CYCLIC VOMITING SYNDROME

  • An increasingly recognized disorder with sudden, repeated attacks—also called episodes—of severe nausea, vomiting, and physical exhaustion that occur with no apparent cause.
  • The episodes can last from a few hours to several days. Episodes can be so severe that a person has to stay in bed for days, unable to go to school or work.
    • A person may need treatment at an emergency room or a hospital during episodes. After an episode, a person usually experiences symptom-free periods lasting a few weeks to several months.
  • To people who have the disorder, as well as their family members and friends, cyclic vomiting syndrome can be disruptive and frightening.
  • The disorder can affect a person for months, years, or decades. Each episode of cyclic vomiting syndrome is usually similar to previous ones, meaning that episodes tend to start at the same time of day, last the same length of time, and occur with the same symptoms and level of intensity.

Main symptoms: severe nausea and sudden vomiting lasting hours to days.

One or more of the following symptoms may be felt:

  • Retching, or making an attempt to vomit
  • Heaving or gagging
  • Lack of appetite
  • Abdominal pain
  • Diarrhea
  • Fever
  • Dizziness
  • Headache
  • Sensitivity to light

Intensity of symptoms will vary as a person cycles through four distinct phases of an episode:

  • Prodrome phase
    • Person feels that an episode of nausea and vomiting is about to start.
    • Often marked by intense sweating and nausea—with or without abdominal pain—this phase can last from a few minutes to several hours.
    • The person may appear unusually pale.
  • Vomiting phase
    • Consists of intense nausea, vomiting, and retching. Periods of vomiting and retching can last 20 to 30 minutes at a time.
    • The person may be subdued and responsive, immobile and unresponsive, or writhing and moaning with intense abdominal pain.
    • An episode can last from hours to days.
  • Recovery phase
    • Begins when the vomiting and retching stop and the nausea subsides. Improvement of symptoms during the recovery phase can vary.
    • Healthy color, appetite, and energy return gradually or right away.
  • Well phase
    • Occurs between episodes when no symptoms are present.

DIAGNOSIS

  • Physician may do/request:
    • History & Physical Exam
  • Other additional tests such as:
    • Blood tests
    • Urine tests
    • Imaging tests
    • Upper GI endoscopy
    • Gastric emptying test

 

RECOMMENDED MEDICATIONS

  • A health care provider may refer patients to a gastroenterologist for treatment.
  • People with cyclic vomiting syndrome should get plenty of rest and take medications to prevent a vomiting episode, stop an episode in progress, speed up recovery, or relieve associated symptoms.
  • Treatment is tailored to the symptoms experienced during each of the four cyclic vomiting syndrome phases:
    • Prodrome phase treatment.
      • Goal: stop an episode before it progresses.
      • Taking medication early in the phase can help stop an episode from moving to the vomiting phase or becoming severe; however, people do not always realize an episode is coming. For example, a person may wake up in the morning and begin vomiting.
      • Possible medications:
        • Ondansetron (Zofran) or lorazepam (Ativan) for nausea
        • Ibuprofen for abdominal pain
        • Ranitidine (Zantac), lansoprazole (Prevacid), or omeprazole (Prilosec, Zegerid) to control stomach acid production
        • Sumatriptan (Imitrex)—prescribed as a nasal spray, an injection, or a pill that dissolves under the tongue—for migraine
      • Vomiting phase treatment
        • Health care provider may recommend the following for both children and adults:
          • Medication for pain, nausea, and reducing stomach acid and anxiety.
          • Anti-migraine medications such as sumatriptan to stop symptoms of a migraine or possibly stop an episode in progress.
          • Hospitalization for severe nausea and vomiting.
          • IV fluids and medications to prevent dehydration and treat symptoms.
          • IV nutrition if an episode continues for several days.
        • Recovery phase treatment
          • Drinking and eating will replace lost electrolytes.
            • A person may need IV fluids for a period of time. Some people find their appetite returns to normal right away, while others start by drinking clear liquids and then moving slowly to other liquids and solid food.
          • Medications may be given during the recovery phase and well phase to prevent future episodes.
        • Well phase treatment
          • Medications for patients whose episodes are frequent and long lasting in an effort to prevent or ease future episodes.
            • Medication may be taken daily for 1 to 2 months before evaluating whether it helps prevent episodes.
            • Possible medications:
              • Amitriptyline (Elavil)
              • Propranolol (Inderal)
              • Cyproheptadine (Periactin)

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