Definition of Syndrome, cyclic vomiting

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Syndrome, cyclic vomiting: A syndrome characterized by episodes, bouts, or cycles of severe nausea and vomiting that last for hours or even days and alternate with longer asymptomatic periods (with no symptoms). The cause of the syndrome is unknown. Each episode is similar to previous ones and tends 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. Episodes of CVS can be so severe that a person may have to stay in bed for days, unable to go to school or work. Because other common diseases and disorders can also cause cycles of vomiting, people with the syndrome may initially be misdiagnosed.

Age of onset: Cyclic vomiting syndrome (CVS) affects children more often than adults. It starts most commonly between ages 3 and 7. In adults, episodes tend to occur less often but last longer than in children and the events that trigger episodes in adults cannot be pinpointed as easily as they can in children.

Phases of the syndrome: CVS has four phases:

• Prodrome -- 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 a few minutes to several hours. Sometimes, taking medicine early in the prodromal 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.
• Episode -- The episode phase consists of nausea and vomiting; inability to eat, drink, or take medicines without vomiting; paleness; drowsiness; and exhaustion.
• Recovery -- The recovery phase begins when the nausea and vomiting stop. Healthy color, appetite, and energy return.
• Symptom-free interval -- 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, from a birthday or vacation, for example. Colds, allergies, sinus problems, and the flu may also set off episodes.

Symptoms: The main symptoms 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.

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 there are no tell-tale tests to identify the condition. The diagnosis depends upon looking at the symptoms and medical history and by excluding more common diseases or disorders that can also cause nausea and vomiting. Diagnosis takes time because the a pattern or cycle to the vomiting has to be identified.