Cyclic Vomiting Syndrome National Digestive Diseases Information Clearinghouse What is cyclic vomiting What is the gastrointestinal syndrome? (GI) tract? Cyclic vomiting syndrome, sometimes The GI tract is a series of hollow organs referred to as CVS, is an increasingly joined in a long, twisting tube from the recognized disorder with sudden, repeated mouth to the anus—the opening through attacks—also called episodes—of severe which stool leaves the body. The body 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 Esophagus hospital during episodes. After an episode, Mouth a person usually experiences symptom- Stomach 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. Duodenum 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 Small length of time, and occur with the same intestine symptoms and level of intensity. Anus Cyclic vomiting syndrome affects the upper GI tract, which includes the mouth, esophagus, stomach, small intestine, and duodenum. digests food using the movement of muscles • in children, an abnormal inherited gene in the GI tract, along with the release of may also contribute to the condition hormones and enzymes. Cyclic vomiting Specific conditions or events may trigger an syndrome affects the upper GI tract, which episode of cyclic vomiting: includes the mouth, esophagus, stomach, small intestine, and duodenum, the first • emotional stress, anxiety, or panic part of the small intestine. The esophagus attacks—for example, in children, is the muscular tube that carries food and common triggers of anticipatory anxiety liquids from the mouth to the stomach. are school exams or events, birthday The stomach slowly pumps the food and parties, holidays, family conflicts, or liquids through the duodenum and into the travel rest of the small intestine, which absorbs • infections, such as a sinus infection, a nutrients from food particles. This process respiratory infection, or the flu is automatic and people are usually not aware of it, though people sometimes feel • eating certain foods, such as chocolate food in their esophagus when they swallow or cheese, or additives such as something too large, try to eat too quickly, or caffeine, nitrites—commonly found drink hot or cold liquids. in cured meats such as hot dogs—and monosodium glutamate, also called What causes cyclic vomiting MSG syndrome? • hot weather The cause of cyclic vomiting syndrome is • menstrual periods unknown. However, some experts believe • motion sickness that some possible problems with bodily functions may contribute to the cause, such • overeating, fasting, or eating right as the following: before bedtime • gastrointestinal motility—the way food • physical exhaustion or too much moves through the digestive system exercise • central nervous system function— includes the brain, spinal cord, and How common is cyclic nerves that control bodily responses vomiting syndrome? • autonomic nervous system function— Cyclic vomiting syndrome is more common nerves that control internal organs such in children than adults, although reports of as the heart the syndrome in adults have increased in recent years.1 Usually, children are about • hormone imbalances—hormones are 5 years old when diagnosed with cyclic a chemical produced in one part of vomiting syndrome, which occurs in every the body and released into the blood three out of 100,000 children.2 to trigger or regulate particular bodily functions 2 Cyclic Vomiting Syndrome Who is more likely • dizziness to develop cyclic • headache vomiting syndrome? • sensitivity to light Children who suffer from migraines—severe, Intensity of symptoms will vary as a person throbbing headaches with nausea, vomiting, cycles through four distinct phases of an and sensitivity to light and sound—are more episode: likely to develop cyclic vomiting syndrome. Up to 80 percent of children and 25 percent • Prodrome phase. During the prodrome of adults who develop cyclic vomiting phase, the person feels that an episode syndrome also get migraine headaches.1 of nausea and vomiting is about to start. People with a family history of migraines may Often marked by intense sweating and be more likely to develop the syndrome. nausea—with or without abdominal pain—this phase can last from a few People with a history of chronic marijuana minutes to several hours. The person use may also be more likely to develop cyclic may appear unusually pale. vomiting syndrome. • Vomiting phase. This phase consists of intense nausea, vomiting, and retching. What are the symptoms of Periods of vomiting and retching can cyclic vomiting syndrome? last 20 to 30 minutes at a time. The The main symptoms of cyclic vomiting person may be subdued and responsive, syndrome are severe nausea and sudden immobile and unresponsive, or writhing vomiting lasting hours to days. A person may and moaning with intense abdominal also experience one or more of the following pain. An episode can last from hours symptoms: to days. • retching, or making an attempt to vomit • Recovery phase. This phase begins when the vomiting and retching stop • heaving or gagging and the nausea subsides. Improvement • lack of appetite of symptoms during the recovery phase can vary. Healthy color, appetite, and • abdominal pain energy return gradually or right away. • diarrhea • Well phase. This phase occurs between • fever episodes when no symptoms are present. 3 Cyclic Vomiting Syndrome What are the complications of cyclic vomiting Seek Help for Signs syndrome? or Symptoms of Severe The severe vomiting and retching that Dehydration define cyclic vomiting syndrome increase the People who have any signs or symptoms chance of developing several complications, of severe dehydration should call or see including dehydration, esophagitis, a a health care provider right away: Mallory-Weiss tear, and tooth decay. • excessive thirst • Dehydration may occur when a person does not replace fluids that • dark-colored urine were lost because of vomiting and • infrequent urination diarrhea. When dehydrated, the body lacks enough fluid and electrolytes— • lethargy, dizziness, or faintness minerals in salts, including sodium, • dry skin potassium, and chloride—to function properly. Severe dehydration may Infants, children, older adults, and require intravenous (IV) fluids and people with weak immune systems hospitalization. have the greatest chance of becoming dehydrated. People should watch • Esophagitis—inflammation or irritation for the following signs and symptoms of the esophagus—can result from the of dehydration in infants, young stomach acid that exits through the children, and people who are unable to esophagus during vomiting. communicate their symptoms: • A Mallory-Weiss tear—a tear in the • dry mouth and tongue lower end of the esophagus—is caused by severe vomiting. A person with • lack of tears when crying bloody vomit and stool should see a • infants with no wet diapers for health care provider right away. 3 hours or more • Tooth decay or corroding tooth enamel • infants with a sunken soft spot is damage caused by stomach acid. • unusually cranky or drowsy behavior • sunken eyes or cheeks • fever If left untreated, severe dehydration can cause serious health problems, such as organ damage, shock, or coma—a sleeplike state in which a person is not conscious. 4 Cyclic Vomiting Syndrome How is cyclic vomiting Medical and Family History syndrome diagnosed? Taking a medical and family history is one of A specific test to diagnose cyclic vomiting the first things a health care provider may do syndrome does not exist; instead, a health to help diagnose cyclic vomiting syndrome. care provider will rule out other conditions He or she will ask the patient to provide a and diagnose the syndrome based upon medical and family history. • a medical and family history Physical Exam • a physical exam A physical exam may help diagnose other conditions besides cyclic vomiting syndrome. • a pattern or cycle of symptoms During a physical exam, a health care • blood tests provider usually • urine tests • examines a patient’s body • imaging tests • taps on specific areas of the patient’s body • upper GI endoscopy • a gastric emptying test Pattern or Cycle of Symptoms in Children3 Often, it is suspected that one of the following is causing their symptoms: A health care provider will often suspect cyclic vomiting syndrome in a child when • gastroparesis—a disorder that slows or the child stops the movement of food from the stomach to the small intestine • has at least five separate episodes, or at least three separate episodes over • gastroenteritis—inflammation of the 6 months lining of the stomach, small intestine, and large intestine • has episodes of intense nausea and vomiting lasting 1 hour to 10 days and A diagnosis of cyclic vomiting syndrome may occurring at least 1 week apart be difficult to make until the person sees a health care provider. A health care provider • has episodes that are similar to will suspect cyclic vomiting syndrome if previous ones—they tend to start at the person suffers from repeat episodes of the same time of day, last the same vomiting. length of time, and occur with the same symptoms and level of intensity 5 Cyclic Vomiting Syndrome • vomits during episodes at least four Urine Tests times per hour for at least 1 hour Urinalysis involves testing a urine sample. • vomits and it is not attributed to The patient collects a urine sample in a another disorder special container in a health care provider’s office or a commercial facility.