Cyclic vomiting syndrome

Description

Cyclic vomiting syndrome is characterized by episodes of severe vomiting that have no apparent cause. The episodes can last for hours or days and alternate with symptom-free periods. The episodes are similar, meaning that they tend to start at the same time of day, last the same period of time, and occur with the same symptoms and intensity.

Cyclic vomiting syndrome occurs in all age groups, though it often begins in children 3 to 7 years of age. Although it is more common in children, the number of diagnosed cases in adults is increasing.

The syndrome is difficult to diagnose due to the vomiting is a symptom of many disorders. The treatment often involves lifestyle changes to help prevent the events that can trigger episodes of vomiting. Medications, including anti-nausea, and migraine therapies, may help to lessen the symptoms.

Symptoms

The symptoms of the syndrome of cyclic vomiting often begin in the morning. Signs and symptoms include:

  • Three or more recurrent episodes of vomiting, which started around the same time and finally, for a similar period of time
  • Variable intervals of normal health without nausea between episodes
  • Intense nausea and sweating before an episode starts

Other signs and symptoms during an episode of vomiting may include:

  • Abdominal Pain
  • Diarrhea
  • Dizziness
  • Sensitivity to light
  • Headache
  • Nausea or nausea

When to see a doctor

Call your doctor if you see blood in your or your child vomits.

Continued vomiting may cause severe dehydration that can be fatal. Call your doctor if you or your child has symptoms of dehydration, such as:

  • Excessive thirst and dry mouth
  • Less urination
  • Dry skin
  • Sunken eyes or cheeks
  • Absence of tears when crying
  • The fatigue and apathy

Causes

The underlying cause of cyclic vomiting syndrome is unknown. Some of the possible causes include genes, digestive difficulties, problems of the nervous system and hormonal imbalances. Specific attacks of vomiting can be caused by:

  • Colds, allergies or sinus problems
  • Emotional stress or excitement, especially in children
  • Anxiety or panic attacks, especially in adults
  • Certain foods and drinks, such as alcohol, caffeine, chocolate, or cheese.
  • Eating too much, eating just before you go to bed or fast
  • Hot weather
  • The physical exhaustion
  • The exercise too
  • Menstruation
  • Motion sickness

The identification of the triggers of episodes of vomiting can help with the management of cyclic vomiting syndrome.

Risk factors

The relationship between migraine and cyclic vomiting syndrome is not clear. But many children with cyclic vomiting syndrome have a family history of migraine headaches or migraines themselves when they get older. In adults, cyclic vomiting syndrome is also associated with a personal or family history of migraine.

The chronic use of marijuana (Cannabis sativa) has also been associated with the syndrome of cyclic vomiting due to which some people use marijuana to relieve your nausea. However, the use of marijuana can lead to a condition called cannabis hyperemesis syndrome, which usually leads to the persistence of vomiting without normal intervening periods. People with this syndrome often demonstrate frequent showering or bathing behavior.

Cannabis hyperemesis syndrome can be confused with cyclic vomiting syndrome. To discard cannabis hyperemesis syndrome, you need to stop the use of marijuana for at least one to two weeks to see if the vomiting is decreased. If not, your doctor will continue with the tests for cyclic vomiting syndrome.

Complications

Cyclic vomiting syndrome can cause these complications:

  • The dehydration. Excessive vomiting causes the body to lose water quickly. Severe cases of dehydration may need to be treated in the hospital.
  • Injury in the feed tube. The acid from the stomach comes up with the vomit can damage the tube that connects your mouth and stomach (esophagus). Sometimes, the esophagus becomes so irritated that bleeds.
  • Dental caries. The acid in the vomit can erode the enamel of the teeth.

Prevention

Many people know what it is that triggers your cyclic vomiting episodes. Avoiding triggers can reduce the frequency of episodes. While you may feel well between episodes, it is very important to take medications as prescribed by your doctor.

If the episodes occur more than once a month, or that require a hospital stay, your doctor may recommend preventive medicine, such as amitriptyline, propranolol (Inderal), cyproheptadine and topiramate.

Lifestyle changes can also help, including:

  • Get enough sleep
  • For children, minimizing the importance of the upcoming events, as that emotion can be a trigger
  • Avoid trigger foods, such as alcohol, caffeine, cheese and chocolate
  • Eat small meals and snacks low in fat daily on regular schedules

Cyclic vomiting syndrome

Diagnosis

Cyclic vomiting syndrome can be difficult to diagnose. There is no specific test to confirm the diagnosis, and vomiting is a sign of many conditions that must be ruled out in the first place.

The doctor will start by asking about your child or your medical history and perform a physical exam. The doctor will also want to know about the pattern of the symptoms you or your child experiences.

After that, your doctor may recommend:

  • Imaging studies — such as endoscopy, ultrasound, or computed tomography scan (CT scan) — to check if there are obstructions in the digestive system, or symptoms of other digestive conditions
  • Motility tests to monitor the movement of food through the digestive system, and to control digestive disorders
  • The lab tests to check for thyroid problems and other metabolic diseases

Treatment

There is No cure for the syndrome of cyclic vomiting, despite the fact that many children do not have episodes of vomiting in the time that they reach adulthood. For those who experience an episode of cyclic vomiting, treatment focuses on controlling the signs and symptoms.

You or your child may be prescribed:

  • Anti-nausea drugs
  • Medications to ease the pain
  • Medications that suppress stomach acid
  • Antidepressants
  • Anti-seizure medications

The same types of medications used for migraines can sometimes help to stop or even prevent the episodes of cyclic vomiting. These medicines may be recommended for people whose episodes are frequent and of long duration, or for people with a family history of migraine.

intravenous (IV) fluids may be needed to prevent dehydration. The treatment is individualized based on the severity and duration of symptoms, as well as the presence of complications.

Self-care

Lifestyle changes can help control the signs and symptoms of the syndrome of cyclic vomiting. People with cyclic vomiting syndrome usually need to get a proper sleep. Once you begin to vomit, can help you to stay in bed and sleep in a dark, quiet room.

When the vomiting phase has stopped, it is very important to drink liquids, such as an oral electrolyte solution (Pedialyte) or a sports drink (Gatorade, Powerade, others) diluted with 1 ounce of water for every ounce of sports drink.

Some people may feel well enough to begin eating a normal diet after you stop the vomiting. But if not, or your child does not feel like eating right away, you can begin with clear liquids and then gradually add solid foods.

If the episodes of vomiting are caused by stress or emotion, try it for a symptom-free interval of finding ways to reduce stress and keep calm. Eat small meals and low-fat snacks daily instead of three large meals, can also help.

Alternative medicine

Alternative and complementary treatments can help prevent episodes of vomiting, although none of these treatments has been well studied. These treatments include:

  • Coenzyme Q10 (ubiquinone) , which is a natural substance in the body that is available as a supplement. Coenzyme Q10 helps with the basic functions of the cells.
  • L-carnitine , a natural substance that is produced in the body and is available as a supplement. L-carnitine helps the body convert fat into energy.
  • Riboflavin (vitamin B-2) , a vitamin that is found in some foods and is available as a supplement. Riboflavin plays a role in the body's mitochondrial processes.

Coenzyme Q10, L-carnitine and riboflavin may work by helping your body to overcome the difficulty in the conversion of food into energy (mitochondrial dysfunction). Some researchers believe that mitochondrial dysfunction may be a causative factor for both cyclic vomiting syndrome and migraine.

Be sure to consult a doctor and the diagnosis of syndrome of cyclic vomiting confirmed before starting any supplement. Always consult with your doctor before taking any supplement to be sure that you or your child is taking a safe dose, and that the supplement does not negatively interact with any medications you are taking. Some people may experience side effects of coenzyme Q10 and L-carnitine, including diarrhea and fish smell in the body.

Coping and support

Because you never know when the next episode could occur, cyclic vomiting syndrome can be difficult for the whole family. Children can be especially worrisome, and you can worry constantly that you will be with other children when an episode happens.

You or your child can benefit from your connection with other people who understand what it's like to live with the uncertainty that the syndrome of cyclic vomiting. Ask your doctor about support groups in your area.

Preparing for your appointment

It is likely to start by seeing your primary care doctor or your child's pediatrician. But you may be referred immediately to a specialist in diseases of the digestive system (gastroenterologist). If you or your child is in the middle of a severe vomiting episode, the doctor may recommend immediate medical attention.

Here's some information to help you prepare for your appointment and know what to expect from your doctor.

What you can do

  • Keep a record of symptoms, including the frequency of vomiting, and any typical triggers you may have noticed, such as the power supply or the activity.
  • Make a note of the key medical information, including other conditions diagnosed.
  • Write down key personal information, including dietary habits and any major stresses or recent changes — positive and negative — in your child's life or yours.
  • Bring a list of all medications, vitamins or supplements that you or your child need.
  • Write down questions to ask the doctor.

Questions to ask the doctor

Some basic questions to ask the doctor include:

  • What is the most likely cause of these symptoms?
  • Are any tests needed?
  • Do you think that this condition is temporary or long lasting?
  • What treatments are recommended?
  • There is a medication that can help?
  • Are there restrictions in the diet that can help?

Do not hesitate to ask other questions that occur to you during your appointment.

What to expect from your doctor

Be prepared to answer the questions your doctor may ask:

  • When you or your child begin to experience the symptoms?
  • What is the frequency of an episode of severe vomiting occur, and how many times have you or your child usually vomit?
  • How long do the episodes usually last?
  • Do you or your child is experiencing abdominal pain?
  • Have you noticed warning signs that an episode is coming, such as loss of appetite or feeling unusually tired, or any common triggers, such as intense emotions, illness or menstruation?
  • Have you or your child has been diagnosed with any other medical problems, including mental health problems?
  • What treatments, including over the counter medications and home remedies are for you or for your child, taking for other conditions?
  • Nothing seems to improve the symptoms or shorten the duration of an episode?
  • Do you or your child have a history of severe headaches?
  • Does someone in your family has a history of cyclic vomiting syndrome or migraines?
  • Do you or your child to use cannabis in any of its forms? If so, how often?

What you can do in the meantime

It is likely that the doctor wants to see you or your child immediately if an episode of severe vomiting is underway. But if the vomiting has passed, rest, drink more fluids, and follow an easy-to-digest diet. It is also a good idea to avoid caffeinated drinks or foods that contain caffeine, as these can trigger the symptoms.

Symptoms and treatment of Cyclic vomiting syndrome