Cyclic Vomiting Syndrome

By Meg Marinis, Director of Medical Research Nov 15, 2012
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Imagine the frustration. 

You're vomiting nonstop. You're severely nauseated and dizzy to the point that you have trouble even standing. You have terrible stomach pain, yet medication barely helps. And even though you're so miserable, you manage to drag yourself to the doctor. And? They find nothing wrong with you.

That's how Santa Claus and numerous other patients feel until they receive their diagnosis of Cyclic Vomiting Syndrome (CVS).

Why is CVS so difficult to diagnose?

As we saw on tonight's episode, there are currently no blood tests, x-rays, or specific procedures that can confirm a CVS diagnosis. Doctors frequently mistake the patient's presentation for the stomach flu or food poisoning, discharging the patient with instructions to rest and take in fluids. An accurate CVS diagnosis comes from careful review of the patient's medical history, physical exam, and lab studies to rule out other disorders that cause vomiting. Also, patients with CVS experience distinct periods of normal health in between episodes of vomiting. Experts in CVS have determined that patients present in four different phases:

The prodrome phase signals that an episode of vomiting and nausea will soon begin. Lasting from minutes to hours, the patient may experience abdominal pain and can even take medicine to try and prevent the episode in progress.

The episode phase consists of the full range of symptoms – vomiting, nausea, inability to eat, drink or take medicine without vomiting, exhaustion, paleness, and drowsiness.

Recovery begins when the vomiting and nausea have stopped. Patients will have a return in color, appetite, and energy.

And the symptom-free interval obviously describes the period between episodes when patients experience no symptoms.

Santa Claus' vomiting episodes are triggered by migraines.

Many patients can identify "triggers" that precede a vomiting episode. In children, triggers commonly can be stress or excitement – such as a family event or a birthday party. Other reported triggers include:

• Colds, allergies, sinus infections, the flu.
• Medications.
• Eating certain foods, as in chocolate or cheese.
• Eating too much.
• Eating before going to bed.
• Hot weather.
• Physical exhaustion.
• Menstruation.
• Motion sickness.

Since CVS cannot be cured, appropriate treatment includes identifying the trigger, preventing the episode from happening, and lessening the severity of the symptoms. So since Santa Claus now knows his migraines trigger his vomiting, he can take medication designed to treat the headaches. If he can eliminate his triggers, his vomiting episodes should decrease in frequency. If the episode still occurs, early intervention is vital. For example, doctors suggest patients settle into a dark and quiet environment to sleep and to drink lots of fluids to replace lost electrolytes. Regardless of the specific presentation, it is essential that the patient find a physician willing to create and fine-tune an individual treatment strategy that works for them.

CVS is a mitochondrial disorder.

An integral part of our cells, mitochondria are responsible for converting energy into food molecules to power our body's cells to function. If the mitochondria do not work properly for some reason, then the process is interrupted, and disorders in the body will ensue. Other mitochondrial and functional disorders include: Autism, Anxiety Disorder, Irritable Bowel Syndrome, Tinnitus, Fibromyalgia, Chronic Fatigue Syndrome, Restless Leg Syndrome, Attention Deficit Disorder, Temporal Mandibular Joint Disorder, Postural Orthostatic Tachycardia Syndrome, Sudden Infant Death Syndrome, Reflex Sympathetic Dystrophy, Bipolar Disorder, and Ketotic Hypoglycemia.

For more information on Cyclic Vomiting Syndrome, please visit the following link:

http://digestive.niddk.nih.gov/ddiseases/pubs/cvs/index.aspx