Cyclic vomiting syndrome (CVS) is a condition characterized by recurrent, stereotypical bouts of intense vomiting interspersed with periods of completely normal health.
The average child with CVS starts bouts of cyclic vomiting at 5.2 years of age. Typically, he or she has been affected for 2.6 years before diagnosis. Females and males are equally affected (55:45).
The vomiting is invariably accompanied by what has been described as the most intense kind of nausea a human can experience. The typical child vomits 6 times per hour at the peak. The average is 25 bouts of vomiting (emesis) per episode.
Affected children characteristically appear almost motionless during episodes. They refuse to swallow saliva for fear of inducing vomiting. Others compulsively drink water. This is possibly to reduce the upper abdominal pain due to the continual vomiting of acid content from the stomach. A period of exhausted sleep often follows.
Once awake, the child is eager to eat. Attacks tend to be stereotypical. Ninety-eight percent (98%) of children experience the same progression and character of attack with each episode. Symptoms include:
- Abnormal drowsiness, or lethargy (91%)
- Paleness, or pallor (87%)
- Abdominal pain (80%)
- Headache (40%)
- Diarrhea (36%)
- Sometimes fever (29%)
Treatment of CVS begins with identification of the condition. A distinction is made between chronic vomiting and cyclic vomiting syndrome. Underlying conditions such as gastroesophageal reflux disease (GERD) and sinus infection (sinusitis) should be sought and treated in the patient.
Not every child requires every medical test. However, if certain warning signs are present the doctor may order one or more tests including:
- Upper GI endoscopy
- Abdominal ultrasound
- Brain CT or MRI
- Metabolic blood tests
Three levels of treatment include:
- Abortive treatment (to try to stop an attack after it starts),
- Rescue therapy (to keep the child as comfortable as possible if unable to stop an attack), and
- Prophylatic (steps to take to try to prevent future attacks)
Numerous medicines have been used to abort attacks. Rescue therapy is needed if it proves impossible to abort the attack. Most children will respond to these measures. For the rare patient with persistence of recurrent attacks, daily preventative (prophylactic) measures are indicated.
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Adapted from IFFGD Publication: Cyclic Vomiting Syndrome #817 by Robert M. Issenman, MD, Professor of Pediatrics, McMaster University, Chief of Pediatric Gastroenterology, Children’s Hospital, Hamilton Health Sciences, Hamilton, Ontario, Canada.