CYCLIC VOMITING SYNDROME

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)