The following is a summary of “Diagnosis and Management of Cyclic Vomiting Syndrome: A Critical Review,” published in the July 2023 issue of Gastroenterology by Frazier, et al.
Cyclic vomiting syndrome (CVS) is a chronic disorder characterized by recurring episodes of severe nausea, vomiting, and abdominal pain. It affects children and adults, with an estimated prevalence of around 2% in the United States. CVS is more commonly observed in females and occurs in individuals of all races. The exact underlying mechanisms of CVS were unknown, but it was believed to involve a combination of genetic, environmental, autonomic, and neurohormonal factors. A close association between CVS and migraine headaches suggests a shared pathophysiology.
The diagnosis of CVS is based on the Rome criteria, and minimal recommended testing includes an upper endoscopy and abdominal imaging studies. Anxiety, depression, and autonomic dysfunction are frequently associated with CVS. Many patients with CVS use cannabis for therapeutic purposes to alleviate symptoms. However, chronic heavy cannabis use can lead to a distinct condition known as cannabinoid hyperemesis syndrome, a subset of CVS characterized by persistent vomiting.
Due to the challenging nature of the illness, patients with CVS often seek emergency department care and require hospitalization during acute flares. Management guidelines for CVS emphasize a comprehensive biopsychosocial approach. Prophylactic treatment options include tricyclic antidepressants (like amitriptyline), antiepileptic drugs (like topiramate), and aprepitant for refractory cases. Abortive therapy involves using triptans, antiemetics (such as ondansetron), and sedatives. Treating any comorbid conditions is crucial for improving overall patient outcomes.
CVS significantly impacts the lives of patients, their families, and the healthcare system. Further research was needed to understand the underlying mechanisms of the syndrome better and develop targeted therapies to alleviate its symptoms.