Disease: Cyclic vomiting syndrome

Overview

Cyclic vomiting syndrome is characterized by episodes of severe vomiting that have no apparent cause. Episodes can last for hours or days and alternate with symptom-free periods. Episodes are similar, meaning that they tend to start at the same time of day, last the same length of time, and occur with the same symptoms and intensity.

Cyclic vomiting syndrome occurs in all age groups, though it often begins in children around 3 to 7 years old. Although more common in children, the number of cases diagnosed in adults is increasing.

The syndrome is difficult to diagnose because vomiting is a symptom of many disorders. Treatment often involves lifestyle changes to help prevent the events that can trigger vomiting episodes. Medications, including anti-nausea and migraine therapies, may help lessen symptoms.

Source: http://www.mayoclinic.com

Symptoms

The symptoms of cyclic vomiting syndrome often begin in the morning. Signs and symptoms include:

  • Severe vomiting that occurs several times an hour, continues for hours to days, but lasts less than one week
  • Three or more separate episodes of vomiting with no apparent cause in the past six months, or five or more episodes occurring at any time
  • Severe nausea
  • Intense sweating

Other signs and symptoms during a vomiting episode may include:

  • Abdominal pain
  • Diarrhea
  • Fever
  • Dizziness
  • Sensitivity to light
  • Headache
  • Retching or gagging

The time between vomiting episodes is usually symptom-free.

When to see a doctor

Call your doctor if you see blood in your or your child's vomit.

Continued vomiting may cause severe dehydration that can be life-threatening. Call your doctor if you or your child is showing symptoms of dehydration, such as:

  • Excess thirst
  • Less urination
  • Dry skin
  • Exhaustion and listlessness

Source: http://www.mayoclinic.com

Causes

The underlying cause of cyclic vomiting syndrome is unknown. Some possible causes include genes, digestive difficulties, nervous system problems and hormone imbalances. Specific bouts of vomiting may be triggered by:

  • Colds, allergies or sinus problems
  • Emotional stress or excitement, especially in children
  • Anxiety or panic attacks, especially in adults
  • Foods, such as caffeine, chocolate or cheese
  • Overeating, eating right before going to bed or fasting
  • Hot weather
  • Physical exhaustion
  • Exercising too much
  • Menstruation
  • Motion sickness

Identifying the triggers for vomiting episodes may help with managing cyclic vomiting syndrome.

Source: http://www.mayoclinic.com

Diagnosis

Cyclic vomiting syndrome can be difficult to diagnose. There's no specific test to confirm the diagnosis, and vomiting is a sign of many conditions that must be ruled out first.

The doctor will start by asking about your child's or your medical history and conducting a physical exam. The doctor will also want to know about the pattern of symptoms that you or your child experiences.

After that, the doctor may recommend:

  • Imaging studies — such as endoscopy, ultrasound or a CT scan — to check for blockages in the digestive system or signs of other digestive conditions
  • Motility tests to monitor the movement of food through your digestive system and to check for digestive disorders
  • Laboratory tests to check for thyroid problems and other metabolic conditions

Source: http://www.mayoclinic.com

Complications

Cyclic vomiting syndrome can cause these complications:

  • Dehydration. Excessive vomiting causes the body to lose water quickly. Severe cases of dehydration may need to be treated in the hospital.
  • Injury to the food tube. The stomach acid that comes up with the vomit can damage the tube that connects the mouth and stomach (esophagus). Sometimes the esophagus becomes so irritated it bleeds.
  • Tooth decay. The acid in vomit can corrode tooth enamel.

Source: http://www.mayoclinic.com

Prevention

Many people know what triggers their cyclic vomiting episodes. Avoiding those triggers can reduce the frequency of episodes. While you may feel well between episodes, it's very important to take medications as prescribed by your doctor.

If episodes occur more than once a month or require hospitalization, your doctor may recommend preventive medicine, such as amitriptyline, propranolol (Inderal), cyproheptadine and topiramate. Lifestyle changes also may help, including:

  • Getting adequate sleep
  • Downplaying the importance of upcoming events because excitement can be a trigger
  • Avoiding trigger foods, such as caffeine, cheese and chocolate
  • Eating small meals and small carbohydrate-containing snacks daily at regular times

Source: http://www.mayoclinic.com

Alternative medicine

Alternative and complementary treatments may help prevent vomiting episodes, although none of these treatments has been well-studied. These treatments include:

  • Coenzyme Q10 (ubiquinone), a natural substance made in the body that is available as a supplement. Coenzyme Q10 assists with the basic functions of cells.
  • L-carnitine, a natural substance that is made in the body and is available as a supplement. L-carnitine helps your body turn fat into energy.

L-carnitine and coenzyme Q10 may work by helping your body overcome difficulty in converting food into energy (mitochondrial dysfunction). Some researchers believe mitochondrial dysfunction may be a factor causing both cyclic vomiting syndrome and migraine.

Be sure to see a doctor and have the diagnosis of cyclic vomiting syndrome confirmed before starting any supplements. Always check with your doctor before taking any supplements to be sure you or your child is taking a safe dose and that the supplement won't adversely interact with any medications you're taking. Some people may experience side effects from L-carnitine and coenzyme Q10 that are similar to the symptoms of cyclic vomiting syndrome, including nausea, diarrhea and loss of appetite.

Source: http://www.mayoclinic.com

Lifestyle and home remedies

Lifestyle changes can help control the signs and symptoms of cyclic vomiting syndrome. People with cyclic vomiting syndrome generally need to get adequate sleep. Once vomiting begins, it may help to stay in bed and sleep in a dark, quiet room.

When the vomiting phase has stopped, it's very important to drink fluids, such as an oral electrolyte solution (Pedialyte) or a sports drink (Gatorade, Powerade, others) diluted with 1 ounce of water for every ounce of sports drink. Some people may feel well enough to begin eating a normal diet soon after they stop vomiting. But if you don't or your child doesn't feel like eating right away, you might start with clear liquids and then gradually add solid food.

If vomiting episodes are triggered by stress or excitement, try during a symptom-free interval to find ways to reduce stress and stay calm. Eating small meals and small carbohydrate-containing snacks daily, instead of three large meals, also may help.

Source: http://www.mayoclinic.com

Coping and support

Because you never know when the next episode might occur, cyclic vomiting syndrome can be difficult for the whole family. Children may be especially concerned, and may worry constantly that they'll be with other children when an episode happens.

You or your child may benefit from connecting with others who understand what it's like to live with the uncertainty of cyclic vomiting syndrome. Ask your doctor about support groups in your area.

Source: http://www.mayoclinic.com

Risk factors

The relationship between migraines and cyclic vomiting syndrome isn't clear. But many children with cyclic vomiting syndrome have a family history of migraines or have migraines themselves when they get older. In adults, the association between cyclic vomiting syndrome and migraine may be lower.

Chronic use of marijuana (Cannabis sativa) also has been associated with cyclic vomiting syndrome because some people use marijuana to treat their symptoms.

However, cannabis can lead to a condition called cannabis hyperemesis syndrome, which typically leads to persistent vomiting without normal intervening periods. People with this syndrome often demonstrate frequent showering or bathing behavior.

Cannabis hyperemesis syndrome can be confused with cyclic vomiting syndrome. To rule out cannabis hyperemesis syndrome, you need to stop using marijuana for at least one to two weeks to see if vomiting lessens. If it doesn't, your doctor will continue testing for cyclic vomiting syndrome.

Source: http://www.mayoclinic.com

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