Cyclic Vomiting Syndrome in Children: A Review of the Literature

Cyclic vomiting syndrome (CVS) was first described by Samuel Gee in 1882 [1]. It is classified as a functional gastrointestinal disorder. It is still poorly understood. CVS is a disorder characterized by recurrent, discrete, self-limited stereotypical episodes of nausea and vomiting interspersed with symptom-free intervals or baseline health. It is defined by symptom-based criteria and the absence of positive laboratory, radiographic, and endoscopic testing. During these nausea and vomiting episodes, patients are usually lethargic, pale, have abdominal pain, and anorexia. Episodes are frequently triggered by psychological and physical stress. An association of CVS with migraine headache and abdominal migraine has been described [2,3]. Migraine may have similar symptoms to CVS; both may coexist in same patient, and has high family prevalence in patients with CVS. Affected children are more often girls than boys (60:40). It affects up to 1.9% of children between 5-15 years of age [2]. CVS is a source of substantial morbidity: 50% of children with CVS require intravenous rehydration. Children with CVS miss a mean of 20 days of school each year. The average cost of emergency department visits, hospital stays, diagnostic tests, and missed work is estimated at more than $17,000 yearly per child with CVS [4]. The NASPGHAN and Rome IV diagnostic criteria for CVS are [5,6]: