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Cyclic Vomiting Syndrome

Jennifer M. Cornwell, DO Reviewed 06/2020
 


BASICS

DESCRIPTION

  • An idiopathic chronic functional GI disorder characterized by discrete, recurrent, stereotypical paroxysmal episodes of high-intensity nausea and vomiting lasting hours to days, sepa...

DIAGNOSIS

HISTORY

  • Children often present with bilious emesis (83%), severe abdominal pain (80%), and/or hematemesis.

  • The North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition ...

TREATMENT

GENERAL MEASURES

  • Patient reassurance

  • Avoid triggers (stress, sleep deprivation, chocolate, cheese, monosodium glutamate, red wine) (4)[A].

  • Nonstimulating environment

  • Relaxation techniques and ps...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Patient Monitoring

  • Weekly appointments for severe cases

  • Monitor for hypokalemia, acid-base disturbances, and ketosis if ongoing emesis.

  • Regular outpatient visits for...

REFERENCES

1
Venkatesan T, Levinthal DJ, Tarbell SE, et al. Guidelines on management of cyclic vomiting syndrome in adults by the American Neurogastroenterology and Motility Society and the Cyclic Vomi...

ADDITIONAL READING

  • Fleisher DR. The cyclic vomiting syndrome described. J Pediatr Gastroenterol Nutr.  1995;21(Suppl 1):S1–S5.

  • Hermus IP, Willems SJ, Bogman AC, et al. Cyclic vomiting syndrome: An...

CODES

ICD10

  • G43.A0 Cyclical vomiting, not intractable

  • G43.A1 Cyclical vomiting, intractable

ICD9

  • 536.2 Persistent vomiting

  • 346.20 Variants of migraine, not elsewhere classified, without mention of intracta...

CLINICAL PEARLS

  • CVS is more common in children than adults. The average age of diagnosis is 5 years.

  • A food diary helps identify patterns and triggers for vomiting cycles.

  • Proper sleep hygiene, stress m...

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