Did you know that about 3 out of every 100,000 kids have Cyclic Vomiting Syndrome (CVS)? This condition, which usually starts between 3 and 7 years old, can cause dehydration and is often misdiagnosed by doctors. Let's learn more about cyclic vomiting syndrome and its symptoms.
What is Cyclic Vomiting Syndrome (CVS)?
Cyclic vomiting syndrome, or CVS, is a functional disorder of the digestive system that causes sudden, repeated, and severe episodes of feeling sick and vomiting. It has a particular pattern of symptoms, with no symptoms in between episodes, and is caused by a miscommunication between the brain and gastrointestinal tract.
Who Is Most At Risk For Developing This Illness?
- Cyclic vomiting syndrome (CVS) is most common in children between the ages of 3 and 7 years old.
- There is a peak incidence of CVS around age 5 in children.
- CVS affects approximately 60% of women and 70% to 80% of people with a history of migraines.
What Can Cause A CVS Episode?
- Emotional triggers such as anxiety or panic attacks
- Physical exhaustion
- Prolonged fasting
- Respiratory infections or flu
- Menstrual periods
- Motion sickness
- Reactions to certain foods such as chocolate, paneer, caffeine, or MSG (monosodium glutamate)
- Seasonal changes, with symptoms more common in fall and winter
How Is Cyclic Vomiting Syndrome (CVS) Caused?
- The cause of CVS is not fully known, but mitochondrial dysfunction may play a role
- Changes in mitochondrial DNA can occur due to illness, genetic conditions, certain drugs, or exposure to toxins
- CVS may be more common in those with a family history of migraines
- Brain, spinal cord, or nervous system problems controlling GI tract responses, autonomic nervous system changes, hormone imbalances, and migraines may also contribute to CVS.
Signs And Symptoms Of Cyclic Vomiting Syndrome
Some symptoms of CVS include-
- A low-level fever (up to 101 degrees Fahrenheit)
- Extremely thirsty
- Heaving or gagging
- Lack of hunger
- Light sensitivity
- Pain in the stomach
- pale skin
- Refusing to speak
- Severe fatigue
- Severe headaches
- Severe nausea, retching, and vomiting
- Spitting up or drooling
Complications of CVS
- Dehydration results from not replacing fluids lost from vomiting and diarrhea.
- Esophagitis is an inflammation of the esophagus (the tube that connects the mouth to the stomach) caused by repeated exposure to highly acidic vomit.
- A Mallory-Weiss tear is a tear in the lower end of the esophagus that is caused by the muscular contractions of severe vomiting.
Diagnosis Of Cyclic Vomiting Syndrome
CVS diagnosis is based on symptoms, medical history, and physical examination.
- Medical tests are conducted to rule out other potential causes of vomiting and gastrointestinal symptoms.
- Detailed description of vomiting episodes including frequency, duration, and timing is crucial for diagnosis.
- Rome criteria specifies at least 3 separate episodes of vomiting in a 6-month period for CVS diagnosis.
- A medication trial may be used to help confirm the CVS diagnosis by reducing the frequency/severity of vomiting episodes.
Treatment of CVS
- Anti-migraine and anti-vomiting medications may be prescribed as preventative measures.
- IV hydration and sedation may be administered during an episode in the ER or hospital.
Follow-up after Treatment
- The child's doctor will monitor symptoms and adjust treatment as needed.
Prevention of CVS
- Identify and avoid specific triggers such as illness, stress, exhaustion, or certain foods.
- Cognitive behavior therapy (CBT) may benefit children with CVS who also have an anxiety disorder.
- Address allergies and congestion promptly.
- Get enough sleep, reduce anxiety and stress, and use medications as prescribed.
Severity of CVS
- Most children will outgrow CVS around puberty, but about 75% will develop migraines later in life.
When to Consult a Doctor
- Consider CVS in children with recurrent vomiting that starts with severe vomiting, lasts less than a week, occurs several times an hour, and there is no vomiting or nausea between episodes.
- Vomiting three or more times in the previous six months, for a total of five times, should also prompt consultation with a pediatrician.
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