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Cyclic Vomiting Syndrome – Symptoms, Causes, Treatment

What is Cyclic Vomiting Syndrome?

Cyclic vomiting syndrome is a condition wherein there is a recurring attacks of nausea, vomiting, abdominal pain accompanied with headache or migraine.  The attacks of nausea and vomiting can happen from hours to days which can prohibit a person from doing their activity like going to school or even work. This problem is thought to be a pediatric disease but then it also occurs to teenagers and even adults.

Cyclic vomiting syndrome is first described byt Samuel Gee in 1882 to children wherein they have recurrent vomiting episodes. Usually, an individual with cyclic vomiting syndrome experiences 4 phases which are:

  1. Symptom-free interval phase– this is the period wherein there are no symptoms present.
  2. Prodome phase– this is the phase wherein a signals or an episode of nausea and vomiting will begin. Usually, it starts with nausea which can last for minutes to hours. This can be accompanied with abdominal pain or not. If that happens, medications can be taken to stop the episode. But cyclic vomiting syndrome can happen without any signals.
  3. Vomiting phase– this is the most difficult phase because episodes of nausea and vomiting occurs. In this phase, the person doesn’t want to eat or drink because vomiting still be triggered. Thus, exhaustion, drowsiness and paleness occur.
  4. Recovery phase– the nausea and vomiting tops and everything will go back to normal.

These episodes can be triggered with a lot of factors. The common ones include emotions like the feeling of excitement and infections. Sometimes, the attack would be triggered by fasting, extreme temperatures, lack of sleep, stress, overexertion, allergies, alcohol ingestion and menstruation. Accordingly, about 6 episodes can happen in an hour and it can last for hours to weeks. Sometimes, with the vomiting or emesis, acid and bile and sometimes blood can be vomited. This depends on the severity of the attack. In between the episodes, the patient appears healthy but also becomes weak and has muscle pain.

The exact epidemiology of this disease is still unknown but experts estimate that about 4 to 2,000 cases happen per 100,000 children. It is less common in adults and women are slightly more affected than men. A patient with cyclic vomiting syndrome generally appears to be well but they have to be hydrated with the fluids and electrolytes loss during the attack.

Cyclic Vomiting Syndrome Symptoms

  • Vomiting- in an episode, the vomiting peaks at the first hour and then declines over the next 4-8 hours. It occurs either in the dawn, in the morning upon waking up.
  • Nausea
  • Pallor
  • Abdominal pain
  • Loss of appetite
  • Gagging
  • Fatigue or body weakness
  • Headache
  • Fever
  • Diarrhea
  • Migraine
  • In some cases: photophobia and vertigo

Cyclic Vomiting Syndrome Causes

The exact cause is unknown but there are episodes that trigger the syndrome which includes:

  • Foods like chocolate or cheese
  • Overeating or eating before going to bed
  • Hot weather
  • Stress or excitement
  • Allergies and sinus problems
  • Colds
  • Motion sickness
  • Physical exhaustion
  • Menstruation

Cyclic Vomiting Syndrome Treatment

When the patient is brought to the hospital, he or she will be assessed thoroughly. Blood work will be taken which includes complete blood count, differential erythrocyte sedimentation rate, pancreatic amylase, lipase and at some point, liver profile tests. The patient will also be asked for medical histories and physical exam will be done.

Physicians will check for abdominal tenderness, abdominal pain, bilious vomiting or bile contents in the vomit. Also questions about fasting and overeating will be asked as well as recurrent illness and a high protein diet.

Recently, a criteria was published by Rome III study group when it comes to diagnosing cyclic vomiting syndrome. It includes:

  • Stereotypical episodes of vomiting regarding onset (acute duration: less than 1 week)
  • Three or more episodes in the prior year
  • Absence of nausea and vomiting between episodes

They also include supportive criteria like family history and history of migraine and headaches.

Once diagnosed, the treatment for cyclic vomiting syndrome depends on the clinical experience of the patient. this is because there is no known cure for the condition. medications would be given like:

  • Anti-emetics or drugs that prohibits vomiting
  • Anti nausea drugs
  • Sedatives
  • Acid-suppressing medications
  • Medications for migraine like Amitriptyline
  • Analgesics like ibuprofen

Sometimes, hospitalization may be required for intravenous fluids because of dehydration. 10% of total body fluid loss is dangerous and about 20% loss is considered fatal. Also in vomiting, there is also a loss of electrolytes that is why intravenous fluids that contains electrolytes like sodium is administered. If hospitalization is not required, the patient should hydrate and even take fluids which also contains electrolytes to avoid complications.

When vomiting episodes begins, the patient losses adequate sleeping period so the patient needs to stay in a dark and quiet room. Since the patient can become photophobic, placing in a dark room is often advised. If the vomiting stops, hydration is very important. They can drink fruit juices or sports drinks. Eating full meal is not suggested since it can trigger the episodes again. General liquid diet can be taken and gradually, solid foods can be incorporated in the meal.

Studies were made that certain treatments can help prevent vomiting episodes like L-carnitine. This is often heard in products that help reduce weight. this natural substance converts fat into energy. These days, there are certain drinks and supplements that have L-carnitine in it. Patients can discuss with their doctors if it can be safely taken. The other substance is Coenzyme Q10. This is also a natural substance that assists with the basic functions of cells in the body.

Although cyclic vomiting syndrome is not really a life threatening condition when attacks happen, an individual with this sickness should know the possible complications for their condition. It includes:

  • Dehydration
  • Electrolyte imbalance which includes losing sodium, potassium and other important electrolytes in the body
  • Hematemesis or vomiting of blood because of the irritation in the esophagus
  • Tooth decay. Acids are also excreted when vomiting and this causes corrosion of the enamel, the protective layer of the tooth.
  • Peptic esophagitis. There is an injury in the esophagus because of frequent vomiting

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