Cyclic vomiting syndrome is a disorder known since the 19th century, characterized by recurrent and intense episodes of vomiting, with no apparent cause being determined. The bouts of vomiting come and go, but during the break, the patient is perfectly healthy and without complaints.
As explained in the introduction, cyclic vomiting syndrome is a disorder characterized by repeated and intense bouts of nausea and vomiting, with no apparent reason, which alternate with periods of rest when the patient is without symptoms or complaints.
It was once thought that cyclic vomiting syndrome was a disease that only affected children. Today, however, it is known that this problem can arise in any age group. Studies suggest that cyclic vomiting syndrome affects about 2% of school-age children. The number of cases diagnosed in adults is progressively increasing, but no major studies have determined its actual incidence in this group.
In order to think about cyclic vomiting syndrome, the patient must present the following criteria:
1. Three or more distinct episodes of recurrent vomiting in the last 6 months.
2. Intervals between crises, with complete resolution of complaints and symptoms.
3. Episodes of stereotyped vomiting, with onset, duration and symptoms always very similar.
4. Absence of an identifiable cause for bouts of vomiting.
In children, symptoms usually appear between 5 and 10 years of age, while in adults the disease appears around age 35. The diagnosis of cyclic vomiting syndrome is usually established more quickly in children because, as the disorder is more common in this age group, pediatricians are more accustomed to dealing with this problem.
The causes of cyclic vomiting syndrome are unknown. In fact, it is not known whether there is a single cause or whether the disorder is a common manifestation of several different diseases.
It is now known that there is a relationship between cyclic vomiting syndrome and migraine. Some facts corroborate with this hypothesis:
About 1/3 of patients with cyclic vomiting syndrome also have migraine attacks.
Children with cyclic vomiting syndrome usually develop migraine headaches when adults.
More than 80% of patients with cyclic vomiting syndrome have a positive family history of migraine.
About 80% of patients present improvement when treated for migraine, even those who do not have headache.
Despite the association with migraine, other diseases also appear to be related to cyclic vomiting syndrome, such as food allergy, mitochondrial diseases, defects in the hypothalamic-pituitary-adrenal axis, and hereditary neuropathy autonomic sense.
Cyclic vomiting syndrome may also be related to female hormones. Some girls have the syndrome in the first months of menstruation of life. In some adult women with cyclic vomiting syndrome, bouts of vomiting are clearly related to the menstrual period. The use of oral contraceptives is controversial; in some cases there is improvement, but in others, the seizures can be triggered by the hormones.
Chronic use of marijuana has also been described as a risk factor for cyclic vomiting syndrome. In these cases, the suspension of the drug for 1 or 2 weeks is sufficient for the crises to cease.
When episodes of frequent vomiting occur in pregnancy, we call hyperemesis gravidarum. The denomination is different because, apparently, the causes are different.
As the name of the disease itself says, the syndrome of cyclic vomiting is characterized by repeated and cyclic episodes of vomiting. The patient vomits several times throughout the day, for more than a day, even vomiting more than 4 times in just 1 hour. In general, episodes of vomiting last 24-48 hours, but can take up to 1 week to disappear. The crises are shorter in children and longer in adults. After the crisis, the patient is apparently healthy and without complaints, until the appearance of new episodes, which can occur only after weeks or months.
About 2/3 of the patients can identify a trigger factor for seizures, such as respiratory infections, food, intense physical exertion, stress crises, medications, prolonged fasting, etc.
The episodes of vomiting are usually stereotyped, that is, they have very similar characteristics, such as triggering factor, time of onset, duration, intensity and associated symptoms.
In addition to nausea and vomiting, the patient with cyclic vomiting syndrome may have other associated symptoms, such as abdominal pain, headache, diarrhea, light intolerance (photophobia), dizziness, etc.
The main immediate complication of cyclic vomiting syndrome is dehydration. In some cases, the bouts of vomiting are so intense and long lasting that the patient needs to be admitted for intravenous IV administration. The patient can not feed or drink fluids. The main symptoms of dehydration are mucosal dryness, intense thirst, pallor of the skin and reduction of the volume of urine.
Frequent passage of highly acidic gastric contents through the esophagus and mouth can cause some complications, such as esophagitis (inflammation of the esophagus) and corrosion of the enamel of the teeth.
There is no cure for cyclic vomiting syndrome through treatments. However, in most cases, especially in children, the disease disappears spontaneously after a few years, usually in the pre-pubertal stage.
As there is no curative treatment, medical care is focused on the prevention of complications and symptom control. If the patient can not feed and hydrate, he should be admitted for the administration of sera. Medications such as antiemetics (nausea medicines), sedatives, gastric acid inhibitors and antidepressants are often used.
As already mentioned, many patients improve if they are treated as if they have migraines. Propranolol, amitriptyline, sumatriptan and ciproeptadine are drugs that can be tried.
In general, the prognosis of the disease is good. Most patients can control the symptoms of the disease until it disappears by itself after a few years.
