Cyclic Vomiting Syndrome causes severe vomiting episodes with breaks in between periods of wellness. It is first discovered in children by Samuel Gee in 1882. 

It is a GI disorder causes intense nausea and vomiting episodes lasting hours to days. Diagnosed in children and adults but more common in children. 

Triggers includes stress, infections, foods, sleep deprivation, and menstrual cycles. Main symptoms are recurrent, stereotypical episodes of severe vomiting, and nausea. 

Duration of episodes last between a few hours to a few days. Patients noticed symptom-free between episodes. 

CVS incidence and prevalence in the US are unknown, with an estimated 2% prevalence in children/adults. 

Cullen and MacDonald estimated periodic vomiting prevalence in western Australia at 2.3%. 

White-derived figures may not accurately represent prevalence in all races or ethnic populations.  

The median age of onset for CVS is 4.8 years, with cases seen in infants to 73-year-olds. 

Study shows CVS patients have higher migraine prevalence in family suggests genetic link. 

28% of CVS patients vomiting resolves develop migraines, while 80% with familial migraine history responded to treatment. 

Mutations in mtDNA are linked to CVS pathogenesis. 86% of children with CVS and neuromuscular disease had migraines. 

In children, high frequency mtDNA polymorphisms may indicate increased susceptibility to the disease. 

Genetic factors are: 

Familial Links 

Mitochondrial Dysfunction 

Neurological factors are: 

Migraine Association:  

Autonomic Nervous System Dysfunction 

Psychological factors are: 

Stress and Anxiety 

Gastrointestinal factors are: 

Gastric Dysrhythmias 

Gut-Brain Axis 

CVS lasts 2.5 to 5.5 years, that resolves in late childhood or early adolescence but can persist into adulthood. Correlations found between attack duration and hormone levels in study. 

Frequent and severe episodes raise risk of dehydration, malnutrition, hospitalization, and negative prognosis impact. 

Patients with infrequent and mild episodes have better outlook and easier management with proper treatment. 

The clinical history of CVS is crucial for its diagnosis and management. It involves detailed information of the patient’s symptoms, frequency, duration of episodes, and potential triggers. 

• Neurological Examination 
• Abdominal Examination 

• Clinical symptoms during an episode are: 
• Vomiting/Nausea 
• Abdominal Pain 
• Dehydration and Electrolyte Imbalance 
• Pallor and Fatigue 

If psychological stressors trigger episodes, stress management techniques or benzodiazepine anxiolytics may help to abort attacks in the early stages.  

Detailed diary tracks vomiting frequency, pre-meal consumption, and life events to help identify and avoid triggers. 

Pharmacologic therapy prevents and treats vomiting episodes to reduce frequency and severity. 

Medication should take daily to prevent frequent or severe migraine episodes effectively. 

Family history of migraines indicates high response rate to antimigraine medications as first choice. 

Pediatrics, General

Balanced diet should be preferred such as fruits, vegetables, whole grains, and lean proteins. 

Regular physical activity/exercise to improve overall well-being and reduce stress. 

Regular sleep schedule with consistent bedtimes should be maintained. 

Ensure a quiet, dark, and comfortable sleeping environment. 

Proper awareness about CVS should be provided and its related causes with management strategies. 

Appointments with a pediatrician and preventing recurrence of disorder is an ongoing life-long effort. 

Ondansetron: 

It directly acts at the CTZ and vagal afferents from the gastrointestinal tract. 

Prochlorperazine: 

It blocks postsynaptic mesolimbic dopamine receptors through its anticholinergic effects. 

Pediatrics, General

Cyproheptadine: 

It is a nonselective antihistamine that acts as appetite stimulant.  

Diphenhydramine: 

Their antinausea and antiemetic actions synergistic with 5-HT3 antagonists. 

Pediatrics, General

Amitriptyline: 

Due to their anticholinergic and sedating side effects it should be taken during bedtime. 

Pediatrics, General

Propranolol: 

It reduces the frequency and severity of episodes due to their CNS penetration. 

Pediatrics, General

Topiramate: 

It blocks glutamate activity to help reduce the frequency and severity of episodes. 

Levetiracetam: 

It initiates GABAergic inhibitory transmission through displacement of negative modulators. 

Pediatrics, General

Erythromycin: 

It is a gastric prokinetic that stimulates coordinated gastric emptying.  

Sumatriptan: 

It effectively terminates an episode of CVS to constrict the cerebral vasculature.  

Pediatrics, General

Lorazepam: 

It induces sedation and anxiolysis through central inhibition of gamma-aminobutyric acid.  

Pediatrics, General

Gastrostomy tube placement is performed in patients with severe and frequent episodes that cause significant malnutrition and weight loss. 

Placement of a nasogastric tube is suggested for temporary relief from vomiting to provide nutrition. 

Pediatrics, General

In the initial assessment phase, evaluation of medical history, physical examination and laboratory test to confirm diagnosis. 

Pharmacologic therapy is effective in the treatment phase as it includes use of antiemetic, antihistamine, antibiotic and anxiolytic agents. 

In supportive care and management phase, patients should receive required attention such as lifestyle modification and intervention therapies. 

The regular follow-up visits with the pediatrician are scheduled to check the improvement of patients along with treatment response.