Cyclic Vomiting Syndrome

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Cyclic vomiting syndrome is a condition where a person suffers from repeated episodes of severe vomiting, but is normal between episodes.

Cyclic vomiting syndrome is a condition where the patient suffers from repeated, sudden bouts of intense nausea and vomiting. The bouts last for few hours to days, and the patient may be normal in the weeks between the bouts.

Cyclic vomiting syndrome has mainly been diagnosed in Caucasian children, usually around the age of 5 years. However, it is now being also diagnosed in adults, especially around the age of 35 years. It appears to be more common in girls than boys; in adults, it appears to be more common in males than females.

Cyclic vomiting syndrome appears to arise due to signals generated in the brain that stimulate vomiting. It has been suggested that a mismatch between the high energy required at times of stress and infections, and the inadequate energy produced by cells results in metabolic abnormalities. These affect certain nerves called the autonomic nerves, which stimulate vomiting. A hormone secreted by the hypothalamus (a part of the brain) called corticotrophin-releasing factor (CRF) could also be responsible for the vomiting.

There appears to be a relation between cyclic vomiting syndrome and migraine. People with a family history of migraine headaches seem to be particularly prone to developing cyclic vomiting syndrome. Many children go on to suffer from migraine in later life. Most adults with cyclic vomiting also suffer from a psychological problem like anxiety, depression and panic attacks.

Cyclic vomiting is not the same as chronic vomiting. Both cyclic vomiting and chronic vomiting are characterized by repeated episodes of vomiting. In cyclic vomiting syndrome, tests conducted are usually negative. These include laboratory, radiographic and endoscopic tests. Chronic vomiting is usually accompanied by a disease in the upper digestive tract.

The episodes of vomiting are treated with medications used to treat migraine. They can be prevented to some extent with certain medications or by avoiding any triggering factors.

Reference:

1. Venkatasubramani N, Venkatesan T, Li BU K. Extreme Emesis: Cyclic Vomiting Syndrome. Practical Gastroenterology September 2007; 21-34.

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