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Kaul A, Kaul KK. Cyclic Vomiting Syndrome: A Functional Disorder. Pediatr Gastroenterol Hepatol Nutr. 2015;18(4):224-9doi: 10.5223/pghn.2015.18.4.224.
Kaul, A., & Kaul, K. K. (2015). Cyclic Vomiting Syndrome: A Functional Disorder. Pediatric gastroenterology, hepatology & nutrition, 18(4), 224-9. https://doi.org/10.5223/pghn.2015.18.4.224
Kaul, Ajay, and Kaul, Kanwar K. "Cyclic Vomiting Syndrome: A Functional Disorder." Pediatric gastroenterology, hepatology & nutrition vol. 18,4 (2015): 224-9. doi: https://doi.org/10.5223/pghn.2015.18.4.224
Kaul A, Kaul KK. Cyclic Vomiting Syndrome: A Functional Disorder. Pediatr Gastroenterol Hepatol Nutr. 2015 Dec;18(4):224-9. doi: 10.5223/pghn.2015.18.4.224. Epub 2015 Dec 23. PMID: 26770896; PMCID: PMC4712534.
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Pediatr Gastroenterol Hepatol Nutr. 2015 Dec;18(4):224-9. doi: 10.5223/pghn.2015.18.4.224. Epub 2015 Dec 23.

Cyclic Vomiting Syndrome: A Functional Disorder.

Pediatric gastroenterology, hepatology & nutrition

Ajay Kaul, Kanwar K Kaul

Affiliations

  1. Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
  2. Department of Pediatrics, NSCB Medical College, Jabalpur, India.

PMID: 26770896 PMCID: PMC4712534 DOI: 10.5223/pghn.2015.18.4.224

Abstract

Cyclic vomiting syndrome (CVS) is a functional disorder characterized by stereotypical episodes of intense vomiting separated by weeks to months. Although it can occur at any age, the most common age at presentation is 3-7 years. There is no gender predominance. The precise pathophysiology of CVS is not known but a strong association with migraine headaches, in the patient as well as the mother indicates that it may represent a mitochondriopathy. Studies have also suggested the role of an underlying autonomic neuropathy involving the sympathetic nervous system in its pathogenesis. CVS has known triggers in many individuals and avoiding these triggers can help prevent the onset of the episodes. It typically presents in four phases: a prodrome, vomiting phase, recovery phase and an asymptomatic phase until the next episode. Complications such as dehydration and hematemesis from Mallory Wise tear of the esophageal mucosa may occur in more severe cases. Blood and urine tests and abdominal imaging may be indicated depending upon the severity of symptoms. Brain magnetic resonance imaging and upper gastrointestinal endoscopy may also be indicated in certain circumstances. Management of an episode after it has started ('abortive treatment') includes keeping the patient in a dark and quiet room, intravenous hydration, ondansetron, sumatriptan, clonidine, and benzodiazepines. Prophylactic treatment includes cyproheptadine, propranolol and amitriptyline. No mortality has been reported as a direct result of CVS and many children outgrow it over time. A subset may develop other functional disorders like irritable bowel syndrome and migraine headaches.

Keywords: Cyclic vomiting; Vomiting

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