Cyclic vomiting syndrome

Definition

Cyclic vomiting syndrome (CVS) is a rare disorder characterized by recurring periods of vomiting in an otherwise normal child.

Description

Children in the pre-school or early school years are most susceptible to CVS, although it can appear anywhere from infancy to adulthood. This disorder was identified a century ago, but its cause is still unknown. Episodes can be triggered by emotional stress or infections, can last hours or days and can return at any time. Abdominal pain is a frequent feature.

Causes & symptoms

The cause of CVS is still a mystery. Similarities to migraine suggest a common cause, but as yet no firm evidence has surfaced. Patients can usually identify some factor that precedes an attack. Vomiting can be protracted and lead to complications such as dehydration, chemical imbalances, tearing, burning and bleeding of the esophagus (swallowing tube). Between attacks there is no sign of any illness.

Diagnosis

The most important and difficult aspect of CVS is to be sure there is not an acute and life-threatening event in progress. So many diseases can cause vomiting--from bowel obstruction to epilepsy--that an accurate and timely diagnosis is critical. Because there is no way to prove the diagnosis of CVS, the physician must instead disprove every other diagnosis. This can be tedious, expensive, exhausting, and involve almost every system in the body. The first episode may be diagnosed as a stomach flu when nothing more serious turns up. Only after several episodes and several fruitless searches for a cause will a physician normally consider the diagnosis of CVS.

Treatment

Several different medications have given good results in small trials. The antimigraine drugs amitriptyline and cyproheptadine performed well for one study group. Propanolol is sometimes effective, and erythromycin helped several patients in one study, not because it is an antibiotic but because it irritates the stomach and encourages it to move its contents forward instead of in reverse.

Alternative treatment

Constitutional homeopathic medicine can work well in treating CVS because it addresses rebalancing the whole person, not just the symptoms.

Prognosis

The disease may go on for many years without a change in pattern. If the acute complications of prolonged vomiting can be successfully prevented or managed, most patients can lead normal lives between episodes. Medications may ease the symptoms during attacks.

Further Reading

For Your Information

Periodicals

• Andersen, J.M., et al. "Effective Prophylactic Therapy for Cyclic Vomiting Syndrome in Children Using Amitriptyline or Cyproheptadine." Pediatrics 100 (December 1997): 977-981.
• Fleisher, D.R. "Cyclic Vomiting Syndrome: A Paroxismal Disorder of Brain-Gut Interaction." Journal of Pediatric Gastroenterology & Nutrition 25 (1997): S13.
• Fleisher, D.R. "Management Of Cyclic Vomiting Syndrome." Journal of Pediatric Gastroenterology & Nutrition 21 (1995): S52-56.
• Fleisher, D.R. "The Cyclic Vomiting Syndrome Described." Journal of Pediatric Gastroenterology & Nutrition 21 (1995): S1-5.
• Forbes D. and G. Withers. "Prophylactic Therapy In Cyclic Vomiting Syndrome." Journal of Pediatric Gastroenterology & Nutrition 21 Suppl (1995): S57-59.
• Forbes D. "Differential Diagnosis Of Cyclic Vomiting Syndrome." Journal of Pediatric Gastroenterology & Nutrition 21 (1995): S11-14.
• Li, B.U. "Cyclic Vomiting Syndrome. Introduction." Journal of Pediatric Gastroenterology & Nutrition 21 (1995): 7-8.
• Li, B.U. "Cyclic Vomiting: The Pattern And Syndrome Paradigm." Journal of Pediatric Gastroenterology & Nutrition 21 (1995): S6-10.
• Vanderhoof, J.A., et al. "Treatment of cyclic vomiting in childhood with erythromycin." Journal of Pediatric Gastroenterology & Nutrition 21 (1995): S60-62.

Gale Encyclopedia of Medicine. Gale Research, 1999.