Cyclic Vomiting Syndrome: Causes, Symptoms, Treatment and Cost

Cyclic Vomiting Syndrome (CVS) is a rare medical condition in which the patient experiences recurrent episodes of severe vomiting without any identifiable cause or illness. This condition is most commonly seen in childhood, but can affect adults as well. It is estimated that 1 in 400 children have DVS.

• Classical cyclic vomiting syndrome (CVS): It is the most common form of CVS and typically involves recurrent episodes of severe vomiting that occur over a period of days or weeks, with no explanation for its sudden onset. Common symptoms include abdominal pain, migraines, fever, exhaustion, and dehydration.
• Abdominocystic cyclic vomiting syndrome: ACVS is a version of CVS in which most episodes occur after eating and involve abdominal pain instead of just nausea and vomiting as seen in classical CVS. It usually lasts longer than classical CVS, with episodes lasting several hours to days instead of weeks or months as with classical CVS.
• Post-infectious cyclic vomiting syndrome: (PICS) develops after an infection such as certain viral illnesses or food poisoning leading to excessive vomiting that can last up to two weeks at a time before subsiding completely for periods up to several months before the next episode begins again. This pattern can persist for years or decades unless treated appropriately.

• The exact cause of CVS is unknown, though it is believed to be influenced by both genetic and environmental factors. Possible contributing factors include stress, fatigue, changes in environment or food choices, sleep disturbances, hormonal imbalances and respiratory or gastrointestinal illnesses.
• In some cases of CVS, experts believe that the body’s basic ‘Flight or Fight’ response may be disrupted triggering intense episodes from seemingly minor triggers such as anxiety or emotional turmoil.

• Vomiting episodes that occur with similar frequency and intensity.
• Nausea
• Abdominal pain
• Headache or migraine.
• Decreased appetite or food avoidance.
• High temperature (fever) in some cases.
• Fatigue and exhaustion between episodes.

• Get enough sleep: Insufficient sleep may increase risk for CVS episodes.
• Eat regularly: Follow a regular meal plan and avoid skipping meals or fasting.
• Stay away from caffeine and drugs: Avoiding alcohol, nicotine, and drug use can reduce the risks of CVS episodes.
• Manage stress: Utilise stress-management techniques such as relaxation exercises, yoga or tai chi to reduce the stress levels in your life which will consequently have a positive effect on CVS symptoms.
• Know triggers: Identify any potential food or environmental triggers that may be causing episodes of vomiting and work to avoid these triggers when possible in order to reduce the frequency of episodes occurring
• Exercise regularly: Regular physical activity has been shown to help manage nausea and vomiting symptoms related to gastroenterological conditions such as Cyclic Vomiting Syndrome (CVS).

• Physical examination:To diagnose Cyclic Vomiting Syndrome, doctors will often perform a physical exam and review any medical history that the patient may have, which can include recurrent vomiting episodes, associated with abdominal pain and lack of appetite.
• Abdominal ultrasound scan:An abdominal ultrasound scan is a non-invasive imaging procedure that uses sound waves to create an image of the abdominal organs, including the pancreas, liver, gallbladder, and abdomen. By looking at these images, doctors can assess how certain organs are functioning and look for any abnormalities associated with cyclic vomiting syndrome.
• CT scan:CT scan is a diagnostic imaging test which can be used to help diagnose cyclic vomiting syndrome. It produces detailed images of the body and its organs, including the abdominal area. A CT scan can look for abnormalities in the digestive tract that may be potentially linked to cyclic vomiting syndrome, such as an obstruction or inflammation in the stomach or small intestines.
• Endoscopy:An endoscopy procedure may be needed to rule out serious ingestion problems such as inflammation, ulceration, intestinal blockage etc.
• EEG/EMG study:An electromyogram (EMG) may be used to detect abnormal muscle activity in the muscles of the throat that lead to vomiting due to neurological disorders such as spasm etc.
• Genetic testing/molecular analysis:To determine genetic causes behind cyclic vomiting syndrome molecular analysis may be taken up where an individual's genetic makeup is studied with regard to any specific mutation affecting their symptoms and treatment options.

• Gastrointestinal issues:Abdominal pain, dehydration, malnutrition, weight loss.
• Anxiety and depression:Emotional and psychological distress, difficulty functioning in social gatherings.
• Heart and lung problems:Increased risk of stroke or heart attack if untreated.
• Kidney damage:High levels of ketones in urine due to persistent vomiting leading to kidney damage and failure over time.

• Drink ginger tea made from fresh ginger root or powdered ginger.
• Take fennel seeds to improve digestion and reduce vomiting.
• Drink plenty of fluids to prevent dehydration.
• Take ayurvedic herbs like ashwagandha, shatavari and amalaki which improve digestion and reduce the duration of vomiting episodes in CVS patients.

• Consume small, frequent meals: Eating many smaller meals throughout the day may help prevent nausea and vomiting associated with CVS.
• Choose digestive-friendly snacks: Low fat, easily digested snacks like toast, crackers, rice cakes and nuts may help those with CVS feel better than greasy or spicy foods that are harder to digest.
• Eat bland foods: Opt for simple food items like bananas, applesauce and mashed potatoes instead of richer food items that can be harder to digest.
• Stay hydrated: Drinking plenty of fluids when experiencing nausea due to CVS is important; ginger tea or broth may also reduce some symptoms associated with the disease.

• Highly sugary and processed foods:Foods like candy, chips and snacks, white bread and white pasta should be avoided as they can trigger the symptoms of Cyclic Vomiting Syndrome (CVS).
• Caffeine:Caffeinated beverages such as coffee, energy drinks and soda should be avoided as they can stimulate the digestive system and cause an exacerbation of symptoms.
• Dairy products:Dairy products such as milk, cheese, ice cream and yoghurt can exacerbate CVS symptoms due to their high fat content which can aggravate nausea and vomiting sensations.
• Alcohol:Consuming alcohol can dehydrate the body and increase the frequency of vomiting episodes in people with CVS.
• Spicy foods:Foods with a high concentration of spices may contribute to worsening cyclic vomiting episodes due to their ability to irritate the stomach lining and trigger nausea or vomiting sensations.

• Medications:Treatment for CVS typically includes medications to relieve nausea and vomiting, reduce stomach acid, and correct electrolyte balance.
• Cognitive-behavioural therapy:Cognitive-behavioural therapy (CBT) is a form of psychotherapy that looks at how thoughts, beliefs, and behaviours can affect an individual's wellbeing. CBT can help people with CVS by addressing their worries and concerns, teaching them more helpful coping strategies, helping them manage stress, and identifying emotional triggers for their symptoms.
• Gastric Decompression:A tube is inserted in the stomach to reduce gastric pressure and divert the bile.
• Fundoplication:The upper portion of the stomach is wrapped around a device called a fundoplication, which tightens the lower esophageal sphincter muscle to prevent acid reflux.
• Pyloroplasty:A procedure in which muscles and tissue around the pylorus (the lower opening of the stomach) are cut or relaxed to allow food to pass more easily into the small intestine and reduce symptoms.
• Vagotomy:Incision in vagus nerve (responsible for sensation of nausea and vomiting) to decrease severity of symptoms
• Appendix Removal:Removal of appendix has been associated with decreased severity for some patients with Cyclic Vomiting Syndrome
• Gastrointestinal Reconstruction:Surgical reconstruction can increase functional activity of the gastrointestinal system, which may help reduce symptoms in some cases.

For Cyclic Vomiting Syndrome, it is best to consult a gastroenterologist or a paediatrician who specialises in digestive diseases.

• Antiemetics:Antiemetic drugs work by blocking certain receptors in the brain to help with nausea and vomiting. Examples include Metoclopramide, Prochlorperazine, Ondansetron, and Promethazine.
• Antispasmodics:These drugs act to relax the digestive system muscles, reduce acid production and inhibit nerve pathways of pain. Examples include Hyoscyamine, Dicyclomine and Scopolamine.Anti-nausea medication:This class of medications focus on reducing nausea associated with CVS by slowing gastric emptying. Examples include Ondansetron, Droperidol and Levomepromazine.
• Tricyclic antidepressants (TCAs):These medications can be used to manage the stress associated with CVS as well as provide partial relief of symptoms such as nausea, vomiting and abdominal pain due to their action on serotonin neurotransmitters in the brain. Examples include Nortriptyline, Amitriptyline and Desipramine.
• H2-receptor antagonists:These drugs work by inhibiting stomach acid production which can help reduce nausea associated with CVS .Examples include Ranitidine and Nizatidine .
• GABAergic agents:GABAergic agents increase the amount of a neurotransmitter called GABA which helps inhibit activities in the central nervous systems that can lead to nausea during CVS episodes. Examples include Valproate sodium , Gabapentin , Pregabalin.

The length of a person's recovery from Cyclic Vomiting Syndrome (CVS) depends on the underlying cause, treatment received and individual factors.

Generally, it can take several weeks to return to full health, with complete symptoms resolution in some cases taking up to 8 weeks or more.

The results of treatment for CVS are not necessarily permanent; rather they typically provide temporary relief from symptoms until the individual experiences a recurrence of their disorder. In some cases though, with long-term treatment and lifestyle changes, CVS may become less frequent or even cease entirely.

• Follow any dietary advice prescribed by the doctor, such as avoiding certain foods or eating small meals throughout the day.
• Avoid strenuous physical activity and take time to rest and heal.
• monitor and record relevant symptoms such as nausea, vomiting, appetite changes, or abdominal pain regularly for evaluation by a doctor.
• Drink plenty of fluids to stay hydrated and maintain electrolyte balance.
• Take all medications as prescribed to help limit symptoms; avoid skipping doses or taking medications in incorrect amounts or quantities.
• Seek medical attention promptly if any concerning new symptoms develop after surgery.

The costs depend on the severity and various other factors associated with the condition, such as the type of medications used. Generally, the average cost of medicine can range from Rs. 5000-25000 per month while therapy sessions cost around Rs 1000-2500 per hour.

• Common side-effects of Cyclic Vomiting Syndrome treatments include nausea, vomiting, abdominal pain, diarrhoea and constipation.
• In some cases, neurotoxic side-effects such as headache, dizziness, fatigue and confusion can occur.
• Mental health issues such as depression and anxiety may be exacerbated by medications used in treating Cyclic Vomiting Syndrome.
• Complications related to the digestive tract such as decreased appetite and weight loss can also occur with treatment of Cyclic Vomiting Syndrome.

If you are suffering from any complications relating to cyclic vomiting syndrome then you should consult a doctor nearby as they can cause complications like 'gastrointestinal issues, heart and lung problems, liver damage' in which treatment courses can range from a few months to years depending on the severity of the situation.