Cyclic vomiting syndrome: epidemiology, diagnosis, and treatment

Abstract

Cyclic-vomiting syndrome (CVS) is a chronic functional gastrointestinal disorder characterized by recurrent episodes of nausea and vomiting. Although once thought to be a pediatric disorder, there has been a considerable increase in recognition of CVS in adults. The exact pathogenesis is unknown and several theories have been proposed. Migraine and CVS share a similar pathophysiology as suggested by several studies. Since there are no specific biomarkers available for this disorder, physicians should rely on Rome criteria for the diagnosis. Due to the lack of randomized control trials, the treatment of CVS is primarily empirical.

Guidelines on management of cyclic vomiting syndrome in adults by the American Neurogastroenterology and Motility Society and the Cyclic Vomiting Syndrome Association

“…Childhood CVS frequently progresses to migraine headache. There is a high prevalence of migraine among close relatives with CVS and both often respond to similar medications . Given the links between these two disorders, mitochondrial supplements have been used in the prophylaxis of CVS.…”

“…Childhood CVS frequently progresses to migraine headache. There is a high prevalence of migraine among close relatives with CVS and both often respond to similar medications 15,56,57. Given the links between In a systematic review of the efficacyofriboflavinasprophylactictherapy,riboflavinwasassociated with a positive therapeutic effect in five clinical trials in adults with migraine 59.…”

Cannabinoid Hyperemesis

“…Hyperemesis gravidarum differs from typical morning sickness in that it is more severe and frequently requires medical intervention to rehydrate the mother. CVS was originally thought to be predominantly a pediatric illness [82] and, in children, CVS may be associated with autonomic dysfunction. Abnormal levels of adrenocorticotropic and antidiuretic hormones have been hypothesized [83, 84].…”

Cyclic vomiting syndrome: the nervous system has the guts

“…In the meantime, as described by Bhandari and colleagues [1], available therapies acting on dopaminergic and serotoninergic receptors in the nervous system are effective at attenuating nausea and vomiting. This is also the case with the most extensively studied etiology of severe emesis, i.e., chemotherapy-induced nausea and vomiting, which is also preventable and treatable by agents targeting neurokinin, dopamine, serotonin, and endocannabinoid receptors located in the peripheral and central nervous systems.…”

“…In this issue of Clinical Autonomic Research, Bhandari and colleagues publish a comprehensive state-of-the-art review on cyclic vomiting syndrome [1]. As described in this article, cyclic vomiting syndrome is a difficult, presumably neural as well as psychological condition.…”