Has your child, or even you, suddenly started vomiting violently for no apparent reason and it lasted for a day or two? Then it went back to normal as if nothing had happened? If this happens repeatedly for several months, you should be aware of this condition we are talking about today called Cyclic Vomiting Syndrome (CVS). This is not just an upset stomach, it is something much different.
What exactly is cyclic vomiting syndrome (CVS)?
Simply put, CVS is a condition in which you experience repeated bouts of severe nausea and vomiting for no apparent reason. These episodes of vomiting can last from a few hours to a few days. It can be so severe that you may not be able to get out of bed. Because a lot of fluid is lost from your body, you may need to go to the hospital or emergency room (ETU) to receive IV fluids to prevent dehydration.
But the amazing thing is, once this period of severe vomiting is over, you become completely healthy and normal again, as if you had no problems at all.
This condition can last for months, years, or even decades. However, symptoms are not always present. Typically, vomiting like this may occur several times a year. For some people, it may even occur once or twice a month.
The pattern of vomiting, the time of day, how severe it is, and how long it has been going on can vary from person to person. But for the same person, the symptoms tend to be more or less the same, following the same pattern each time.
Is this situation common?
CVS is more common in children than in adults. It is estimated that about 3 in 100,000 children may have the condition. It most often begins in children between the ages of 3 and 7. However, it can start at any age.
What are the symptoms of this condition?
The main symptom of CVS is sudden, recurring, severe nausea and vomiting. There are several distinct stages of this.
| Phase | A simple description of what is happening |
|---|---|
| Prodrome phase | A few minutes or hours before you start vomiting, you may start to feel nauseous and sweaty. For many people, this feeling comes in the early morning. You may feel like "Today is not going to be good." |
| Vomiting phase | During this stage, you will vomit continuously. Sometimes several times an hour. Young children may vomit rapidly (projectile vomiting). This can last from a few hours to a few days. It can be so severe that you may feel like you can't even talk and want to stay in bed alone. |
| Recovery phase | The vomiting and nausea are gradually decreasing and getting better. I feel like I'm gradually gaining strength. |
| Well phase | You will feel completely normal and healthy again, as if you had no problem. You will be fine until the next episode of vomiting. |
In addition to these, there may be other symptoms:
- Stomach ache
- Diarrhea (stomach ache)
- Dizziness
- Drooling or drooling
- Intense thirst
- Appetite
- Pale skin
- Severe headache and extreme fatigue
- Sensitivity to light or sound (like someone with a migraine)
- Fever (up to 101°F / 38.3°C)
- Retching (dry-heaving): This means that you feel like you're about to vomit, but nothing comes out because there's nothing in your stomach.
What can cause CVS?
It is not yet known whether this is the only cause of CVS, but there are several factors that are thought to contribute to it.
The important thing is that this is not something you imagined, nor is it your fault. This is actually the result of a process that occurs in the body.
- Issues with your brain-gut axis: Simply put, when there is a problem with the 'communication link' between our brain and the nervous system in our gut, uncontrollable vomiting can occur. Some scientists also call this a brain-gut disorder.
- Changes in your autonomic nervous system: This is the part of your body that controls things that are out of your control, like your heart rate, blood pressure, and vomiting. If there's a problem with this system, you may lose control of your vomiting.
- Migraine headaches: About 80% of children with CVS and 25% of adults also have migraines. Migraines are not just a severe headache. Like CVS, migraines can be uncomfortable at the onset. Many people with CVS have a family history of migraines.
- Abnormal mitochondrial DNA: Mitochondria are like the 'power plants' that provide energy to every cell in our body. The instructions for how they should work are contained in DNA. If there is a defect in this DNA due to an illness, genetic condition, or other cause, the nerve cells in the intestines do not get the energy they need. This can also cause uncontrollable vomiting.
What are the 'Triggers' that cause vomiting?
Certain events, emotions, or situations can trigger vomiting. We call these 'triggers'. If you have CVS, it's important to identify your triggers.
- Changes in weather (especially in autumn and winter).
- Certain foods: things like chocolate, cheese, coffee, and MSG (flavoring agents).
- Children's excessive happiness: Imagine, this can start at a time when the child is very happy, like the night before a school trip, or the morning of a birthday.
- Mental stress in adults: Things like excessive anxiety and stress.
- Allergies, sinus infections, or the common cold.
- Physical exhaustion.
- Fasting for a long time.
- Long-term use of cannabis.
- Menstrual periods in women.
- Motion sickness.
Complications that may occur if vomiting continues
If CVS is not controlled, severe vomiting can lead to other health problems.
| Complication | A simple explanation |
|---|---|
| Dehydration | Excessive loss of fluid from the body due to vomiting and diarrhea. This can be dangerous. |
| Esophagitis | The tube that runs from the throat to the stomach (esophagus) is injured and swollen by stomach acid that comes with vomiting. |
| Mallory-Weiss tear | The pressure of severe vomiting can tear the lower part of the esophagus. This can cause blood to come out with the vomit. |
| Tooth decay | Frequent exposure to stomach acid causes the enamel of the teeth to dissolve and lead to tooth decay. |
How does a doctor diagnose this disease?
Diagnosing CVS is a bit complicated because there is no specific test for it. Your doctor will make sure you don't have other conditions that cause similar symptoms.
Your doctor will ask you a lot of questions about your medical history, family medical history, and your vomiting pattern. He or she will then perform a physical exam and order additional tests if necessary.
What tests are performed?
- Blood and urine tests: Check for metabolic disorders, mitochondrial diseases, or problems with other organs.
- Imaging tests: You may be asked to have an abdominal ultrasound scan, an MRI or CT scan of the brain, or an X-ray of the abdomen. These can look for any blockages in the digestive system or nervous system.
- Upper endoscopy: This involves using a thin tube with a camera to examine your esophagus, stomach, and the beginning of your small intestine to check for other problems that may be causing your vomiting.
Other diseases that can be associated with CVS
Before a doctor can diagnose CVS, they need to make sure you don't have any other conditions that cause similar symptoms.
- Stomach infection or gastritis
- Stomach ulcers
- Inflammation of the pancreas (pancreatitis)
- Appendicitis
- Intestinal twisting (volvulus or malrotation)
What are the treatments for CVS?
Treatment for CVS depends on whether you are in the vomiting phase or the healthy phase where you are trying to prevent it.
- Prodrome phase: As soon as symptoms begin, your doctor may prescribe medications to reduce nausea, reduce stomach acid, and relieve migraines/stomach aches.
- Vomiting phase: During this time, you will still be given medication for migraines, heartburn, and anxiety. You may need to be hospitalized to receive IV fluids and nutrition to prevent dehydration. Resting in a dark, quiet room can help relieve symptoms during this time.
- Recovery phase: Continue to give saline if necessary. Gradually, liquids and then solid foods can be introduced.
- Well phase: During this time, your doctor may prescribe daily medications to prevent future vomiting.
Types of medications used
- Anti-migraine medicines
- Anti-nausea medicines
- Some anti-seizure medicines
Additionally, some people find relief from supplements such as coenzyme Q10, riboflavin, and L-carnitine. However, never start anything like this without your doctor's approval.
What should you expect when living with this condition?
Most children outgrow this CVS condition as they get older. However, they may develop severe migraines as adults. This persistent, severe vomiting can prevent children from going to school and adults from going to work. This can have a major impact on daily life.
The most important thing is to work with your doctor to find out what treatments work for you and what your triggers are. Everyone's experience is different, so it may take some time to find what works for you.
What can be done to prevent vomiting?
You can reduce your vomiting by avoiding your triggers and taking the medications your doctor prescribes. Also consider these things:
- If you have allergies and sinus problems, get them treated quickly.
- Stay active, but don't overdo it.
- Avoid foods and sweeteners that are not good for you.
- Avoid strict dieting or fasting.
- Get enough sleep.
- Manage stress and anxiety.
Questions to ask your doctor
When you go to see the doctor, don't forget to ask these questions:
- What tests should I have to know for sure if I have CVS?
- What medicine should I take to stop vomiting when it starts, and to prevent it from happening again?
- What changes do I need to make in my lifestyle to avoid my triggers?
- What other things can I do to reduce symptoms?
- What symptoms should I see you for, or go to an ETU (Emergency Treatment Unit) ?
CVS can be a frustrating and life-threatening condition. There is no single cure or solution. You and your doctor need to be patient as you find the right treatment and triggers for you. Over time, most people become better at identifying and avoiding their triggers. In the meantime, if vomiting does occur, there are medications that can help control symptoms.
Take-Home Message
- CVS is a real medical condition characterized by repeated episodes of severe vomiting for no apparent reason, followed by periods of complete recovery.
- It is believed that this is not just a "stomach ache", but is caused by a problem in the connection between the brain and the digestive system.
- Identifying and avoiding the triggers that cause vomiting in you or your child is a very important part of treatment.
- It is essential to work closely with your doctor to properly diagnose this disease and get a treatment plan.
- In cases of severe vomiting, it may be important to receive intravenous saline (IV fluids) in a hospital or ETU to prevent dehydration.
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