Cyclic vomiting syndrome (CVS) is a condition characterized by recurrent, stereotypical bouts of intense vomiting interspersed with periods of completely normal health. The average child with CVS starts bouts of cyclic vomiting at 5.2 years of age and has been affected for 2.6 years before diagnosis. Females and males are equally affected (55:45).
The vomiting is invariably accompanied by what has been described as the most intense kind of nausea a human can experience. The typical child vomits 6 times per hour at the peak with an average of 25 bouts of vomiting (emesis) per episode. Affected children characteristically appear almost motionless during episodes, refusing to swallow saliva for fear of inducing vomiting. Others compulsively drink water, possibly to reduce the upper abdominal (epigastric) pain due to the continual emesis of acid content from the stomach. This is often followed by a period of exhausted sleep.
Once awake, the child is eager to eat. Attacks tend to be stereotypical, in that 98% of children experience the same progression and character of attack with each episode. Symptoms include abnormal drowsiness, or lethargy (91%); paleness, or pallor (87%); abdominal pain (80%); headache (40%); diarrhea (36%); and occasionally fever (29%).
Treatment of CVS begins with identification of the condition and making the distinction between chronic vomiting and cyclic vomiting syndrome. Underlying conditions such as gastroesophageal reflux disease (GERD) and sinus infection (sinusitis) should be sought and treated in these patients.
Not every child requires every medical test. However, certain warning signs may require urinalysis, upper GI endoscopy, abdominal ultrasound, brain CT or MRI, and metabolic blood tests.
Three levels of treatment include:
- Abortive treatment (to try to stop an attack after it starts),
- Rescue therapy (to keep the child as comfortable as possible if unable to stop an attack), and
- Prophylatic (steps to take to try to prevent future attacks)
Numerous medicines have been used to abort attacks. Rescue therapy is needed if it proves impossible to abort the attack. Most children will respond to these measures. For the rare patient with persistence of recurrent attacks, daily preventative (prophylactic) measures are indicated.
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