Cyclic Vomiting Syndrome in Children: Causes and Treatment Options

Cyclic Vomiting Syndrome (CVS)

Dear Vice Dean Liu,
My daughter, who is 4 years old, has been experiencing severe vomiting episodes approximately every three weeks for the past two years.
During each episode, she is unable to eat at all and requires intravenous fluids in the emergency room for improvement.
We have tried administering antiemetic injections at the clinic, but they have not been very effective.
After receiving IV fluids and returning home, her symptoms completely resolve, and during the intervals between episodes, her appetite and overall well-being appear normal.

Over the past two years, we have consulted with neurologists and gastroenterologists, and she has undergone gastroscopy, brain MRI, and EEG, yet we have not been able to identify a definitive cause.
The literature on Cyclic Vomiting Syndrome (CVS) indicates that the etiology is often unknown, with potential links to mitochondrial defects possibly due to genetic factors or a family history of migraines.

I kindly request your guidance on further medical treatment options.
Would it be possible for you to examine my daughter in your clinic? If you are able to see her, I would be grateful to bring her to your office for assistance.
Thank you very much, Vice Dean Liu.

xin ji ru wen de mu qin, 40~49 year old female. Ask Date: 2021/12/06

Dr. Liu Qingshan reply Rare Disease

Based on your description, please contact Ms.
Li at the Genetic Counseling Clinic to arrange an appointment at 04-7238595, extension: 7244.

Reply Date: 2021/12/06

More Info

Cyclic Vomiting Syndrome (CVS) is a complex and often misunderstood condition that primarily affects children, although it can persist into adulthood. It is characterized by recurrent episodes of severe vomiting that can last for hours to days, followed by periods of normal health. The exact cause of CVS remains unclear, but several factors have been identified that may contribute to its development.

One of the key aspects of CVS is its episodic nature. Children with CVS typically experience episodes of vomiting that can occur every few weeks, as described in your case. During these episodes, the child may be unable to eat or drink, leading to dehydration and the need for intravenous fluids. The fact that your daughter has normal health between episodes is a hallmark of CVS, distinguishing it from other gastrointestinal disorders.

Research suggests that CVS may have a genetic component, as it is often associated with a family history of migraines or other headache disorders. This connection to migraines is significant because CVS can sometimes be considered a variant of migraine, particularly in children. Additionally, mitochondrial dysfunction has been proposed as a potential underlying cause, although more research is needed to fully understand this relationship.

In terms of treatment, managing CVS can be challenging. The primary goal during an episode is to provide supportive care, which often includes hydration and antiemetic medications to control vomiting. Since your daughter has not responded well to antiemetic injections, it may be worth discussing alternative medications with her healthcare provider. Some children benefit from preventive treatments, such as medications that are typically used for migraines, including beta-blockers, tricyclic antidepressants, or anticonvulsants.

Lifestyle modifications can also play a crucial role in managing CVS. Keeping a detailed diary of your daughter's episodes, including potential triggers such as stress, dietary factors, or infections, can help identify patterns and inform treatment strategies. Ensuring she maintains a regular sleep schedule and managing stress levels may also be beneficial.

In your case, since extensive testing has not revealed a definitive cause for your daughter's symptoms, it may be worthwhile to seek out a specialist in pediatric gastroenterology or a headache specialist who has experience with CVS. They may be able to provide further insights and treatment options tailored to your daughter's specific needs.

It's important to remain vigilant and proactive in managing your daughter's condition. While CVS can be distressing for both the child and the family, many children with CVS eventually outgrow the condition. In the meantime, supportive care and a comprehensive management plan can help improve her quality of life and reduce the frequency and severity of episodes.

If you are considering further evaluation or treatment options, I encourage you to reach out to a healthcare provider who specializes in CVS or related disorders. They can offer guidance on the best course of action for your daughter and help you navigate this challenging condition.

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