Pediatr Gastroenterol Hepatol Nutr.  2015 Dec;18(4):224-229. 10.5223/pghn.2015.18.4.224.

Cyclic Vomiting Syndrome: A Functional Disorder

• Kaul A
• Kaul KK

• KMID: 2383299
• DOI: http://doi.org/10.5223/pghn.2015.18.4.224

Abstract

Cyclic vomiting syndrome (CVS) is a functional disorder characterized by stereotypical episodes of intense vomiting separated by weeks to months. Although it can occur at any age, the most common age at presentation is 3-7 years. There is no gender predominance. The precise pathophysiology of CVS is not known but a strong association with migraine headaches, in the patient as well as the mother indicates that it may represent a mitochondriopathy. Studies have also suggested the role of an underlying autonomic neuropathy involving the sympathetic nervous system in its pathogenesis. CVS has known triggers in many individuals and avoiding these triggers can help prevent the onset of the episodes. It typically presents in four phases: a prodrome, vomiting phase, recovery phase and an asymptomatic phase until the next episode. Complications such as dehydration and hematemesis from Mallory Wise tear of the esophageal mucosa may occur in more severe cases. Blood and urine tests and abdominal imaging may be indicated depending upon the severity of symptoms. Brain magnetic resonance imaging and upper gastrointestinal endoscopy may also be indicated in certain circumstances. Management of an episode after it has started ('abortive treatment') includes keeping the patient in a dark and quiet room, intravenous hydration, ondansetron, sumatriptan, clonidine, and benzodiazepines. Prophylactic treatment includes cyproheptadine, propranolol and amitriptyline. No mortality has been reported as a direct result of CVS and many children outgrow it over time. A subset may develop other functional disorders like irritable bowel syndrome and migraine headaches.

Keyword

Cyclic vomiting; Vomiting

MeSH Terms

Amitriptyline
Benzodiazepines
Brain
Child
Clonidine
Cyproheptadine
Dehydration
Endoscopy, Gastrointestinal
Hematemesis
Humans
Irritable Bowel Syndrome
Magnetic Resonance Imaging
Migraine Disorders
Mortality
Mothers
Mucous Membrane
Ondansetron
Propranolol
Sumatriptan
Sympathetic Nervous System
Vomiting*
Amitriptyline
Benzodiazepines
Clonidine
Cyproheptadine
Ondansetron
Propranolol
Sumatriptan

Figure

• 

  Fig. 1 Evaluation of a child with suspected cyclic vomiting syndrome (CVS). Labs: laboratory tests, IV: intravenous; BUN: blood urea nitrogen, ALT/GGT: alanine aminotransferase/gamma glutamyl transferase, UGI: upper gastrointestinal series, EGD: esophagogastroduodenoscopy, MRI: magnetic resonance imaging.

• 

  Fig. 2 Management of a child with cyclic vomiting syndrome (CVS). CoQ-10: coenzyme Q-10, Labs: laboratory tests, IV: intravenous, NS: normal saline, KCl: potassium chloride.

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