Cyclic Vomiting Syndrome: It’s As Terrible As It Sounds

Whether it was the latest stomach bug or a bout of food poisoning, most of us are unfortunate enough to have had at least one epic vomiting episode. And if you’re like me, you’re probably queasy just thinking about it. For most of us, vomiting lasts a day or two and might be followed by a few days of nausea, but then we move on with our lives.

For people with a disorder called cyclic vomiting syndrome (CVS), unpredictable episodes of severe vomiting can go on for days and recur at least multiple times a year, sometimes as often as several times a month. In 1882, Dr. Samuel Gee first noticed the syndrome in children 4 to 8 years old, and for years afterward it was thought to primarily affect children, but recent research shows that it may be just as common among adults.

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Since vomiting can have many causes, a diagnosis of CVS can be difficult, and patients often undergo invasive and ineffective treatments and diagnostic procedures before other causes are ruled out. In one study of 41 adults, 16 patients had surgery to try to cure their vomiting episodes, and it wasn’t effective in a single case. Patients can be bedridden for days, and the same study found that 32% of study participants were completely disabled and needed financial support.

Though the cause of cyclic vomiting syndrome is unknown, it’s thought to be related to migraines, and children who have a family history of migraines are at greater risk. Some children are even fortunate enough to find their vomiting episodes replaced by migraines after adolescence.

But the link between migraines in adults and CVS isn’t as strong, and the syndrome may become more common in adults with the increasing legalization of marijuana. Multiple studies have linked chronic marijuana use with CVS, and the symptoms are nearly identical to cannabinoid hyperemesis syndrome, a cyclical vomiting-type syndrome linked directly to marijuana use.

There are no specific blood tests or other procedures that can diagnose the disorder, so doctors are careful to review a patient’s medical history and symptoms before making a diagnosis. The criteria for diagnosis include episodes of severe vomiting (several times an hour) that last for less than one week, and there must be three or more separate episodes with no other known cause within the past year. Other less common symptoms include abdominal pain, diarrhea, dizziness, light sensitivity, and fever.

Usually people with CVS have no symptoms outside of these events, but it’s possible to have symptoms like nausea, abdominal pain, and limb pain show up between vomiting episodes.

There are no known risk factors apart from migraines and marijuana use, but the episodes can be triggered by everyday things like colds and allergies, menstruation, stress, certain foods, overeating, motion sickness, exhaustion, and hot weather.

For some people treatment is more effective than for others, but it usually includes avoiding triggers and taking either anti-nausea or migraine medications. Antidepressants and sedatives are also used in some treatment plans. About half of people with CVS also have anxiety, but it’s not clear whether anxiety is a potential cause of CVS or if it’s a natural result of living with the disorder.

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Though most patients return to full health in between episodes, there can be life-threatening complications associated with CVS. When vomiting is intense and goes on night and day for a period of 24 hours or more, severe hydration becomes a real risk. The signs of dehydration include excessive thirst, very little urine output, paleness, and listlessness. Cases of severe dehydration can be life-threatening and require hospitalization.

Other risks facing people with CVS include damage to the esophagus, including bleeding during severe episodes, and tooth decay from the acid in found in vomit.

Always consult your doctor if you have unexplained vomiting or nausea that is severe or doesn’t resolve on its own.