Cyclic Vomiting Syndrome: Phases, Symptoms, Causes and Treatment

Do you know Cyclic Vomiting Syndrome (CVS)? It is a disease that usually appears more in children than in adults, and consists of the appearance of repeated episodes or cycles of nausea and/or vomiting of severe intensity.

In this article we will learn more details about this syndrome, general characteristics and prevalence, as well as its symptoms, causes and treatments.

Cyclic vomiting syndrome: what is it?

Cyclic vomiting syndrome (CVS) is an illness where severe, repeated nausea and vomiting occur at regular intervals These can appear in episodes or in cycles (that is, even more frequently).

Between cycles of nausea and/or vomiting, the person is in good general health. Cyclic vomiting syndrome usually appears in children, although there are adults who also manifest it.

Vomiting cycles

In cycles of vomiting and/or nausea, the child may vomit several times in an hour Cycles vary in length, that is, they can last hours or up to days.

On the other hand, Vomiting cycles are usually similar in each child in duration and frequency; That is, they usually start at the same time of day (for example at night), last the same amount of time (which is usually a long time) and have a similar intensity.

A child who suffers from cyclic vomiting syndrome has, on average, around 12 episodes or cycles of vomiting per year, although this depends on each child, of course.

Prevalence and population

The exact prevalence of cyclic vomiting syndrome is unknown, although an estimate has been made; In the United States, for example, it is estimated that the syndrome affects 3 out of every 100,000 children. Regarding its distribution by sex, the syndrome is slightly more common in girls than in boys.

At what age is cyclic vomiting syndrome most likely to manifest? At pre-school age or beginning of school, the risk is greater. Specifically, The average age of onset of the syndrome is 5 years As we have seen, its appearance is more common in boys and girls, but it can also affect the adult population.

Symptoms

The symptoms of cyclic vomiting syndrome can appear at any time of the day, although it is common for them to appear either in the afternoon/night or first thing in the morning.

The two main symptoms of the syndrome are nausea and vomiting. Both are of severe intensity, and repeat over time in episodes or cycles.

In addition to these two main symptoms, other associated symptoms appear, such as: paleness, abdominal pain, excessive tiredness, migraines or headaches, diarrhea, low-grade fever sensitivity (especially to sounds/noises and light) and drooling, among others.

Phases

Cyclic vomiting syndrome is characterized by four defined phases, which are as follows.

1. Phase 1: prodrome

In the first phase, a type of warning or signal is produced that announces the arrival of an attack of vomiting and/or nausea. In this phase, typical symptoms are: stomach pain, headache, anxiety and nausea

These symptoms (or some of them) appear in 60% of people with cyclic vomiting syndrome.

2. Phase 2: vomiting

In the second phase of the syndrome, attacks of vomiting or nausea (which can be retching) come. The symptoms of this phase can last for hours or even a whole day.

3. Phase 3: recovery

In this third phase the vomiting and nausea have ceased. It is the recovery phase, where the boy or girl feels a little better. At the moment Some children can eat solid foods right away; others, however, need a little more time and they must start with liquids.

In this phase, abdominal pain and fatigue or exhaustion may also appear as a result of vomiting.

4. Phase 4: absence of symptoms

This fourth phase of cyclic vomiting syndrome is the one that appears between cycles of vomiting, where There are no notable symptoms and the person feels well, in good health

Causes

Regarding the cause of cyclic vomiting syndrome, it is unknown. However, some data is known about it; For example, it has been seen how children who suffer from the syndrome, They frequently also manifest symptoms such as migraines or abdominal migraines In this sense, it has also been seen that the majority of patients have a family history of migraines, especially on the mother’s side of the family.

Thus, although the cause is unknown, certain factors have been related to cyclic vomiting syndrome, which could even be its cause (or part of it). These factors or situations are:

Treatment

In most cases of cyclic vomiting syndrome, the symptoms resolve without treatment Furthermore, there is no “cure” for it, so treatment for it aims to manage or alleviate the symptoms to the extent possible.

What to do when an episode of vomiting starts? If it happens to your child, try to keep him/her calm. Try to get him to relax. When vomiting has not yet appeared, It is ideal for the child to be somewhere quiet and quiet (for example your room). In addition, sleeping also helps a lot.

In some cases, certain drugs are also taken for nausea, as well as sedatives to help the child relax and sleep. In severe cases, you should go to the hospital to avoid severe dehydration. In the hospital, fluids are usually administered intravenously to prevent such dehydration.

Pharmacotherapy

In relation to the drugs that are usually administered in cyclic vomiting syndrome, the treatment can be of two types:

1.1. abortive treatment

This type of treatment aims to prevent or stop the appearance of attack symptoms; includes anti-nausea drugs, sedatives, and anxiety drugs (anxiolytics).

1.2. Preventive treatment

In the case of preventive treatment, Its objective is to reduce or eliminate attacks It usually includes mainly two types of drugs: amitriptyline (tricyclic antidepressant and analgesic) and cyproheptadine (antihistamine).