Treatment of Cyclic Vomiting Syndrome

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Cyclic vomiting syndrome (CVS), with its recurrent episodes of extreme nausea and vomiting, not only takes a toll on a person's quality of life, but also can result in ongoing psychiatric and physical symptoms. Therefore, treatment focused on preventing episodes, or reducing their severity when they do occur, is imperative.

Medical Treatment for CVS

There is no one treatment for CVS. Rather, treatment strategies will vary depending on which phase of CVS a person is in:

Between Episodes:

The goal when a person is feeling well is to try to prevent episodes from happening. This involves avoiding any known episode triggers and treating any health problems that increase the risk for an episode. Medications are recommended for patients whose episodes are frequent and severe. Options include:

  • Anti-anxiety medication
  • Digestive medications
  • Migraine medications
  • Seizure medications
  • Medications for PMS

In some cases, CVS patients can benefit from psychotherapy so as to improve their ability to deal with stress and to work to reduce anticipatory anxiety (fear of future episodes) that can lead to an episode.

The Prodromal Phase (episode is imminent):

In an attempt to prevent the onset of vomiting, patients may be prescribed medications that have anti-anxiety, anti-nausea, or anti-pain effects. Some migraine medications may be offered. For some patients, such medication can not be tolerated orally, and must be given through an intravenous, intra-muscular, or rectal manner.

The Emetic Phase (episode is ongoing):

Once vomiting starts, patients need to call their doctor as soon as possible. Transport to the hospital may be necessary. Goals of treatment in the emetic phase include the need to prevent dehydration and resulting kidney and electrolyte problems, as well as to prevent any tearing of the esophagus.

Once in the hospital, it is optimal that the patient be placed in a dark, quiet environment. Intravenous fluids will be started. Medications include antiemetics (to stop nausea and vomiting), sedating drugs (to induce sleep) and pain-relieving drugs.

The Recovery Phase:

Although some people can tolerate a return to normal eating once the nausea ends, others require a slower approach, as anything other than clear liquids could prompt a return of symptoms. The goal of recovery treatment is to replenish fluids and electrolytes. Medications for preventing a relapse may be initiated.

Preventative Self Care Strategies

A person who has CVS can take steps on their own to try to prevent further episodes. Keeping in mind common episode triggers, one can focus on:

  • Avoiding any known food triggers, such as caffeine, cheese, chocolate, MSG and nitrites
  • Avoiding fasting or over-eating
  • Avoiding over-exertion or over-excitement
  • Getting adequate rest and sleep
  • Getting treatment for any chronic infections or pre-menstrual problems

Strategies for Dealing with Nausea

People who have CVS report that taking the following actions can help to relieve nausea:

  • Avoiding lights and sounds
  • Curling on one's side
  • Drinking water
  • Eating
  • Taking baths or showers
  • Vomiting

Sources:

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

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.

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

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

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