The Story of Mariam and CVS

It slowly began to feel normal for Mariam to get hospitalized 4 times in a month. But it is shocking for anyone when they come to know that it is because of nothing but vomiting. Everything started 3 years back on the day after her ninth birthday. Mariam was taken to the hospital by her mother because of recurrent episodes of vomiting. The doctor reassured that the vomiting could be because of the food she had consumed the previous night and prescribed her medications, following which she recovered the next day. A similar episode of vomiting happened to her in the same month-end, for which she had to get hospitalised. Her condition worsened with 2 more episodes in the next month and episodes in the subsequent months. What was started as food poisoning now interferes significantly with her daily life. Deeply concerned and confused about her child’s sickness and the uncertain diagnosis around it, Mariam’s mother decided to take her to the pediatric gastroenterologists. After a thorough evaluation, the doctor diagnosed her with a rare medical condition called cyclic vomiting syndrome (CVS).

What is Cyclic vomiting syndrome?

Cyclic Vomiting Syndrome (CVS) is characterised by acute, stereotyped and recurrent episodes of intense nausea with intractable vomiting, lasting from a few hours to a few days.

The exact cause of CVS is not well established. It is believed to be due to problems in the signaling between the brain and the gut. Doctors diagnose about 3 out of 100,000 children with cyclic vomiting syndrome every year. The disease is more common in children and young adults, and females are more affected than males. Research shows a significant association between anxiety and migraine.

What symptoms does CVS manifest with

• vomiting starts at the same time of the day, lasts for the same time with similar intensity

• retching — trying to vomit but having nothing come out of your mouth, also called dry vomiting

• pain in the abdomen

• abnormal drowsiness

• pale skin

• headaches

• lack of appetite

• drooling or spitting

• extreme thirst

• sensitivity to light or sound

• dizziness

• diarrhea

How do doctors diagnose CVS?

The relapsing pattern of clinical symptoms, together with associated symptoms, family and personal history, helps the clinician arrive at the diagnosis of CVS after necessary investigations. The investigations include blood tests, urine tests, upper GI endoscopy,USG, and CT scan.

What are the treatment options available?

The treatment options mainly focused on lifestyle modifications, including managing stress avoid triggering factors. Adequate sleep and rest, eating nutritious foods and avoiding foods with monosodium glutamate, alcohol reduction help to prevent episodes.

Drugs include antiemetics (ondansetron, promethazine) and prophylactic medications like amitriptyline, propranolol, and topiramate, which are being used in the management of CVS.

What are the consequences if left untreated

Patients develop dehydration due to recurrent episodes of vomiting; therefore, it becomes essential to adequately hydrate the patients with glucose-rich fluids and IV Fluids if not tolerating. Other less common complications include esophagitis and severe complications like Mallory Weiss tears(tears in the food pipe)

Although CVS can affect a patient’s life significantly, public awareness about the disease, early diagnosis, and appropriate management reduces the impact of the disease and helps patients lead a stable life

The article is intended for educational purposes only and should not replace professional medical advice. The story is fictional to support the information.

References

• NIDDK

• Raucci U, Borrelli O, Di Nardo G, Tambucci R, Pavone P, Salvatore S, Baldassarre ME, Cordelli DM, Falsaperla R, Felici E, Ferilli MAN, Grosso S, Mallardo S, Martinelli D, Quitadamo P, Pensabene L, Romano C, Savasta S, Spalice A, Strisciuglio C, Suppiej A, Valeriani M, Zenzeri L, Verrotti A, Staiano A, Villa MP, Ruggieri M, Striano P, Parisi P. Cyclic Vomiting Syndrome in Children. Front Neurol. 2020 Nov 2;11:583425. doi: 10.3389/fneur.2020.583425. PMID: 33224097; PMCID: PMC7667239.