce their frequency:
- amitriptyline (Elavil)
- propranolol (Inderal)
- cyproheptadine (Periactin)
If you have any questions or wish to schedule an appointment, please do not hesitate to call the office at (706) 548-0058. Remember that we usually require that you see a primary care physician (your family doctor or PCP) before we can schedule you. If you are having a medical emergency, get medical attention immediately at your nearest healthcare provider:
Athens Regional Medical Center: (706) 475-7000
St. Mary's Hospital: (706) 354-3000
This informational material is taken from the National Digestive Diseases Information Clearinghouse, a division of the U.S. Department of Health and Human Resources.
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