Introduction Cyclic Vomiting syndrome (CVS) is a condition characterised by recurrent, stereotyped attacks of intense nausea and intractable vomiting with no identifiable organic cause. The diagnosis of CVS has been helped by the Rome III diagnostic criteria, however, the condition is still a very heterogeneous group of symptoms and there have been very little studies analysing in detail patient-reported features. There is now some evidence for the role of tricyclic antidepressants in managing these patients, but as yet, there is no evidence on the long-term outcomes of patients treated conservatively.
Methods This was a retrospective cohort study of all patients treated at two London teaching hospitals. Information was gathered by means of inpatient case notes, clinic letters and telephone interviews with standardised questions.
Results 28 patients were identified, 17 with adult onset-CVS and 11 with childhood-onset CVS. Overall, 54.5% of patients noted that each attack occurred at the same time of day, usually between 4:00–6:00. In the adult-onset CVS cohort, the average age of onset was 30.9 years; the prevalence of headache was 57.1%. Vomiting attacks occurred on average 10 times a year with a mean duration of 55.3 h. In the childhood-onset CVS cohort, the average age of onset was 5.7 years and the prevalence of headaches was 44.4%. Vomiting attacks occurred on average 25.5 times a year with a mean duration of 54.5 h. During acute admissions patients rated morphine-based medications and ondansetron as most effective. Long-term, 65.4% of our patients were treated conservatively and of these 42.1% felt their symptoms had improved and a further 23.8% noted that their symptoms had resolved completely.
Conclusion Cyclic Vomiting Syndrome is a debilitating illness with a high impact on patient's quality of life. There is a high association with anxiety/depression as well as headaches. Morphine based medications are the most efficacious symptomatic acute treatment. Conservative management has a role to play in the long-term treatment of these patients. The prognosis of these patients is good with nearly 70% of patients having an improvement in their symptoms and nearly a quarter having resolution of the condition after 7 years.
Competing interests None declared.