The Cyclical Vomiting Syndrome Association (CVSA-UK) for patients, families and professionals providing support, education and research for Cyclical Vomiting SyndromeCVSCVS

Cyclical Vomiting SyndromeCharity Registration No 1045723

Facts about CVS

Medical Advisers CVSA-UKDr. Ishaq Abu-Arafeh, Consultant Paediatrician, Stirling Royal Infirmary, Scotland.

Professor Paul Andrews, Professor of Physiology, St George's Medical School, London.

Dr. Sonny Chong, Consultant Paediatrician, Queen Mary's Hospital, Carshalton, Surrey.

Dr. Keith Lindley, Consultant Gastroenterologis, Great Ormond Street Children's Hospital, London.

Dr. George Russell, Retired Consultant Paediatrician.

Dr. David Symon, Consultant Paediatrician, General Hospital, Hartlepool.

Professor David Thompson, Consultant Gastroenterologist, Hope Hospital, Salford.

CVSA - UK Helpline 0151 342 1660http://freespace.virgin.net/cvsa.uk/

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CVSCVSCyclical Vomiting Syndrome

Charity Registration No 1045723

Helpline number: 0151 342 1660 or visit http://freespace.virgin.net/cvsa.uk/

history of migraine and the sufferer may haveallergies, e.g. asthma, travel sickness, developmental

delays and/or behavioural difficulties. Thedisorder may fade out during adolescence

or change to migraine headaches.Some cases persist into adult life.

SymptomsEpisodes almost always beginat night or when waking in the

morning. Symptoms include forcefulrepeated vomiting and retching,as often as 5-6 timesan hour at the peakof an episode. Thisis accompanied by

unrelenting nausea,extreme lethargy and markedpallor. The child usually sleeps

around the clock when not vomiting.Patients describe being in a state ofconfusion and exhaustion during theepisode, with no control over theirbody's reactions. This has beennamed a "conscious coma". Nauseaincreases salivation, but patientsmay be unwilling to swallow theirsaliva as this causes retching.They may dribble, spit or holdtheir saliva in their mouths,making speech difficult. Thirstis often intense even thoughtaking fluids results almostimmediately in vomiting. Patientsmay drink in order to dilute thegastric acid and bile that causes painin the oesophagus during vomiting. Somepatients drink large quantities of water toinduce vomiting deliberately, in an attempt torelieve the intolerable nausea. The vomit isbile-stained and often bloody from oesophagealirritation. There may also be abdominal pain,

headache, dizziness, low-grade feverand/or diarrhoea. The symptoms ofthis disorder are frightening to boththe child and the family, and can belife-threatening, due to dehydrationand electrolyte imbalance.

TriggersSome children seem to have episodesat regular intervals of time regardlessof circumstances; others can identify

specific physical trigger factors like infections, e.g.colds, exhaustion, menstruation, specific foods oranaesthesia. Emotional stress or excitement may

trigger attacks in some patients, while otherscan identify no precipitating factor.

DiagnosisThere are no specific diagnostic tests for CVS.It is a diagnosis made after careful review

of the patient’s history, physicalexamination and tests to rule out

specific conditions that causesevere intermittent vomiting.As vomiting is

such a commonsymptom, and asCVS is so poorlyunderstood or

recognised, many casesare misdiagnosed, or go

unrecognised for years.Abdominal migraine, in which

severe abdominal pain is themain presenting symptom, isclosely related to CVS. CVSCVS

Cyclical Vomiting SyndromeCharity Registration No 1045723

Cyclical VomitingSyndrome (CVS) is a poorly recognised, unexplained disorderof children and some adults that causesintense suffering in those affectedand their families. The illness ischaracterised by recurrent, prolongedepisodes of severe nausea, vomitingand exhaustion, with no apparentcause. The episodes are self-limitedand they tend to be similar toeach other in symptomsand duration. Occurrencesusually end in a dramaticallysudden way regardless oftreatment. The sufferer ishealthy and symptom-freebetween episodes. The illnesswas first described in the early 19th century.Dr. Samuel Gee wrote a classic description

of the condition at St. Bartholomew’sHospital, London, in 1882.

OccurrenceThe symptoms can start at any age

from infancy to adulthood but mostcommonly the onset is betweenthe ages of 3 and 7. The disordermay continue for months todecades. Vomiting persists atfrequent intervals for hours to10 days or more (1-4 days mostcommonly). The episodes mayrecur several times a year toseveral times a month. There

are sufferers throughoutthe world from manydifferent backgrounds.

Females are slightlymore affected than males.There is often a family

TreatmentTreatment is generallysupportive with muchimportance placed onearly intervention. It iscritical to create a dark,quiet environment forsleep. Hospitalisationand intravenous fluidreplacement may beneeded during episodes.

Medication trials sometimes succeed in findingsomething to prevent, abort or shorten theepisodes. Stress management techniques aresometimes helpful.

Doctor-patient relationshipsA good doctor-patient-family relationship isvital for long-term management of this illness. Thedoctors need to be aware of the impact of the illnessupon the sufferer and the family, and the feelingsand attitudes that predispose to attacks. Consistent,accessible care by a doctor who understands and

communicates the nature ofCVS, regardless of speciality,is vital to the family's wellbeing. Joining the CyclicalVomiting SyndromeAssociation, CVSA-UK, afamily/professional network,can be helpful to bothfamilies and their doctors.

The illness is characterised by recurrent, prolongedepisodes of severe nausea, vomiting and exhaustion.“ ”

As CVS is so poorly understood

or recognisedmany cases are

misdiagnosed, orgo unrecognised

for years.

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