Cyclic vomiting syndrome

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Classification according to ICD-10
R11 Cyclic vomiting (diagnostic thesaurus)
ICD-10 online (WHO version 2019)

The cyclic vomiting syndrome (English: cyclical vomiting syndrome (CVS)) is a disease which is characterized by recurring bouts of nausea , vomiting distinguished and seriously disturbed general condition. As a rule, cyclical vomiting begins in childhood between the ages of three and seven years. Although it often goes away in adulthood, it can last until then. Familial presence of migraines was observed in 67 to 82% of the cases.

Complaints (symptoms)

Vomiting occurs at short intervals, six to twelve times an hour at the peak of the attack, and can last a few hours, but also up to ten days and more. Most of the time, however, an attack lasts one to four days. The seizures are similar in course and duration and end spontaneously. Most of the time, the affected person feels fine between attacks.

Accompanying symptoms are nausea, abdominal pain, headache, sensitivity to movement, sensitivity to light, fever, paleness, diarrhea, water loss (dehydration), profuse salivation, social seclusion.

diagnosis

CVS is difficult to diagnose because vomiting can be caused by a variety of other known conditions. The diagnosis of CVS is usually made using exclusion criteria. No diagnostic tests, such as blood or urine tests, are currently available. A diagnosis, or rather a classification of CVS, can take several years. Many sufferers undergo a variety of tests and are sometimes misdiagnosed before realizing their true condition.

In a small subset of those affected, it is believed that a mutation in mitochondrial DNA is responsible.

Criteria for cyclic vomiting syndrome are

  • repeated severe attacks of vomiting. At least five seizures in a time interval or at least three seizures within six months;
  • episodic attacks of severe nausea and vomiting lasting between an hour and up to ten days. The interval between attacks is at least a week;
  • stereotypical course and stereotypical symptoms in an individual patient;
  • Vomiting during a seizure at least four times an hour and lasting for at least one hour;
  • Well-being between seizures;
  • Rule out other causes of vomiting.

Trigger for CVS

For many patients there is no obvious cause of a seizure; for others there may be specific circumstances. Physical stress is one of the most common triggers. Mild viral illnesses, such as cold or flu, inflammation in the neck and chest area, and minor injuries that lead to pain, can be triggers, as can prolonged fasting and insomnia.

Less common triggers are anesthetics, cold or sensitivity to certain foods. Also negative stress, caused by anxiety and family problems, as well as the fear of falling ill, e.g. B. on birthdays or during the holidays, can be a trigger for some people. In the case of a large number of sufferers, no obvious trigger can be identified.

treatment

Treating CVS is difficult and there is no clear cure. Treatment is supportive. Providing a dark, quiet environment is often helpful during a seizure. Administration of intravenous fluids may be required, and early treatment and monitoring are important. Treatments with a range of anti-emetic or other drugs have been used and each individual patient can find a treatment that is helpful to them, but there is no one-size-fits-all method of treatment. A variety of treatments were tried between seizures. Some work well for certain people, reducing the number, duration, and severity of the episode, but the same drug need not help other people.

Cyclic vomiting in adults

As in children, cyclic vomiting in adults is characterized by multiple episodes of vomiting that is associated with nausea, vomiting, and dehydration. The mean age of first onset is about 35 years. It is associated with severe abdominal pain in 58–71% of adult patients.

The diagnostic criteria proposed by the Rome Foundation in 2006 are ( Rome III ):

  1. Vomiting stereotypical in terms of onset (acute) and duration (less than a week)
  2. Three or more clearly separated episodes in the past year
  3. Absence of nausea and vomiting between attacks

All three criteria must be met for the diagnosis to be made. A positive family history of migraines supports the diagnosis.

Namin describes possible prophylactic therapies.

Individual evidence

  1. ^ KJ Lindley, PL Andres: Pathogenesis and Treatment of Cyclical Vomiting. In: J Pediatr Gastroenterol Nutr . 41 (2005), pp. 38-40.
  2. ↑ BU Li et al .: North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Consensus Statement on the Diagnosis and Management of Cyclic Vomiting Syndrome. In: J Pediatr Gastroenterol Nutr. 47 (2008), pp. 379-393.
  3. ↑ TL Abell et al.: Cyclic vomiting syndrome in adults. In: Neurogastroenterol Motil. 20 (2008), pp. 269-284.
  4. ^ BU Li, DR Fleisher: Cyclic vomiting syndrome: features to be explained by a pathophysiologic model. In: Dig Dis Sci. 44: 8-13 (1999).
  5. ^ BU Li, L. Misiewicz: Cyclic vomiting syndrome: a brain-gut disorder. In: Gastroenterol Clin N Am. 32 (2003), pp. 997-1019.
  6. ↑ RG Boles, JC Williams: Mitochondrial Disease and Cyclic Vomiting Syndrome. In: Dig Dis Sci. 44 (1999), pp. 103S-107S
  7. ↑ EA Zaki et al. : Two common mitochondrial DNA polymorphisms are highly associated with migraine headache and cyclic vomiting syndrome. In: Cephalalgia. 29 (2009), pp. 719-728.
  8. ^ BU Li: Cyclic Vomiting Syndrome. In: Curr Treat Opt Gastroenterol. 3 (2000), pp. 395-402.
  9. ↑ P. Chepyala, RP Svoboda, KW Olden: Treatment of Cyclic Vomiting Syndrome. In: Curr Treat Opt Gastroenterol. 10 (2007), pp. 273-282, 2007.
  10. ^ Rome III Diagnostic Criteria for FGIDs . Rome III: The Functional Gastrointestinal Disorders. Third edition. Retrieved February 12, 2013.
  11. ^ F. Namin et al .: Clinical, psychiatric and manometric profile of cyclic vomiting syndrome in adults and response to tricyclic therapy. In: Neurogastroenterol Motil. 19 (2007), pp. 196-202.