Overview
Cyclic vomiting syndrome is a condition characterized by recurrent episodes of severe vomiting with no apparent cause. These episodes can last for hours or days and alternate with symptom-free periods. The episodes tend to start around the same time, last for similar lengths of time, and occur with similar symptoms and intensity. Cyclic vomiting syndrome can affect people of all ages but often begins in children aged 3 to 7. The exact cause is unknown, but it may be related to genetic factors, digestive problems, nervous system issues, or hormone imbalances. Triggers for episodes can include dehydration, injury to the food tube, tooth decay, and excitement or stress. Treatment typically involves lifestyle changes and medications to help prevent triggers and lessen symptoms.
Understanding the disease
Symptoms
The symptoms of cyclic vomiting syndrome include recurrent episodes of vomiting that start around the same time and last for a similar length of time, varying intervals of generally normal health without nausea between episodes, intense nausea and sweating before an episode starts, abdominal pain, diarrhea, dizziness, sensitivity to light, headache, retching or gagging. If you or your child is showing symptoms of dehydration, such as excess thirst or dry mouth, less urination, dry skin, sunken eyes or cheeks, no tears when crying, or exhaustion and listlessness, you should call your doctor. Causes of cyclic vomiting syndrome are unknown, but some possible causes include genes, digestive difficulties, nervous system problems, and hormone imbalances. Triggers for vomiting episodes may include stress, excitement, and infections.
Development
Cyclic vomiting syndrome (CVS) is a condition characterized by episodes of severe vomiting with no apparent cause. The exact cause of CVS is unknown, but it is believed to have a genetic component. Triggers for CVS episodes may include dehydration, injury to the food tube (esophagus), tooth decay, and other factors such as stress, anxiety, or excitement. The episodes may be similar in terms of their timing, duration, and symptoms, with varying intervals of normal health between them. CVS can occur in people of all ages, but it often starts in childhood, typically between 3 and 7 years old. Treatment for CVS often involves lifestyle changes to avoid triggers and medications to manage symptoms.
Assessment and Diagnosis
Triage
You should see a doctor if cyclic vomiting syndrome is suspected, especially when there are signs of severe dehydration or blood in the vomit. Additionally, consult a doctor if the episodes of vomiting are frequent (more than once a month) or require hospitalization. It is important to seek medical advice for proper diagnosis and treatment.
Diagnosis
To diagnose cyclic vomiting syndrome, the doctor will start by asking about your child's or your medical history and conducting a physical exam. They will also want to know about the pattern of symptoms you or your child experiences. The doctor may recommend imaging studies like endoscopy, ultrasound, or a computed tomography (CT) scan to check for blockages or signs of other digestive conditions. Motility tests can monitor the movement of food through the digestive system and check for digestive disorders. Laboratory tests can help detect thyroid problems or other metabolic conditions. There's no specific test to confirm the diagnosis, but ruling out other conditions is crucial.
Management and Treatment
Complications
Potential complications of cyclic vomiting syndrome may include dehydration, injury to the food tube (esophagus), tooth decay, and malnutrition due to the frequent vomiting episodes. Severe dehydration can be life-threatening and may require hospitalization. Repeated vomiting can also cause damage to the esophagus, leading to bleeding and other complications. Tooth decay is another potential complication due to the acid in vomit corroding tooth enamel. Prolonged vomiting can also lead to malnutrition and weight loss, affecting overall health and well-being.
Treatment
Treatment for cyclic vomiting syndrome often involves lifestyle changes to help prevent triggers, as well as medications to manage symptoms. Some of the treatments and strategies include:
- Identifying and avoiding triggers: Many people with cyclic vomiting syndrome know what triggers their episodes, such as stress, excitement, or certain foods. Avoiding these triggers can help reduce the frequency of episodes.
- Lifestyle changes: Encouraging adequate sleep, downplaying the importance of upcoming events for children, and maintaining a regular routine can help prevent episodes.
- Medications: Depending on the severity and frequency of episodes, doctors may recommend preventive medications such as amitriptyline, propranolol, cyproheptadine, and topiramate. These medications can help reduce the intensity and occurrence of symptoms.
- Hydration: During an episode, it is essential to stay hydrated to prevent dehydration. Encourage the consumption of water, electrolyte-rich drinks, and clear broths.
- Pain relief: Over-the-counter pain relievers like acetaminophen or ibuprofen can help alleviate abdominal pain and headaches associated with vomiting episodes. It's important to consult with a healthcare professional to determine the most appropriate treatment plan based on the individual's specific symptoms and medical history.
Preparing for medical consultation
To prepare for an appointment for cyclic vomiting syndrome, follow these steps:
- Gather medical history: Compile information about your child's or your medical history, including any previous episodes of vomiting, abdominal pain, headaches, or other related symptoms.
- Note symptom patterns: Keep track of the frequency and duration of vomiting episodes, as well as any common triggers or warning signs.
- Prepare a list of medications: Make a list of all prescription and over-the-counter medications, vitamins, or supplements currently being taken by you or your child.
- Document dietary habits: Note any dietary habits or food preferences that could be contributing to the symptoms.
- Write down key personal information: Include any major stresses, recent changes, or significant life events that might be relevant to your child's or your health.
- Compile questions: Prepare a list of questions to ask the doctor, such as potential causes, recommended treatments, and any lifestyle changes that could help manage the symptoms.
- Be ready to answer questions: Anticipate the doctor's questions and gather the necessary information to provide clear and detailed responses. Remember to bring these documents and lists to the appointment, as they will help facilitate an accurate diagnosis and appropriate treatment plan.