Cyclic Vomiting Syndrome

Cyclic vomiting syndrome (CVS) is a chronic functional disorder characterized by episodes of severe nausea and vomiting that alternate with prolonged symptom-free intervals.1 Symptoms are often triggered by social stress; episodes can occur after the loss of a loved one, job-related stress, during exams, and even on vacations.2 The etiology of CVS is not known, but several theories have been proposed, including genetic factors in children and marijuana use in adults. Patients also have many associated conditions, including a history of migraine and autonomic dysfunction and high rates of anxiety and depression. While CVS is generally not life threatening, it is associated with significant morbidity. Many patients are often misdiagnosed as having viral gastroenteritis, gastroparesis, or even psychogenic vomiting given the lack of awareness in the medical community.3 Approximately 20% of patients are subjected to surgical procedures such as cholecystectomies and appendectomies that fail to improve their symptoms. Affected adults also have multiple emergency department visits and hospitalizations for relief of symptoms, which poses a significant economic burden on limited health care resources.3 Prompt diagnosis, education about the disease, and treatment are essential and can reduce severity and frequency of episodes. This review on CVS will elucidate the epidemiology, historical perspective, clinical features, diagnosis, and available therapy in CVS and also provide a suggested algorithm for workup of recurrent vomiting.