Extreme emesis: Cyclic vomiting syndrome

Cyclic vomiting syndrome (CVS) is an idiopathic disorder that has been primarily identified in children but has recently been increasingly recognized in adults. Acute episodes are typically misdiagnosed as gastroenteritis and food poisoning that leads to a three-to-eight year delay in diagnosis. The major challenge for the frontline clinician is to differentiate CVS, a functional disorder without laboratory markers, from the myriad organic causes of vomiting. Better awareness and earlier recognition and treatment of CVS will reduce the morbidity, avoid unnecessary investigations and repeated hospitalizations that are estimated to incur $17,035 per patient annually (1). This arti-cle focuses on the clinical features, including differences between adults and children, potential pathophysiologic mechanisms, pertinent exclusionary investigations and specific treatment approaches.

Duke Scholars

Author Narayanan Venkatasubramani Pediatrics, Gastroenterology, Hepatology and Nutrition