 |
Additional Information
|
|
Cyclic Vomiting Syndrome
In cyclic vomiting syndrome (CVS), people experience bouts
or cycles of severe nausea and vomiting that last for hours
or even days and alternate with longer periods of no symptoms.
CVS occurs mostly in children, but the disorder can affect
adults, too.
CVS has no known cause. Each episode is similar to the previous
ones. The episodes tend to start at about the same time of
day, last the same length of time, and present the same symptoms
at the same level of intensity. Although CVS can begin at
any age in children and adults, it usually starts between
the ages of 3 and 7. In adults, episodes tend to occur less
often than they do in children, but they last longer. Furthermore,
the events or situations that trigger episodes in adults cannot
always be pinpointed as easily as they can in children.
Episodes can be so severe that a person may have to stay
in bed for days, unable to go to school or work. No one knows
for sure how many people have CVS, but medical researchers
believe that more people may have the disorder than is commonly
thought (as many as 1 in 50 children in one study). Because
other more common diseases and disorders also cause cycles
of vomiting, many people with CVS are initially misdiagnosed
until the other disorders can be ruled out. What is known
is that CVS can be disruptive and frightening not just to
people who have it, but to the entire family as well.
The Four Phases of CVS
CVS has four phases: prodrome — episode — recovery
— symptom-free interval
The prodrome phase signals that an episode of nausea and
vomiting is about to begin. This phase, which is often marked
by abdominal pain, can last from just a few minutes to several
hours. Sometimes taking medicine early in the prodrome phase
can stop an episode in progress. However, sometimes there
is no warning: A person may simply wake up in the morning
and begin vomiting.
The episode phase consists of nausea and vomiting; inability
to eat, drink, or take medicines without vomiting; paleness;
drowsiness; and exhaustion.
The recovery phase begins when the nausea and vomiting stop.
Healthy color, appetite, and energy return.
The symptom-free interval phase is the period between episodes
when no symptoms are present.
Triggers
Most people can identify a specific condition or event that
triggered an episode. The most common trigger is an infection.
Another, often found in children, is emotional stress or excitement,
often from a birthday or vacation, for example. Colds, allergies,
sinus problems, and the flu can also set off episodes in some
people.
Other reported triggers include eating certain foods (such
as chocolate or cheese), eating too much, or eating just before
going to bed. Hot weather, physical exhaustion, menstruation,
and motion sickness can also trigger episodes.
Symptoms
The main symptoms of CVS are severe vomiting, nausea, and
retching (gagging). Episodes usually begin at night or first
thing in the morning and may include vomiting or retching
up to five or six times an hour during the worst of the episode.
Episodes usually last anywhere from 1 to 4 days, though they
can last for up to 10 days.
Other symptoms include pallor, exhaustion, and listlessness.
Sometimes the nausea and vomiting are so severe that a person
appears to be almost unconscious. Sensitivity to light, headache,
fever, dizziness, diarrhea, and abdominal pain may also accompany
an episode.
In addition, the vomiting may cause drooling and excessive
thirst. Drinking water usually leads to more vomiting, though
the water can dilute the acid in the vomit, making the episode
a little less painful. Continuous vomiting can lead to dehydration,
which means that the body has lost excessive water and salts.
Diagnosis
CVS is hard to diagnose because no clear tests--such as a
blood test or x ray--exist to identify it. A doctor must diagnose
CVS by looking at symptoms and medical history and by excluding
more common diseases or disorders that can also cause nausea
and vomiting. Also, diagnosis takes time because doctors need
to identify a pattern or cycle to the vomiting.
CVS and Migraine
The relationship between migraine and CVS is still unclear,
but medical researchers believe that the two are related.
First, migraine headaches, which cause severe pain in the
head; abdominal migraine, which causes stomach pain; and CVS
are all marked by severe symptoms that start quickly and end
abruptly, followed by longer periods without pain or other
symptoms.
Second, many of the situations that trigger CVS also trigger
migraines. Those triggers include stress and excitement.
Third, research has shown that many children with CVS either
have a family history of migraine or develop migraines as
they grow older.
Because of the similarities between migraine and CVS, doctors
treat some people with severe CVS with drugs that are also
used for migraine headaches. The drugs are designed to prevent
episodes, reduce their frequency, or lessen their severity.
Treatment
CVS cannot be cured. Treatment varies, but people with CVS
are generally advised to get plenty of rest; sleep; and take
medications that prevent a vomiting episode, stop or alleviate
one that has already started, or relieve other symptoms.
Once a vomiting episode begins, treatment is supportive.
It helps to stay in bed and sleep in a dark, quiet room. Severe
nausea and vomiting may require hospitalization and intravenous
fluids to prevent dehydration. Sedatives may help if the nausea
continues.
Sometimes, during the prodrome phase, it is possible to stop
an episode from happening altogether. For example, people
who feel abdominal pain before an episode can ask their doctor
about taking ibuprofen (Advil, Motrin) to try to stop it.
Other medications that may be helpful are ranitidine (Zantac)
or omeprazole (Prilosec), which help calm the stomach by lowering
the amount of acid it makes.
During the recovery phase, drinking water and replacing lost
electrolytes are very important. Electrolytes are salts that
the body needs to function well and stay healthy. Symptoms
during the recovery phase can vary: Some people find that
their appetites return to normal immediately, while others
need to begin by drinking clear liquids and then move slowly
to solid food.
People whose episodes are frequent and long-lasting may be
treated during the symptom-free intervals in an effort to
prevent or ease future episodes. Medications that help people
with migraine headaches--propranolol, cyproheptadine, and
amitriptyline--are sometimes used during this phase, but they
do not work for everyone. Taking the medicine daily for 1
to 2 months may be necessary to see if it helps.
In addition, the symptom-free phase is a good time to eliminate
anything known to trigger an episode. For example, if episodes
are brought on by stress or excitement, this period is the
time to find ways to reduce stress and stay calm. If sinus
problems or allergies cause episodes, those conditions should
be treated.
Complications
The severe vomiting that defines CVS is a risk factor for
several complications:
- Dehydration. Vomiting causes the body to lose water quickly.
- Electrolyte imbalance. Vomiting also causes the body to
lose the important salts it needs to keep working properly.
- Peptic esophagitis. The esophagus (the tube that connects
the mouth to the stomach) becomes injured from the stomach
acid that comes up with the vomit.
- Hematemesis. The esophagus becomes irritated and bleeds,
so blood mixes with the vomit.
- Mallory-Weiss tear. The lower end of the esophagus may
tear open or the stomach may bruise from vomiting or retching.
- Tooth decay. The acid in the vomit can hurt the teeth
by corroding the tooth enamel.
To read more about cyclic vomiting syndrome from the The National
Digestive Diseases Information Clearinghouse, please click
here: http://digestive.niddk.nih.gov/ddiseases/pubs/cvs/index.htm
|
Additional
Information