Cyclical (cyclic) vomiting syndrome (CVS)

• since its initial description by Samuel Gee more than a century ago, cyclic vomiting syndrome (CVS) has remained an enigma to clinicians (1)
  • Gee used the following description, 'These cases seem to be all of the same kind, their characteristic being fits of vomiting, which recur after intervals of uncertain length. The intervals themselves are free from sign of disease.'(1)
• CVS is characterised by recurrent, explosive bouts of vomiting causing time lost from school and work.
  • attacks of vomiting are interspersed with normal periods
  • duration of vomiting episodes is from hours to days, with spontaneous resolution if left untreated
  • the episodic occurrence of emesis may be precipitated by fatigue and stress
  • the attacks begin in childhood and often wane in frequency with progression into young and middle adult life
• the aetiology of CVS is unknown
  • some evidence of clinical and physiological overlap between CVS and migraine headaches
    • patients with CVS subsequently may develop migraine and may show a positive response to antimigraine medication
    • other aetiologic possibilities include ion channelopathies, mitochondrial DNA mutations and excessive endocrine dysfunction
• CVS has as yet no established diagnostic biochemical, radiological, electroencephalographic, or anatomical markers, either during or between attacks (2)
• management involves a responsive, collaborative doctor-patient relationship, sensitivity to stresses caused by the illness and to feelings and attitudes that may predispose to attacks, use of antiemetic agents to abort or shorten attacks, treatment of complications, and use of prophylactic agents in patients whose episodes are of sufficient frequency and severity to warrant their trial

Reference:

1. Gee S On fitful or recurrent vomiting. St Bartholomew's Hosp. Rep. 1882; 18: 1 6
2. Fleisher DR & Matar M The cyclic vomiting syndrome: A report of 71 cases and literature review. J. Pediatr. Gastroenterol. Nutr. 1993; 17: 361 9
3. Li BU, Murray RD, Heitlinger LA, Robbins JL, Hayes JR. Is cyclic vomiting syndrome related to migraine? J Pediatr. 1999;134: 567-572.