The ultimate goal of prophylaxis is to prevent attacks altogether but, at the very least, to reduce the frequency, duration, or intensity of episodes. Metabolic causes include mitochondrial disorders disorders of fatty acid oxidation, mitochondrial encephalopathy, lactic acid, and stroke-like syndrome , urea cycle defects partial ornithine transcarbamylase deficiency , organic acidurias propionic acidemia , aminoacidurias, and porphyrin degradation disorders acute intermittent porphyria. The prognosis of CVS is favorable in the majority of patients. The progression to coalescence of episodes is most often observed in patients with untreated CVS. Some investigators have suggested that it is a manifestation of migraine diathesis [ 1 , 8 - 10 ].
Neuroimaging studies have identified a locus of migraine activation in the brainstem with variable responses to sumatriptan. Fewer than half of the patients have migraine features, including headache, photophobia, and phonophobia. Winter holidays, including Thanksgiving, Christmas, and New Year, can serve as excitatory triggers for some children. This coalescent pattern can exacerbate underlying stress and anxiety and is commonly associated with lower attendance at school or work, marital discord, and the need for financial assistance. Other gastrointestinal causes include disorders of gut motor function and hepatopancreatobiliary disorders. Clinical Features and Symptoms CVS is distinguished by discrete, recurrent, and severe episodes of vomiting. Distinguishing a cyclic pattern of vomiting from chronic vomiting is a key first step in the diagnosis of CVS. The typical recovery phase is variable, ranging from minutes to 10 days, in all ages, with a median of 8 hours in children. One series of 9 patients noted the termination of cyclic emesis after cessation of chronic use of marijuana. CVS episodes were stereotypic in respect of their hours of onset, symptomatology and length. Pathophysiology CVS is considered an idiopathic disorder, as no etiopathogenesis has been documented. Other symptoms during episodes include sensory hypersensitivity, vertigo, and sweating, which has been reported as a common feature in adults. Background Cyclic Vomiting Syndrome CVS consists of recurrent, stereotypic episodes of incapacitating nausea and vomiting lasting hours to days and separated by symptom-free intervals, which typically last weeks or months [ 1 - 5 ]. CVS is considered to be a functional disorder [ 7 ]. Abstract Background Cyclic Vomiting Syndrome CVS is a disorder characterized by recurrent, stereotypic episodes of incapacitating nausea, vomiting and other symptoms, separated by intervals of comparative wellness. The most common autonomic symptoms are lethargy and pallor. The most potentially devastating causes of recurrent vomiting including anatomic anomalies of the gastrointestinal tract and renal hydronephrosis should be sought by upper gastrointestinal series with small bowel follow-through and renal ultrasound examination, respectively. CVS episodes are characterized by intense persistent nausea and repeated vomiting occurring at least 4 times per hour for at least 1 hour. Tricyclic antidepressants, which inhibit the promoter activity of the CRF gene, are some of the most successful prophylactic agents in treating CVS. Diagnostic Evaluation At present, there are no specific tests for diagnosing CVS, and the diagnosis rests upon fulfilling clinical criteria. Behaviors such as assuming a fetal position, withdrawing socially, drinking compulsively, taking prolonged hot or cold baths, and avoiding lights and sounds are common attempts to alleviate nausea. It is unclear whether the pathophysiology of this pattern differs from typical CVS; however, most of these patients do improve with conventional CVS therapy. Among gastrointestinal disorders, the most serious involve anatomic anomalies of the gastrointestinal tract, including malrotation with intermittent volvulus, which can cause ischemic necrosis. The most common extraintestinal cause is acute hydronephrosis resulting from proximal or distal ureteral obstruction. Interestingly, two thirds of the stress in children is positive rather than negative. Monitor electrocardiogram QTc interval prior to starting.
Video about sex and cyclic vomiting syndrome:
What is cyclic vomiting syndrome? (CVS)
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