Cyclic Vomiting Syndrome: A Disorder of All Ages

Address correspondence to: Dr. Bhanu Sunku Division of Pediatric Gastroenterology & Nutrition Floating Hospital for Children at Tufts Medical Center 800 Washington Street #213 Boston, MA 02111; Tel: 617-636-3266; Fax: 617-636-8718. Abstract: Initially described in children, cyclic vomiting syndrome (CVS) is an idiopathic disorder that affects patients of all ages and is characterized by recurrent episodes of vomiting separated by symptom-free intervals or baseline health. Frequent misdiagnoses and delays in diagnosis often lead to years of recurrent vomiting. Similarities in the clinical features and symptoms of children and adults with CVS are often linked to migraines. Association with mitochondrial disorders and neuroendocrine dysfunction have been described in the pediatric CVS literature, whereas migraines, anxiety, and panic are common in adults with CVS. Various psychological, infectious, and physical stressors commonly precipitate episodes of CVS. Treatment is mostly empiric, with few controlled therapeutic studies conducted thus far. Associations with migraines have aided in developing pharmacologic treatment strategies for prophylaxis as well as abortive therapy during episodes, including the use of triptans. Most children outgrow CVS with time, though some children transition to migraine headaches or continue to have CVS as adults. Improved recognition of CVS in adults, along with the emergence of data in the use of anticonvulsants and antiemetics, may help further delineate pathophysiologic connections and therapeutic options for this debilitating disorder.