Cyclic vomiting syndrome: epidemiology, clinical features, diagnostics and treatment

Evelina Stankevičiūtė1

1Faculty of Medicine, Lithuanian University of Health Sciences


Cyclic vomiting syndrome (CVS) is a chronic functional gastrointestinal disorder of unknown etiology. It is characterized by acute recurrent episodes of severe nausea and vomiting lasting 1–7 days. Discrete episodes occur at least one week apart. Between attacks patients’ health returns to the baseline. Episodes are stereotypical and might have a predictable periodicity. CVS is often provoked by physical and psychological triggers. Syndrome is associated with various comorbidities. Some of the most prominent ones are psychiatric disorders such as anxiety and depression. CVS syndrome is more common than previously thought and it affects both children and adults. Females are more often affected than males. CVS is of unclear etiology, however, it might have similar pathophysiology as migraine since they share many common features. CVS for children is likely to resolve in adolescence, however, patients are likely to develop migraine later in life. Furthermore, patients often report personal and family history of migraine. Cyclic vomiting syndrome is not well recognized. Despite repeated emergency department visits, patients are often misdiagnosed, undergo unnecessary diagnostic and surgical interventions and significant delays in correct diagnosis. CVS is diagnosed using Rome IV criteria. It is necessary to rule out any possible organic cause of vomiting. Detailed examination is needed in patients who present with alarm symptoms. Treatment goals in CVS are to decrease frequency and severity of attacks. There are four phases of CVS: the prodromal phase, the vomiting phase, the recovery phase and the inter-episodic or asymptomatic phase. The goals of treatment depend on the phase. Treatment includes prophylactic therapy, abortive therapy and supportive care. First-line prophylactic agents are tricyclic antidepressants (amitriptyline). Prophylaxis is used for the prevention of vomiting episodes for patients with moderate/severe cyclic vomiting syndrome. An abortive therapy is used during the prodromal phase to terminate the attack. Ondansetron and/or triptans (sumatriptan) or NK1 receptor antagonist aprepitant is used for this purpose. Cyclic vomiting syndrome is a disabling condition that negatively impacts patients’ quality of life. Care for patients could be improved by increased recognition of cyclic vomiting syndrome. Keywords: cyclic vomiting syndrome, functional nausea and vomiting disorder.