What is Cyclic Vomiting Syndrome?
Cyclic vomiting syndrome in adults or children is a disease condition characterized by intense episodes of nausea and vomiting, which lasts for several days and recurs for several times a year. The episodes of intense nausea and vomiting are also accompanied by symptom free episodes or intervals. The exact cause of this cyclic vomiting syndrome is still unknown.
Who are Most Affected?
This condition affects all ages, although this condition is first seen in pediatric patients. Cyclic vomiting syndrome affects children, young adults, and even middle aged adults. Though cyclic vomiting syndrome is present among all age groups, their cause and presentation vary accordingly.
Cyclic Vomiting Syndrome (CVS) Symptoms
Presentation and Symptoms of CVS in Children
CVS affects all age groups but the presentation of the condition as well as the signs and symptoms may vary. Children may have different set of signs and symptoms compared to that of an adult and the cause or the predisposing factors may also differ. In children, signs and symptoms of cyclic vomiting syndrome are as follows:
- Abdominal pain
- Discrete episodes of vomiting that may last from 2 hours to 10 days
- Episodes of vomiting at a rate of four per hour (happens in almost 70% of patients) and/ four to twelve episodes per year
- Presence of “in between” episodes that are symptom free
Clinical Presentation of CVS in children
- Usually diagnosed at five years of age (but can be delayed for several years)
- In 67-82% of the cases, a family history of migraine is present
- Psychiatric manifestation are commonly seen in some of the cases
- Presence of upper gastrointestinal complications are also common
- Reported cases of DNA disorders, but is observed rarely
Course of CVS among children
- New cases of CVS is approximately 3 for every 100,000 children
- In some cases, emetic episodes cease and the child grows without signs and symptoms of CVS
- Some cases there is a switch from the vomiting episodes to migraine headaches
- And in some, the vomiting episodes still continue
Presentation and Symptoms of CVS in Adults
The presentation and symptoms of CVS among adults also has similarities to that of children. There is also the presence of multiple episodes of vomiting and nausea; there is also abdominal pain that may be severe (50-70% of the cases).
For adults the triggering factors for CVS includes the following:
- Presence of upper respiratory infections such as sinusitis
- Presence of psychological stress
- Lack of sleep
- Certain foods such as monosodium glutamate, chocolate, and cheese
- Motion sickness
These triggering factors is also seen to cause CVS among children
In adult women, CVS can be triggered by their menstrual period, this is called catamenial CVS.
Clinical Presentation of CVS in Adults
CVS in adults is usually diagnosed at age 335, and diagnosis may be delayed after onset of the disease. Most cases of CVS in adults are misdiagnosed as medical or psychiatric conditions such as:
- Viral gastroenteritis
- Food poisoning
- Psychiatric disorders such as conversion disorders, personality disorders or eating disorders
Because most cases are misdiagnosed or undiagnosed, employed treatments usually do not work and fail to relieve the patients of their conditions. Although the exact cause of CVS in adults is yet to be known, Cannabis abuse is reported to be one of the causative factors for CVs among adults.
Cyclic Vomiting Syndrome Causes
The exact cause of this condition remains vague, but experts contend that this condition may probably due to certain disorders.
Problems in the Central Nervous System and Endocrine System
A proposed explanation or cause to CVS involves disorders in the central nervous system and the endocrine system. It is proposed that CVS emanates from a problematic connection between the brain and the gastrointestinal system, as well as pathway problems between the endocrine system and the body.Gas Adaptation Syndrome
In CVS patients, problems and abnormalities in certain areas of the brain controlling arousal, awareness, the sensation of nausea and vomiting are observed. The affected brain areas include:
- Cingulate cortical sub regions
- Pontine regions
- When these areas of the brain are affected, it causes heightened awareness, anxiety, and stimulation of emesis or vomiting.
Delayed Gastric Emptying
In some cases of CVS, a delay in the rate of gastric emptying is observed. Gastric emptying pertains to the rate at which the stomach digests food and empties it into the intestines. Delayed gastric emptying causes the food to stay in the stomach for a longer time, stimulating the emesis center in the brain to activate the vomiting reflex.
A mutation in the genes, particularly of the CRF gene is also seen to contribute to the emergence of CVS. The CRF gene controls the activity of the corticotropin releasing factor, when CRF is increased; this triggers the emesis center and leads to the vomiting reflex.
Cyclic Vomiting Syndrome Treatment
Treatment for this condition involves a multidisciplinary approach and is usually symptomatic and empiric. This is because the cause and the pathogenesis of the condition is not fully understood.
General Approach Treatment
Patients with CVS are referred to gastroenterologists, a primary care giver, nurse, and a psychologist. These professionals work together to manage the condition, assist the patient deal with the condition and prevent any complications or comorbidities associated with CVS. The aim of this treatment is also to educate the patient as well as the family members inorder to reduce anxiety and frustration.
CVS patients are advised to avoid the following:
- Excessive emotional states (too much excitement, frustration, anger)
- Energy depleting activities such as fasting, illness and sleep deprivation
- Triggering foods such as chocolates, red wine, monosodium glutamate and cheese
- Motion sickness
- Avoidance or stabilization of intake of caffeine if migraines are experienced.
- Trycyclic antidepressants
- Beta blockers
- Serotonin inhibitors
- Anxiolytic medications
- Antiemetics and antinausea drugs or medications
Cyclic Vomiting Syndrome (CVS) Prognosis and Life Expectancy
CVS can be debilitating in such a way that it prevents patients from completing daily activities. But with treatment and constant evaluation, the prognosis is good. The life expectancy of CVS patients is not shortened due to the condition, but if CVS remains untreated, dehydration and fluid loss can present as life threatening conditions