Cyclic Vomiting Syndrome in Adults

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Cyclic vomiting syndrome (CVS) is a functional gastrointestinal disorder in which a person experiences recurring episodes of vomiting without having any other signs of disease. These attacks typically come on suddenly, include feelings of intense nausea, and tend to occur in a predictable pattern. In between attacks, a person is generally symptom-free.

Much attention on CVS has been on its manifestations in children, but CVS in adults, although still relatively rare, is starting to get some attention in its own right.

This is a good thing, because CVS patients often go for years without a proper diagnosis. CVS patients are also at risk to undergo unnecessary surgery that does not solve the problem. This overview will provide you with some basic information about CVS, including its symptoms, phases, and what might be causing it to occur in the first place.

Symptoms of CVS

CVS is marked by episodes of extreme nausea with vomiting. Vomiting is usually projectile in nature and may contain bile, mucus, and less frequently, blood. At times, the vomiting is so severe that a person will need to go to the hospital.

Vomiting episodes are characterized as 'stereotypic', meaning that each episode follows a similar course, in terms of time of day, length of episode, and type and severity of symptoms.

Most adults experience a sense that an episode is coming on. Vomiting episodes vary in their length - ranging from a few hours to a few days.

During an episode, vomiting can occur once every few hours to up to 20 times an hour. For adults, the duration of episodes is on average, three to six days, and such episodes occur on average every three months. Episodes are most likely to occur between 1:00 AM and 7:00 AM.

Associated symptoms include:

  • Abdominal pain
  • Diarrhea
  • Dizziness
  • Drooling
  • Elevated blood pressure
  • Feeling weak
  • Fever
  • Light sensitivity
  • Looking pale
  • Loss of appetite
  • Migraine symptoms
  • Rapid heart rate
  • Retching, heaving, gagging
  • Sweating
  • Vertigo

The length of time that a person has CVS can range from months up to decades of their life. Times without symptoms can range from weeks to months. Adults who do not get adequate treatment for their CVS may be at risk for a perception that the disorder is worsening and thus they report a decreasing number of symptom-free days.

CVS Phases

CVS is broken down into four phases:

1. The Inter-Episodic Phase: In this phase, a person experiences few, if any symptoms.

2. The Prodrome Phase: In this phase, a person senses that an episode is approaching. They may experience abdominal pain, dyspepsia, fatigue, nausea, pallor, and/or weakness. This phase can last up to several hours.

3. The Emetic Phase: It is in this phase that a person experiences severe nausea, retching, vomiting and other associated symptoms.

In severe episodes, a person may be unresponsive, and writhing or moaning in pain. This phase can last for hours or days.

4. The Recovery Phase: In this phase, nausea quiets down and vomiting ceases. Hunger and normal energy will return and a person can take in foods and medications by mouth.

Who Is at Risk for CVS?

CVS seems to be experienced by slightly more females than males. People, males in particular, who smoke marijuana regularly, are at higher risk for developing CVS. Approximately 1/4 of all adults who have CVS also experience migraine headaches. Having a family history for either migraines or CVS raises your risk for CVS.

People who have CVS are more likely to experience irritable bowel syndrome (IBS) or epilepsy than those who don't have CVS.

Many people who have CVS also have been diagnosed with anxiety and depression. Once a person has the disorder, they are at risk for anticipatory anxiety related to fear of the next episode.

Newer research suggests that people who have CVS experience normal or rapid gastric emptying. This would thus distiguish them from patients who have gastroparesis.

Episode Triggers

People who have CVS have reported the following as possible triggers for a vomiting episode:

  • Asthma
  • Excitement
  • Exhaustion
  • Foods (caffeine, cheese, chocolate, MSG, nitrites)
  • Hot weather
  • Infections (sinus, flu, upper respiratory)
  • Lack of sleep
  • Menstruation
  • Missed meals
  • Motion sickness
  • Overeating
  • Panic attacks
  • Strenous exercise
  • Stress

Consequential Health Conditions

As one can imagine, episodes of severe vomiting can lead to other health problems. These include:

  • Anxiety
  • Dental cavities
  • Dehydration
  • Depression
  • Electrolyte imbalance
  • Inflammation of the lining of the esophagus or stomach
  • Mallory-Weiss tear (a tear in the lower part of the esophagus)
  • Social withdrawal
  • Weight loss

What Causes CVS?

As of now, researchers are not quite sure why a person would develop CVS. Similar to IBS, CVS is considered to reflect a dysfunction in the connections between the brain and the gut. Two possible causes of the autonomic and gastrointestinal motility dysfunction of CVS are that of a genetic mitochondrial problem or a hormone imbalance.

Diagnosis of CVS

CVS is diagnosed after other health conditions have been ruled out. This includes infectious diseases, neurological conditions, and other gastrointestinal disorders. Severe abdominal pain and tenderness, worsening of vomiting episodes, a large volume of blood in the vomit are all signs of a more serious disease process.

Sources:

"Cyclic Vomiting Syndrome" NIDDK website Accessed August 4, 2015.

Choung, R., et.al. "Cyclic vomiting syndrome and functional vomiting in adults: association with cannabinoid use in males" Neurogastroenterology and Motility 2011 24:20.

Cooper, C., et.al. "Rapid or Normal Gastric Emptying as New Supportive Criteria for Diagnosing Cyclic Vomiting Syndrome in Adults" zMedical Science Monitor 2014 20:1491-1495.

Fleisher, D., et.al. "Cyclic Vomiting Syndrome in 41 adults: the illness, the patients, and problems of management" BMC Medicine 2005 3:20.

Sunku, B. "Cyclic Vomiting Syndrome" Gastroenterology & Hepatology 2009 5:507-515.

Yang, H. "Recent Concepts on Cyclic Vomiting Syndrome in Children" Journal of Neurogastroenterology and Motility 2010 16:139-147.

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