Cyclic vomiting syndrome: Difference between revisions
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==Background== | ==Background== | ||
*Recurrent episodes of [[vomiting]], otherwise normal health in between | |||
*Recurrent episodes of [[Special:MyLanguage/vomiting|vomiting]], otherwise normal health in between | |||
*32% of patients disabled by illness by time of diagnosis<ref>Fleisher DR, Gornowicz B, Adams K, Burch R, Feldman EJ. Cyclic Vomiting Syndrome in 41 adults: the illness, the patients, and problems of management. BMC Med. 2005 Dec 21. 3:20.</ref> | *32% of patients disabled by illness by time of diagnosis<ref>Fleisher DR, Gornowicz B, Adams K, Burch R, Feldman EJ. Cyclic Vomiting Syndrome in 41 adults: the illness, the patients, and problems of management. BMC Med. 2005 Dec 21. 3:20.</ref> | ||
*Pathophysiology not well understood | *Pathophysiology not well understood | ||
*Average age at onset ~21yo | *Average age at onset ~21yo | ||
*Females slightly more affected than males | *Females slightly more affected than males | ||
*[[Marijuana]] use is risk factor | *[[Special:MyLanguage/Marijuana|Marijuana]] use is risk factor | ||
==Clinical Features== | ==Clinical Features== | ||
*Pediatric diagnostic criteria<ref>Li BU, Lefevre F, Chelimsky GG, et al. North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition consensus statement on the diagnosis and management of cyclic vomiting syndrome. J Pediatr Gastroenterol Nutr. 2008 Sep. 47(3):379-93.</ref> | *Pediatric diagnostic criteria<ref>Li BU, Lefevre F, Chelimsky GG, et al. North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition consensus statement on the diagnosis and management of cyclic vomiting syndrome. J Pediatr Gastroenterol Nutr. 2008 Sep. 47(3):379-93.</ref> | ||
**At least 5 episodes or minimum of 3 over 6 mo | **At least 5 episodes or minimum of 3 over 6 mo | ||
**[[Nausea and vomiting (peds)|Nausea/vomiting]]episodes lasting 1hr-10d, with 1 week in between | **[[Special:MyLanguage/Nausea and vomiting (peds)|Nausea/vomiting]]episodes lasting 1hr-10d, with 1 week in between | ||
**Stereotypical pattern and symptoms | **Stereotypical pattern and symptoms | ||
**Return to baseline health in between | **Return to baseline health in between | ||
**Symptoms not due to another condition | **Symptoms not due to another condition | ||
*Adult – Rome III criteria <ref>Venkatasubramani N, Venkatesan T, Li BUK. Extreme Emesis: Cyclic Vomiting Syndrome. Practical Gastroenterology. September 2007. 31:21-34.</ref> | *Adult – Rome III criteria <ref>Venkatasubramani N, Venkatesan T, Li BUK. Extreme Emesis: Cyclic Vomiting Syndrome. Practical Gastroenterology. September 2007. 31:21-34.</ref> | ||
**Stereotypical episodes of [[vomiting]] with acute onset lasting less than 1 week. | **Stereotypical episodes of [[Special:MyLanguage/vomiting|vomiting]] with acute onset lasting less than 1 week. | ||
**At least 3 episodes per year. | **At least 3 episodes per year. | ||
**No nausea/vomiting between episodes. | **No nausea/vomiting between episodes. | ||
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*Nausea typically not relieved by vomiting | *Nausea typically not relieved by vomiting | ||
*+/- | *+/- | ||
**[[Abdominal pain]] | **[[Special:MyLanguage/Abdominal pain|Abdominal pain]] | ||
**[[Diarrhea]] | **[[Special:MyLanguage/Diarrhea|Diarrhea]] | ||
**[[Fever]] | **[[Special:MyLanguage/Fever|Fever]] | ||
**[[Headache]] | **[[Special:MyLanguage/Headache|Headache]] | ||
**[[Vertigo]] | **[[Special:MyLanguage/Vertigo|Vertigo]] | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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{{Nausea and vomiting DDX}} | {{Nausea and vomiting DDX}} | ||
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==Evaluation== | ==Evaluation== | ||
*Clinical diagnosis of exclusion | *Clinical diagnosis of exclusion | ||
*Evaluate for alternate etiologies | *Evaluate for alternate etiologies | ||
*Assess for [[dehydration]], [[electrolyte abnormalities]] if clinically warranted | *Assess for [[Special:MyLanguage/dehydration|dehydration]], [[Special:MyLanguage/electrolyte abnormalities|electrolyte abnormalities]] if clinically warranted | ||
==Management== | ==Management== | ||
*Avoid triggers | *Avoid triggers | ||
**Many patients have known triggers, such as diet, psychological stressors, sleep deprivation, cannabis, or infection. | **Many patients have known triggers, such as diet, psychological stressors, sleep deprivation, cannabis, or infection. | ||
*May be on medications typically used for migraine prophylaxis | *May be on medications typically used for migraine prophylaxis | ||
*Abortive [[antiemetics]] therapy | *Abortive [[Special:MyLanguage/antiemetics|antiemetics]] therapy | ||
**[[Ondansetron]]- works better with [[benzos]] or [[diphenhydramine]] | **[[Special:MyLanguage/Ondansetron|Ondansetron]]- works better with [[Special:MyLanguage/benzos|benzos]] or [[Special:MyLanguage/diphenhydramine|diphenhydramine]] | ||
**[[Promethazine]], [[prochlorperazine]] | **[[Special:MyLanguage/Promethazine|Promethazine]], [[Special:MyLanguage/prochlorperazine|prochlorperazine]] | ||
**Triptans (e.g. [[sumatriptan]]) | **Triptans (e.g. [[Special:MyLanguage/sumatriptan|sumatriptan]]) | ||
*Supportive therapy | *Supportive therapy | ||
**[[IVF]] with [[dextrose]] | **[[Special:MyLanguage/IVF|IVF]] with [[Special:MyLanguage/dextrose|dextrose]] | ||
**Place in quiet, dark room +/- sedative | **Place in quiet, dark room +/- sedative | ||
==Disposition== | ==Disposition== | ||
*If symptoms can be controlled, may discharge | *If symptoms can be controlled, may discharge | ||
*For intractable vomiting unable to be controlled with medications, admit | *For intractable vomiting unable to be controlled with medications, admit | ||
==See Also== | ==See Also== | ||
*[[Cannabinoid hyperemesis syndrome]] | |||
*[[Special:MyLanguage/Cannabinoid hyperemesis syndrome|Cannabinoid hyperemesis syndrome]] | |||
==External Links== | ==External Links== | ||
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==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:GI]] | [[Category:GI]] | ||
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Revision as of 21:59, 4 January 2026
Background
- Recurrent episodes of vomiting, otherwise normal health in between
- 32% of patients disabled by illness by time of diagnosis[1]
- Pathophysiology not well understood
- Average age at onset ~21yo
- Females slightly more affected than males
- Marijuana use is risk factor
Clinical Features
- Pediatric diagnostic criteria[2]
- At least 5 episodes or minimum of 3 over 6 mo
- Nausea/vomitingepisodes lasting 1hr-10d, with 1 week in between
- Stereotypical pattern and symptoms
- Return to baseline health in between
- Symptoms not due to another condition
- Adult – Rome III criteria [3]
- Stereotypical episodes of vomiting with acute onset lasting less than 1 week.
- At least 3 episodes per year.
- No nausea/vomiting between episodes.
- Symptoms not due to another cause
- Symptoms usually begin in early morning or upon waking
- Prodrome of nausea--> vomiting
- Episodes peak/decline over ~8h
- Nausea typically not relieved by vomiting
- +/-
Differential Diagnosis
Nausea and vomiting
Critical
Emergent
- Acute radiation syndrome
- Acute gastric dilation
- Adrenal insufficiency
- Appendicitis
- Bowel obstruction/ileus
- Carbon monoxide poisoning
- Cholecystitis
- CNS tumor
- Electrolyte abnormalities
- Elevated ICP
- Gastric outlet obstruction, gastric volvulus
- Hyperemesis gravidarum
- Medication related
- Pancreatitis
- Peritonitis
- Ruptured viscus
- Testicular torsion/ovarian torsion
Nonemergent
- Acute gastroenteritis
- Biliary colic
- Cannabinoid hyperemesis syndrome
- Chemotherapy
- Cyclic vomiting syndrome
- ETOH
- Gastritis
- Gastroenteritis
- Gastroparesis
- Hepatitis
- Labyrinthitis
- Migraine
- Medication related
- Motion sickness
- Narcotic withdrawal
- Thyroid
- Pregnancy
- Peptic ulcer disease
- Renal colic
- UTI
Evaluation
- Clinical diagnosis of exclusion
- Evaluate for alternate etiologies
- Assess for dehydration, electrolyte abnormalities if clinically warranted
Management
- Avoid triggers
- Many patients have known triggers, such as diet, psychological stressors, sleep deprivation, cannabis, or infection.
- May be on medications typically used for migraine prophylaxis
- Abortive antiemetics therapy
- Ondansetron- works better with benzos or diphenhydramine
- Promethazine, prochlorperazine
- Triptans (e.g. sumatriptan)
- Supportive therapy
Disposition
- If symptoms can be controlled, may discharge
- For intractable vomiting unable to be controlled with medications, admit
See Also
External Links
References
- ↑ Fleisher DR, Gornowicz B, Adams K, Burch R, Feldman EJ. Cyclic Vomiting Syndrome in 41 adults: the illness, the patients, and problems of management. BMC Med. 2005 Dec 21. 3:20.
- ↑ Li BU, Lefevre F, Chelimsky GG, et al. North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition consensus statement on the diagnosis and management of cyclic vomiting syndrome. J Pediatr Gastroenterol Nutr. 2008 Sep. 47(3):379-93.
- ↑ Venkatasubramani N, Venkatesan T, Li BUK. Extreme Emesis: Cyclic Vomiting Syndrome. Practical Gastroenterology. September 2007. 31:21-34.