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What

Cyclic Vomiting Syndrome is a gastroenterological disorder that causes intermittent episodes of severe vomiting, abdominal pain, and nausea.

Who

This disorder affects 0.04-2% of all school-aged children. It affects more females than males at a ratio of 11:9. Although Cyclic Vomiting Syndrome has been diagnosed in all racial and ethnic groups, Caucasians are more likely to be affected by this disorder.

Signs and Symptoms

The main symptom of Cyclic Vomiting Syndrome is recurring episodes of vomiting, which can occur at a peak of 6 times/hour. There are periods of normal health between vomiting episodes. Vomiting episodes may last from hours to days. Several of the following signs and symptoms may also occur: Lethargy (sleepiness, drowsiness, lack of energy) Pallor (paleness) Fever Drooling Nausea Abdominal pain Anorexia or loss of appetite Retching or gagging Diarrhea Photophobia (sensitivity to light) Headache Phonophobia (sensitivity to sound) Vertigo or a sense of dizziness

Possible Causes

The actual cause of Cyclic Vomiting Syndrome is not known, though there are a few hypotheses that involve brain-gut interaction. The brain helps in regulation of the digestive system, and when there is a problem with this communication, dysfunction of the digestive system occurs. Many patients with this disorder also have a family history of migraine headaches, thus one hypothesis is that what causes migraines also causes episodes of vomiting. In people with this disorder, mitochondria (parts of the cell that provides energy) may not make enough energy for the cell (in this case, a neuron in the brain). Neurons will then behave erratically and will not be able to communicate well enough with the digestive system. A third hypothesis is that Cyclic Vomiting Syndrome is caused by physical, psychological, or infectious stressors, which are stimuli that causes stress in a person. When a person is under stress, the brain releases chemicals in the body that will ultimately disrupt the normal function of the digestive system.

Diagnosis

The diagnosis of Cyclic Vomiting Syndrome is made when all clinical tests do not find a cause for the vomiting. It is considered a “diagnosis of exclusion.” The patients must also have recurrent and severe vomiting episodes lasting hours to days and periods of normal health between vomiting episodes. There are two patterns of vomiting episodes: cyclic and chronic. The cyclic pattern is defined as having many vomiting episodes per hour (about 13 per hour) but occurs about 1-2 times per month. The chronic pattern is described as having few vomiting episodes per hour (about 2 per hour), but this happens many times per month (up to 37 times).

Treatment

The management of cyclic vomiting is focused on relieving potential sources of stress and particular “triggers” that may be unique to each individual. Since there is a strong relationship between Cyclic Vomiting Syndrome and migraines, anti-migraine drugs have been shown to be effective in patients with a family history of migraines. Other drugs that have been used are anti-epileptic medications, anti-emetic (vomiting) and medications that help increase gut motility. If certain foods lead to nausea and vomiting, these foods should be taken out of the diet. Also, changing the environment can help with the symptoms, like turning off the lights or getting rid of loud noises. In some cases, only sleep can relieve nausea. For severe cases when the patient vomits too often and becomes dehydrated IV fluids in the emergency room may be required.

Prognosis

Cyclic Vomiting Syndrome can be disruptive. Children may miss many school days because of their illness. Many will spontaneously stop having vomiting episodes within 2 to 5 years, but a significant number will develop migraine headaches. Children with cyclic vomiting syndrome live normal life spans.

Connect with other parents

In the spirit of community and support, Madisons Foundation offers the unique service of connecting parents of children with rare diseases. If you would like to be connected to other parents of children with this disease, please fill out this brief form.

Weblinks

The Cyclic Vomiting Syndrome Association A great website and support group for patients with cyclic Vomiting Syndrome. Provides general information, news, and networking opportunities. National Digestive Diseases Information Clearinghouse (NDICC) Provides general information about Cyclic Vomiting Syndrome. www.cyclicvomitingsyndrome.net. Provides useful and accurate information on Cyclic Vomiting Syndrome

Google Search for Cyclic Vomiting Syndrome

References and Sources

Li BU, Misiewicz L (2003). Cyclic vomiting syndrome: a brain-gut disorder. Gastroenterology Clinics of North America. 32:3, p. 997-1019. Sundaram S (2002). Cyclic Vomiting Syndrome. www.emedicine.com/PED/topic2910.htm