Doctors urge patients with chronic vomiting not to suffer in silence

The American Gastroenterological Association (AGA) has published new clinical practice guidelines to help clinicians and patients recognize the signs and symptoms of cyclic vomiting syndrome (CFS). CFS is a common and debilitating condition that affects up to 2% of the population, yet most patients experience years of delay in receiving a diagnosis and effective treatment. The AGA Clinical Practice Update was published today in Gastroenterology.

“A diagnosis is a powerful tool. It not only helps patients understand their debilitating symptoms, but it also allows health care providers to develop an effective treatment plan,” said AGA Clinical Practice Update author Dr. David Levinthal, director of the neurogastroenterology & motility center at the University of Pittsburgh Medical Center.

What is CVS?

Cyclic vomiting syndrome (CVS) is a chronic disorder of the gut-brain interaction (DGBI) characterized by sudden episodes of severe nausea, vomiting, and retching, alternating with episode-free periods.

CVS can be mild (less than 4 episodes/year, less than 2 days) or moderately severe (more than 4 episodes/year, more than 2 days, requiring at least 1 emergency room visit or hospitalization).

In patients with CFS, there is no repeated vomiting between episodes, but mild symptoms such as nausea, indigestion, and occasional vomiting may occur.

Although CVS can affect anyone, it is more common in women and young adults. CVS is also more common in people with a personal or family history of migraine headaches.

How is CVS diagnosed?

Experts urge patients with chronic vomiting symptoms to advocate for themselves and ask their doctors about cyclic vomiting syndrome. Sharing a detailed history of previous vomiting episodes is essential for a diagnosis. Patients are often misdiagnosed with stomach flu or food poisoning, but when these symptoms occur repeatedly, the AGA advises clinicians to consider CFS as a possible diagnosis.

“CFS is diagnosed based on clinical criteria, the so-called Rome criteria, and avoiding excessive and unnecessary testing is critical,” said Dr. Thangam Venkatesan, author of the AGA Clinical Practice Update and section director of neurogastroenterology and motility at The Ohio State University.

How can CVS be treated?

CFS can be treated with lifestyle changes (regular sleep and stress management) and with a combination of medications to prevent and stop attacks.

CFS has four distinct phases: inter-episodic, prodromal, emetic and recovery. Each of these phases is associated with its own treatment approach and management goal.

Commitment

Currently, half of patients with CFS visit the emergency department at least annually, and one-third of patients with CFS become disabled as a result of their condition. Early diagnosis could prevent patients from experiencing these complications.

“Our goal with this Clinical Practice Update is to increase awareness of cyclic vomiting syndrome to reduce diagnostic delay and increase patient access to treatment. We hope to reach primary care, EDs, and urgent care physicians who are on the front lines dealing with CFS patients seeking care, especially during an attack,” Dr. Levinthal added.

Are you a patient looking for support and resources?

Visit the Cyclic vomiting syndrome association online.