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Cyclic vomiting syndrome
CVS is a chronic disorder characterized by recurrent episodes of severe nausea and vomiting.
The pathophysiology of CVS is complex and not fully understood, but it is believed to involve a dysregulation of the gut-brain interaction. Functional brain imaging studies have shown altered connectivity in the insular cortex in patients with CVS.
The prevalence of CVS in the US is estimated at 2%.
Clinically, CVS presents as stereotypical episodes of severe vomiting lasting from a few hours to several days, separated by symptom-free intervals. These episodes often begin at the same time of day, and patients may experience a prodromal phase characterized by nausea and abdominal pain before the onset of vomiting. Other symptoms may also occur during episodes, such as lethargy, pallor, and loss of appetite.
Prognosis and risk of recurrence
The prognosis of CVS varies. While the syndrome can persist into adulthood, symptoms may lessen over time. The disease burden can be significant, impacting the QoL and resulting in frequent hospitalizations.
The following summarized guidelines for the evaluation and management of cyclic vomiting syndrome are prepared by our editorial team based on guidelines from the American Neurogastroenterology and Motility Society (ANMS/CVSA 2019), the American College of Gastroenterology (ACG 2013), and the American Academy of Family Physicians (AAFP 2013).
History and physical examination: as per ANMS 2019 guidelines, consider screening for and treating comorbid conditions, such as anxiety, depression, migraine, autonomic dysfunction, sleep disorders, and substance use. Consider referring patients to appropriate allied health services (psychologist, psychiatrist, neurologist, sleep, or substance use specialist) as clinically appropriate.
Abortive treatment: consider administering the following agents to abort symptoms of a CVS episode:
triptans, such as sumatriptan
serotonin antagonists, such as ondansetron
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Alternative and complementary therapies
Consider offering mitochondrial supplements, such as coenzyme Q10, and riboflavin as prophylactic therapy in patients with CVS. Consider offering mitochondrial supplements concurrently with other prophylactic agents.
Consider offering meditation, relaxation, and biofeedback as complementary therapy in patients with CVS.