The cyclic vomiting syndrome can occur in a person of any age, but most often this problem is observed in children between the ages of 3 and 7. Women are slightly more likely to suffer from the disease. The exact prevalence of cyclic vomiting syndrome is unknown, and on the basis of available statistics it is estimated that it complicates the lives of 3 out of 100,000 children.
Cyclic vomiting syndrome , when vomiting (along with other ailments) occurs periodically, it can be quite a concern for parents, because this unit most often occurs in children. Cyclic vomiting syndrome is a kind of interesting problem, because neither its exact etiopathogenesis, nor a specific treatment method for this disease is known.
Cyclic Vomiting Syndrome: Causes
The factors responsible for the occurrence of the cyclic vomiting syndrome have not been established to date - the etiology of the disorder is not known. However, there is some suspicion about the role of genetic disorders in the pathogenesis of the syndrome, as it is noted that it appears more frequently in children of mothers who suffer from migraines. A somewhat similar relationship also occurs among children themselves - those who experience migraine headaches have an increased frequency of cyclic vomiting syndrome. There are certain situations that may provoke an episode of cyclic vomiting syndrome, including:
- experiencing strong emotions (both positive and negative)
- infections (e.g. pharyngitis or otitis media)
- period of menstrual bleeding
- inappropriate eating behavior (such as overeating, eating large amounts of food immediately before going to bed, or taking long hours between meals)
- insomnia
- motion sickness
- significant physical exertion
- exhaustion
- eating certain foods (e.g. chocolate or cheese)
- drinking caffeinated beverages
Cyclic Vomiting Syndrome: Symptoms
As the name suggests, vomiting is the main symptom in patients with cyclic vomiting syndrome. However, a number of other ailments appear in the clinical picture, additionally the course of the syndromecan be divided into several phases. During the prodromal (predictive) phase, patients may be aware that another episode of vomiting is just coming. They may feel nauseous, experience extreme sweating, and become very pale. These symptoms last from several minutes to several hours, followed by an episode of vomiting. In a significant number of patients, these episodes begin during the night or morning. The vomiting that occurs in the course of the syndrome may be very severe - patients may vomit 5-6 or more times per hour. The vomiting may be accompanied by other symptoms, such as:
- stomach pains
- dizziness
- diarrhea
- fever
- headache
- sensitivity to light and sounds
- considerable paleness
- drooling
The duration of an episode of vomiting in the course of cyclic vomiting syndrome may be several hours, but even several days. After the vomiting phase, there is a recovery phase, during which the patients' complaints either gradually or completely and immediately disappear. A characteristic feature of the cyclic vomiting syndrome is that between episodes of this disease, the patients' general condition is good and symptoms such as nausea and vomiting do not occur.
Cyclic Vomiting Syndrome: Diagnosis
The diagnosis of the cyclic vomiting syndrome is made by excluding any other potential causes of the patient's symptoms. In this situation, before diagnosing the syndrome, a number of different tests may be performed, including:
- gastrointestinal examinations (such as, for example, gastrointestinal transit assessment and endoscopic examinations of the stomach or intestines - they are used to exclude the presence of, for example, some obstacle in the gastrointestinal tract, which could cause vomiting)
- abdominal ultrasound (to exclude, for example, gallbladder stones)
- blood laboratory tests (to exclude, for example, hormonal disorders, such as hypothyroidism)
- imaging tests (e.g. magnetic resonance imaging of the head, which may be performed in order to exclude the presence of a neoplastic focus in the central nervous system)
Only when other possible causes of the patient's symptoms are excluded, it is possible to consider the diagnosis of the cyclic vomiting syndrome. Special criteria regarding this syndrome should be taken into account, including the following aspects:
- episodes of vomitingthey are similar each time: they are preceded by similar ailments, their length is basically the same, they are provoked each time by similar factors
- having a total of 5 similar episodes of vomiting or three in the last six months
- during an episode, the patient vomits more than 4 times in an hour
- the general condition of the patient is good between episodes
Cyclic Vomiting Syndrome: Treatment
Just as the causes of cyclic vomiting syndrome are unknown, so is the treatment of this individual. However, patients are not left to themselves - they may be offered various medications which - with varying effectiveness - alleviate the symptoms associated with episodes of this individual. The medications used in cyclic vomiting syndrome include:
- antiemetics (like ondansetron)
- pain relieving preparations (e.g. ibuprofen)
- agents that reduce the production of hydrochloric acid (e.g. proton pump inhibitors such as omeprazole)
- preparations typically used in migraine headaches, classified as triptans
Patients with cyclic vomiting syndrome react differently to these agents, therefore there are no universal recommendations as to how such patients should be treated. For this reason, attempts are made to combine different medications until a combination is found that is most effective in relieving the patient's symptoms. The above-mentioned drugs are used both in the prophylaxis of vomiting episodes, as well as during their occurrence, in order to reduce the duration of symptoms in the patient.It should be remembered that vomiting (especially severe vomiting) may lead to dehydration, as well as to dangerous electrolyte disturbances. For this reason, it may be necessary to hospitalize a patient who is in a vomiting attack and to administer intravenous fluids and drugs to stabilize his condition.
Cyclic vomiting syndrome: prognosis
The cyclic vomiting syndrome is a problem that primarily affects the child population. In a significant proportion of patients, with their transition to adulthood, the symptoms pass, but it happens that the symptoms of the cyclic vomiting syndrome also persist in adulthood. Attempts to treat the cyclic vomiting syndrome are very important because the problem can lead to a number of complications. Examples include damage to the esophagus and teeth, gastritis, and gastroparesis (a disorder of gastric emptying).
Cyclic Vomiting Syndrome: Prevention
Patients diagnosedcyclic vomiting syndrome, may themselves reduce the risk of further episodes of the disease. For this they should:
- get enough sleep
- avoid foods they suspect are related to the onset of vomiting
- eat meals regularly
- in case of any infection, go to a doctor quickly and start treatment
- avoid stress and significant emotional arousal