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Cyclic vomiting syndrome

Diseases and Conditions Cyclic vomiting syndrome
Overview Types Causes & Risk Factors Symptoms Preventions Treatment
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Overview

Cyclic vomiting syndrome is a chronic functional disorder characterized by recurrent episodes of severe vomiting without an apparent cause. These episodes can last from a single day to several weeks and alternate with symptom-free periods. Let’s delve into the details:

Types of Cyclic vomiting syndrome

CVS episodes follow a distinct pattern, with four phases:

  1. Inter-episodic phase: The period between episodes when the individual experiences generally normal health without nausea.
  2. Prodrome phase: Intense nausea and sweating precede an episode.
  3. Vomiting phase: Severe vomiting occurs, often accompanied by abdominal pain, diarrhea, dizziness, sensitivity to light, and headaches.
  4. Recovery phase: Symptoms gradually subside, leading to a symptom-free interval.

Causes of Cyclic vomiting syndrome

The exact cause of CVS remains unknown, but several factors may contribute:

  • Genetics: Some individuals may have a genetic predisposition.
  • Digestive difficulties: Abnormalities in the gastrointestinal system.
  • Nervous system problems: Dysregulation of the autonomic nervous system.
  • Hormone imbalances: Hormonal fluctuations may trigger episodes.

Specific triggers for vomiting episodes include:

  • Infections: Colds, allergies, or sinus issues.
  • Emotional stress or excitement: Especially in children.
  • Anxiety or panic attacks: More common in adults.
  • Certain foods and drinks: Alcohol, caffeine, chocolate, or cheese.
  • Overeating, fasting, or eating before bedtime.
  • Hot weather, physical exhaustion, excessive exercise, and motion sickness.

Risk Factors of Cyclic vomiting syndrome

The relationship between migraines and CVS isn’t entirely clear. However, individuals with migraines may be at higher risk for CVS.

Symptoms of Cyclic vomiting syndrome

Individuals experiencing CVS episodes may present with the following symptoms:
1. Severe Nausea: Intense feelings of nausea often precede vomiting episodes.
2. Abdominal Pain: Pain or discomfort in the abdominal region accompanies vomiting.
3. Diarrhea: Loose or watery stools may occur during episodes.
4. Fainting or Dizziness: Individuals may feel lightheaded or dizzy.
5. Sensitivity to Light: Bright lights can exacerbate symptoms.
6. Headaches: Intense headaches may accompany vomiting.
7. Retching or Gagging: Persistent attempts to vomit even when the stomach is empty.

Preventions of Cyclic vomiting syndrome

Lifestyle changes play a crucial role in preventing CVS episodes:

  • Identify triggers: Keep a diary to track potential triggers.
  • Stress management: Practice relaxation techniques.
  • Avoid trigger foods and drinks.
  • Stay hydrated.

Diagnosis of Cyclic vomiting syndrome

To diagnose CVS, healthcare professionals follow these steps:

  1. Clinical Assessment: The doctor will review the patient’s medical history and symptoms.
  2. Exclusion of Other Conditions: CVS is a diagnosis of exclusion, meaning other possible causes of vomiting (such as infections, gastrointestinal disorders, or metabolic conditions) must be ruled out.
  3. Diagnostic Criteria: The Rome IV criteria are commonly used for CVS diagnosis. These include recurrent, severe vomiting episodes lasting at least 1 hour within a 6-month period, with symptom-free intervals between episodes.
  4. Laboratory Tests: Blood tests, urine analysis, and other lab work may help rule out other conditions.
  5. Imaging: Imaging studies (such as abdominal ultrasound or MRI) may be performed to assess the gastrointestinal system.
  6. Electroencephalogram (EEG): To rule out epilepsy-related vomiting.

Treatment for Cyclic vomiting syndrome

The goal of CVS management is to reduce the frequency and severity of episodes. Here’s a pointwise plan:

  1. Lifestyle Modifications:

    • Identify Triggers: Keep a detailed diary to track potential triggers (e.g., stress, specific foods, sleep patterns).
    • Stress Management: Practice relaxation techniques (deep breathing, meditation, yoga).
    • Hydration: Stay well-hydrated to prevent dehydration during episodes.

  2. Medications:

    • Anti-Nausea Drugs: Ondansetron, promethazine, or metoclopramide can help manage nausea and vomiting.
    • Migraine Medications: Prophylactic migraine medications (such as amitriptyline or cyproheptadine) may be effective.
    • Antiepileptic Drugs: Valproic acid or topiramate may be considered.

  3. Emergency Management:

    • IV Fluids: During severe episodes, intravenous fluids may be necessary to prevent dehydration.
    • Hospitalization: In severe cases, hospitalization may be required for close monitoring and symptom control.

  4. Behavioral Interventions:

    • Biofeedback: Helps patients gain control over autonomic functions.
    • Cognitive-Behavioral Therapy (CBT): Reduces anxiety and stress.

  5. When to See a Doctor:

    • Seek medical attention if CVS symptoms occur.
    • Early intervention can prevent complications and improve quality of life.

When to seek medical attention ?

Seek medical attention if you or someone you know experiences CVS symptoms. Early intervention can prevent complications and improve quality of life.