#6- Definition;

Cyclic vomiting syndrome, sometimes referred to as CVS, is an increasingly recognized neurological disorder with sudden, repeated attacks—also called episodes—of severe nausea, vomiting, and physical exhaustion that occur with no apparent cause. The episodes can last from a few hours to several days. Episodes can be so severe that a person has to stay in bed for days, unable to go to school or work. A person may need treatment at an emergency room or a hospital during episodes. After an episode, a person usually experiences symptom-free periods lasting a few weeks to several months. To people who have the disorder, as well as their family members and friends, cyclic vomiting syndrome can be disruptive and frightening.

The disorder can affect a person for months, years, or decades. Each episode of cyclic vomiting syndrome is usually similar to previous ones, meaning that episodes tend to start at the same time of day, last the same length of time, and occur with the same symptoms and level of intensity.

What is the GI Tract? :

The GI tract is a series of hollow organs joined in a long, twisting tube from the mouth to the anus—the opening through which stool leaves the body. The body digests food using the movement of muscles in the GI tract, along with the release of hormones and enzymes. Cyclic vomiting syndrome affects the upper GI tract, which includes the mouth, esophagus, stomach, small intestine, and duodenum, the first part of the small intestine. The esophagus is the muscular tube that carries food and liquids from the mouth to the stomach. The stomach slowly pumps the food and liquids through the duodenum and into the rest of the small intestine, which absorbs nutrients from food particles. This process is automatic and people are usually not aware of it, though people sometimes feel food in their esophagus when they swallow something too large, try to eat too quickly, or drink hot or cold liquids.

What causes Cyclic Vomiting Syndrome?:

The cause of cyclic vomiting syndrome is unknown. However, some experts believe that some possible problems with bodily functions may contribute to the cause, such as the following:

-Gastrointestinal motility—the way food moves through the digestive system
-Central nervous system function—includes the brain, spinal cord, and nerves that control bodily responses
-Autonomic nervous system function—nerves that control internal organs such as the heart
-Hormone imbalances—hormones are a chemical produced in one part of the body and released into the blood to trigger or regulate particular bodily functions, in children, an abnormal inherited gene may also contribute to the condition.

Specific conditions or events may trigger an episode of cyclic vomiting:

-emotional stress, anxiety, or panic attacks—for example, in children, common triggers of -anticipatory anxiety are school exams or events, birthday parties, holidays, family -conflicts, or travel
-infections, such as a sinus infection, a respiratory infection, or the flu
-eating certain foods, such as chocolate or cheese, or additives such as caffeine, nitrites—commonly found in cured meats such as hot dogs—and monosodium glutamate, also called MSG
-hot weather
-menstrual periods
-motion sickness
-overeating, fasting, or eating right before bedtime
-physical exhaustion or too much exercise.

What are the main symptoms?:

The main symptoms of cyclic vomiting syndrome are severe nausea and sudden vomiting lasting hours to days. A person may also experience one or more of the following symptoms:

-retching, or making an attempt to vomit
-heaving or gagging
-lack of appetite
-abdominal pain
-diarrhea
-fever
-dizziness
-headache
-sensitivity to light

Intensity of symptoms will vary as a person cycles through four distinct phases of an episode:

-Prodrome phase. During the prodrome phase, the person feels that an episode of nausea and vomiting is about to start. Often marked by intense sweating and nausea—with or without abdominal pain—this phase can last from a few minutes to several hours. The person may appear unusually pale.
-Vomiting phase. This phase consists of intense nausea, vomiting, and retching. Periods of vomiting and retching can last 20 to 30 minutes at a time. The person may be subdued and responsive, immobile and unresponsive, or writhing and moaning with intense abdominal pain. An episode can last from hours to days.
-Recovery phase. This phase begins when the vomiting and retching stop and the nausea subsides. Improvement of symptoms during the recovery phase can vary. Healthy color, appetite, and energy return gradually or right away.
Well phase. This phase occurs between episodes when no symptoms are present.

What are the complications?

-The severe vomiting and retching that define cyclic vomiting syndrome increase the chance of developing several complications, including dehydration, esophagitis, a Mallory-Weiss tear, and tooth decay.

-Dehydration may occur when a person does not replace fluids that were lost because of vomiting and diarrhea. When dehydrated, the body lacks enough fluid and electrolytes—minerals in salts, including sodium, potassium, and chloride—to function properly. Severe dehydration may require intravenous (IV) fluids and hospitalization.
-Esophagitis—inflammation or irritation of the esophagus—can result from the stomach acid that exits through the esophagus during vomiting.
-A Mallory-Weiss tear—a tear in the lower end of the esophagus—is caused by severe vomiting. A person with bloody vomit and stool should see a health care provider right away.
-Tooth decay or corroding tooth enamel is damage caused by stomach acid.

Points to remember:

-Cyclic vomiting syndrome, sometimes referred to as CVS, is an increasingly recognized disorder with sudden, repeated attacks—also called episodes—of severe nausea, vomiting, and physical exhaustion that occur with no apparent cause.
-The disorder can affect a person for months, years, or decades.
-The cause of cyclic vomiting syndrome is unknown.
-The severe vomiting and retching that define cyclic vomiting syndrome increase the chance of developing several complications, including dehydration, esophagitis, a Mallory-Weiss tear, and tooth decay.
-Intensity of symptoms will vary as a person cycles through four distinct phases of an episode.
-The main symptoms of cyclic vomiting syndrome are severe nausea and sudden vomiting lasting hours to days.
-People with cyclic vomiting syndrome should get plenty of rest and take medications to prevent a vomiting episode, stop an episode in progress, speed up recovery, or relieve associated symptoms.
-During the well phase, a balanced diet and regular meals are important. A health care provider will assist with planning a return to a regular diet.

 

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