How is cyclic vomiting syndrome (CVS) treated?

CVS is treated with abortive therapy and preventive therapy. Abortive therapy is given at the time of an episode and is meant to lessen the intensity or stop (abort) an attack after it starts. Preventive therapy is used to stop attacks from happening or to decrease the severity, duration (how long), or frequency (how often) of the attacks.

In most cases, treatment supports the patient. Doctors try to prevent CVS early on in the attack. The treatment for CVS depends on the stage. In the prodrome (early symptom) phase, when symptoms of a CVS episode first start, doctors use drugs to control nausea, reduce stomach acid production, and relieve migraine symptoms and abdominal pain.

In the vomiting phase, doctors use medicines to control migraine pain and to reduce stomach acid and anxiety. A health care provider should be seen as soon as possible. In cases of severe vomiting, it may be necessary to go to a hospital. Intravenous (IV) fluids may be required to prevent dehydration. In episodes lasting several days, IV fluids and nutrition may be needed. In the recovery phase, the patient continues to get IV fluids as needed. Gradually, the patient may begin to have clear liquids and food as tolerated. Medicines can help prevent future episodes.

In the well phase, preventive medicines such as amitriptyline (Elavil®) or cyproheptadine (Periactin®) can help to control future episodes. A trial period of a daily dose for one or two months is needed to see how effective the treatment is. There may also be a benefit in taking coenzyme Q10 and L-carnitine to treat abnormalities in mitochondria at doses recommended by your physician if appropriate. More research on this topic is still needed.

What complications can result from cyclic vomiting syndrome (CVS)?

  • Dehydration: Dehydration happens when fluids lost due to vomiting and diarrhea are not replaced.
  • Esophagitis: Inflammation of the esophagus (the tube that connects the mouth to the stomach) due to frequent exposure to vomit, which is very acidic.
  • Mallory-Weiss tear: A tear in the lower end of the esophagus caused by the muscular contractions of severe vomiting.

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