Cyclic vomiting syndrome

The long-term outlook for people with cyclic vomiting syndrome varies from person to person. Many children with CVS "outgrow" the condition by late childhood or early adolescence, but some continue to have symptoms through adulthood. It has been reported that many children with CVS go on to develop migraine headaches by late childhood. Some of these children experience a phase of abdominal migraines in between.

In adults with CVS, the course of the condition and how long it lasts have not been well-studied. There is substantial morbidity associated with CVS in adults, possibly due to lack of awareness and long delays in diagnosis.

Although people with CVS are symptom-free about 90% of the time, the condition can be quite disabling. Children with CVS may miss many days of school and may need home tutoring or home schooling. Because of increased likelihood of episodes during times of stress or excitement, CVS may interfere with birthdays, holidays, and vacations.

Treatment of cyclic vomiting syndrome (CVS) aims to prevent episodes (prophylactic therapy), stop episodes (abortive therapy), and provide supportive care while symptoms are present (supportive therapy). There is no specific treatment that has been proven effective in controlled trials, but several therapies based on observation and experience (empiric therapies) have been effective in case series. Treatment options for each person may depend on the person's age, whether there is a family history of migraines, the severity of episodes, and how often episodes occur. People with CVS should consult with their doctor about a personalized treatment plan.

Prophylactic therapy options include:

• Avoiding triggers of episodes (e.g. certain foods, physical exhaustion, sleep deprivation, or psychological stress).
• Various medications (usually for patients with more than one episode per month). Examples include cyproheptadine, amitriptyline (a tricyclic antidepressant), various anti-convulsants, propranolol, and erythromycin. There is consensus among experts that amitriptyline should be used as the first treatment for children over 5 years old, and cyproheptadine for children under 5 years old. Approximately 80% of those with a family history of migraines respond well to anti-migraine medications.
• Supplements called coenzyme Q-10 and L-carnitine. Retrospective studies have shown these to be very effective.

Abortive therapy options include various anti-migraine and anti-nausea medications such as ondansetron, promethazine, prochlorperazine, and a group of drugs used for migraines called triptans (e.g. sumatriptan).

Supportive therapy is needed when both prophylactic and abortive therapies are unsuccessful. Supportive care is an extremely important aspect of treatment while a person is having symptoms. This may involve:

• Oral fluids if possible.
• IV fluids if needed.
• Sedatives or pain medications to allow for sleep and a break from severe nausea.

International Foundation for Functional Gastrointestinal Disorders has an overview of Cyclic vomiting syndrome as well as more information for patients and their families.

The Mayo Foundation for Education and Research provides information about cyclic vomiting syndrome. Click on the above link to access information about this condition.