Cyclic vomiting syndrome


  • Recurrent episodes of vomiting, otherwise normal health in between
  • 32% of patients disabled by illness by time of diagnosis[1]
  • Pathophysiology not well understood
  • Average age at onset ~21yo
  • Females slightly more affected than males
  • Marijuana use is risk factor

Clinical Features

  • Pediatric diagnostic criteria[2]
    • At least 5 episodes or minimum of 3 over 6 mo
    • Nausea/vomitingepisodes lasting 1hr-10d, with 1 week in between
    • Stereotypical pattern and symptoms
    • Return to baseline health in between
    • Symptoms not due to another condition
  • Adult – Rome III criteria [3]
    • Stereotypical episodes of vomiting with acute onset lasting less than 1 week.
    • At least 3 episodes per year.
    • No nausea/vomiting between episodes.
    • Symptoms not due to another cause
  • Symptoms usually begin in early morning or upon waking
  • Prodrome of nausea--> vomiting
  • Episodes peak/decline over ~8h
  • Nausea typically not relieved by vomiting
  • +/-

Differential Diagnosis

Nausea and vomiting







See Also

External Links


  1. Fleisher DR, Gornowicz B, Adams K, Burch R, Feldman EJ. Cyclic Vomiting Syndrome in 41 adults: the illness, the patients, and problems of management. BMC Med. 2005 Dec 21. 3:20.
  2. Li BU, Lefevre F, Chelimsky GG, et al. North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition consensus statement on the diagnosis and management of cyclic vomiting syndrome. J Pediatr Gastroenterol Nutr. 2008 Sep. 47(3):379-93.
  3. Venkatasubramani N, Venkatesan T, Li BUK. Extreme Emesis: Cyclic Vomiting Syndrome. Practical Gastroenterology. September 2007. 31:21-34.