Cyclic Vomiting Syndrome - Causes, Symptoms, Diagnosis, and Treatment

Introduction:

It is a severe functional disorder of the gastrointestinal tract that causes repeated episodes of severe nausea and vomiting. These episodes can last from a few hours to several days. There is always a period of no vomiting and nausea between the two episodes. It can more likely affect people suffering from migraines or the consumption of long-term marijuana. It can be cured by consuming prescribed medicines and treating the health problems that trigger the episodes. The cyclic vomiting syndrome can be classified into four phases: prodrome, vomiting, recovery, and well.

What Are the Causes of Cyclic Vomiting Syndrome?

The causes of cyclic vomiting syndrome are unknown. However, some experts state that the following conditions may play a role in the predisposition to the disorder.

• Problems in nerve signals between the brain and digestive tract. Some neurotransmission alterations can cause misinterpretation of signals from the brain to the digestive system leading to episodes of vomiting and nausea.

• Alterations in the endocrine system due to stress.

• Mutations of certain genes are associated with an increased chance of getting cyclic vomiting syndrome.

What Are the Trigger Factors for Cyclic Vomiting Syndrome?

• Anxiety and panic attacks in adults.

• Cold, flu, or chronic sinusitis. Chronic sinusitis is inflammation of the maxillary sinus.

• Insomnia: lack of proper sleep.

• Allergies: some food items like chocolate or cheese can trigger allergic reactions leading to cyclic vomiting syndrome.

• When the temperature is extreme- either hot or cold.

• Consumption of alcohol.

• Duration of long fastings (without eating anything).

• Emotional stress or extreme excitement in children.

• Menstruation period.

What Could Be Symptoms of Cyclic Vomiting Syndrome?

The symptoms of cyclic vomiting syndrome vary according to its different phases:

• Prodrome Phase: During this phase, the patient feels the upcoming episode. There is intense sweating, and nausea may be accompanied by abdominal pain. The skin may appear abnormally pale. This episode can last from minutes to several hours.

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• Vomiting Phase: The most important symptom of this phase is severe vomiting, nausea, and retching. At the peak of this phase, the vomiting rounds increase several times in an hour. After so much vomiting, the patient has the following signs:

  • Twisting and moaning because of intense pain in the abdomen.

  • Become quiet and dull or weak.

  • Unable to move or respond to people around.

  • Nausea and vomiting are present from a few hours to several days.

• The Recovery Phase: It begins when the vomiting stops, and the feeling of nausea is also reduced. The person feels better, and the recovery phase ends when the skin color, energy, and appetite come to normal.

• Well Phase: It happens between the episodes. No symptoms are noticed in this phase.

When to Seek Medical Help?

If there are symptoms of dehydration during the vomiting phase, the doctor should be immediately consulted. The signs and symptoms of dehydration in adults are:

• Less urination than usual.

• Dark-colored urine.

• Dry mouth and extreme thirst.

• Decreased skin turgor (if the skin is pinched and released, the skin does not flatten to normal immediately).

• Sunken eyes or cheeks.

• Weaken and fainting.

Symptoms in Infants:

• Thirst and dry mouth.

• Less urination, or no wet diapers for three hours or more.

• No tears in my eyes when crying.

• Cranky and tired behavior.

• Reduced skin turgor.

How to Diagnose Cyclic Vomiting Syndrome?

The diagnosis is based on family and medical history, physical examination, symptoms in adults and children, and a few medical tests.

• Family and Medical History: A history of some health problems such as migraines, gastroparesis, and irritable bowel syndrome are asked, as these can trigger cyclic vomiting syndrome. A proper history of consumption of marijuana, cigarettes, or any mental health problems is also taken.

• Physical Examination: It comprises an evaluation of the abdomen for unusual sounds, tenderness, or pain. Additionally, muscle strength, nerves, reflexes, and body balance are evaluated.

The Pattern of Symptoms in Children:

The following symptoms help to confirm cyclic vomiting syndrome in children.

• A minimum of five episodes should be there or at least three over six months.

• Episodes last from one hour to ten days and occur at least one week apart.

• Vomiting during episodes- at least four times in an hour.

• Episodes are separated into weeks to months, usually with no signs and symptoms in between.

• After appropriate medical investigation, symptoms cannot be related to another medical condition.

The Pattern of Symptoms in Adults:

• At least in the past six months, three or more different episodes in the past year or two episodes.

• The duration of episodes lasts for a minimum of a week.

• Episodes are similar to previous ones, which means the timing of the start, length of the episode, and pattern of the end is the same as the last episode.

• No metabolic, central nervous system, or structural disorders.

• Absence of nausea and vomiting between the episodes, but other mild symptoms could be present.

Medical Tests:

• Blood Tests: They help to evaluate the presence of anemia, inflammation, dehydration, or any other infection.

• Urine Tests: They can show signs of infection and kidney problems.

• Upper Gastrointestinal Endoscopy: To investigate the cause of nausea and vomiting.

• Gastric Emptying Test: It is performed in between periods. The patient is asked to eat a bland meal with a radioactive substance. An external camera helps scan the abdomen to locate the position of radioactive material. It helps measure the speed at which the stomach empties after the meal.

• Computed Tomography and MRI (Magnetic Resonance Imaging): They can be done if any mental health condition is expected.

What Is the Treatment of Cyclic Vomiting Syndrome?

Prodrome Phase: Taking medications in the procedure's early phase can sometimes help stop an episode.

The following medications can be prescribed:

• Ondansetron or promethazine for nausea.

• Lorazepam for anxiety.

• Ibuprofen for pain.

• Sumatriptan for migraines.

• Ranitidine and Omeprazole for acid regulation of the stomach.

Vomiting Phase: In this phase, the patient should try to stay in bed and sleep in a dark room. Medications for nausea, migraines, pain, and anxiety should be prescribed. If the symptoms get worse, especially dehydration, an immediate visit to the doctor or hospital is advised.

Treatment in Hospital Are:

• Intravenous fluids for dehydration.

• Intravenous nutrition if the episode is long.

• Medicine for other symptoms.

Recovery Phase: In some cases of severe cyclic vomiting syndrome, intravenous fluids can be continued in this phase as well. It is recommended to drink enough fluids. The liquids should be rich in glucose and electrolytes, such as fruit drinks, oral rehydration solutions, and sports drinks.

Well Phase: In this phase, medicines are prescribed to prevent episodes of cyclic vomiting syndrome, depending on its severity.

• Amitriptyline.

• Zonisamide.

• Propranolol.

What Are the Complications Due to Cyclic Vomiting Syndrome?

• Tooth Decay: Dry mouth can lead to damage to tooth enamel, hence causing tooth decay. Fluoride toothpaste, mouth rinse, and dental fillings can prevent decay.

• Esophagitis: Inflammation of the esophagus. It can be managed by reducing the amount of acid in the stomach.

• Mallory-Weiss Tear: Tears generally heal independently; however, medicines and medical procedures are performed if they do not stop bleeding.

• Dehydration: Plenty of water and liquids with glucose and electrolytes are advised.

Conclusion:

Cyclic vomiting syndrome is characterized by multiple episodes of continuous vomiting and nausea. This episode may last from a few hours to several days, with intervals in between. The cause is unknown, but some trigger factors are known to initiate or worsen the condition. Frequent episodes of cyclic vomiting syndrome can lead to severe dehydration. According to doctors and management, proper medications can prevent the disease from worsening and control the symptoms.