Abstract
Cyclic vomiting syndrome (CVS) is an idiopathic illness characterized by stereotypic and sudden-onset episodes of intense retching and repetitive vomiting that are often accompanied by severe abdominal pain. Many associated factors that predict CVS attacks, such as prolonged periods of fasting, sleep deprivation, physical and emotional stress, or acute anxiety, implicate sympathetic nervous system activation as a mechanism that may contribute to CVS pathogenesis. Furthermore, adult patients with CVS tend to have a history of early adverse life events, mood disorders, chronic stress, and drug abuse—all associations that may potentiate sympathetic neural activity. In this review, we set forth a conceptual model in which CVS is viewed as a brain disorder involving maladaptive plasticity within central neural circuits important for allostatic regulation of the sympathetic nervous system. This model not only can account for the varied clinical observations that are linked with CVS, but also has implications for potential therapeutic interventions. Thus, it is likely that cognitive behavioral therapy, stress management (“mind–body”) interventions, regular exercise, improved sleep, and avoidance of cannabis and opiate use could have positive influences on the clinical course for patients with CVS.
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Abell TL, Adams KA, Boles RG, Bousvaros A, Chong SK, Fleisher DR et al (2008) Cyclic vomiting syndrome in adults. Neurogastroenterol Motil 20:269–284
Acuna-Goycolea C, Obrietan K, van den Pol AN (2010) Cannabinoids excite circadian clock neurons. J Neurosci 28(30):10061–10066
Allen J, de Moore G, Heddle R, Twartz J (2004) Cannabinoid hyperemesis: cyclical hyperemesis in association with chronic cannabis abuse. Gut 53:1566–1570
Armstrong J, Little M, Murray L (2003) Emergency department presentations of naltrexone-accelerated detoxification. Acad Emerg Med 10(8):860–866
Beckerman MA, Ogorodnik E, Glass MJ (2013) Acute morphine associated alterations in the subcellular location of the AMPA-GluR1 receptor subunit in dendrites of neurons in the mouse central nucleus of the amygdala: comparisons and contrasts with other glutamate receptor subunits. Synapse 67(10):692–704
Benowitz N, Rosenberg J, Rogers W, Bachman J, Jones R (1979) Cardiovascular effects of intravenous delta-9-cannabino: autonomic nervous mechanisms. Clin Pharmacol Ther 25:440–446
Berman S, Suyenobu B, Naliboff BD, Bueller J, Stains J, Wong H, Mandelkern M, Fitzgerald L, Ohning G, Gupta A, Labus JS, Tillisch K, Mayer EA (2012) Evidence for alterations in central noradrenergic signaling in irritable bowel syndrome. Neuroimage 63:1854–1863
Blechert J, Wilhelm FH, Meuret AE, Wilhelm EM, Roth WT (2013) Experiential, autonomic, and respiratory correlates of CO2 reactivity in individuals with high and low anxiety sensitivity. Psychiatry Res 209(3):566–573
Boles R (2011) High degree of efficacy in the treatment of cyclic vomiting syndrome with combined co-enzyme Q10, L-carnitine and amitriptyline, a case series. BMC Neurol 11:102
Boles R, Adams K, Li B (2005) Maternal inheritance in cyclic vomiting syndrome. Am J Med Genet Part A 133A(1):71–77
Boles R, Powers A, Adams K (2006) Cyclic vomiting syndrome plus. J Child Neurol 21:182–188
Boles RG, Zaki EA, Lavenbarg T, Hejazi R, Foran P, Freeborn J et al (2009) Are pediatric and adult-onset cyclic vomiting syndrome (CVS) biologically different conditions? Relationship of adult-onset CVS with the migraine and pediatric CVS-associated common mtDNA polymorphisms 16519T and 3010A. Neurogastroenterol Motil 21(9):936
Boles RG, Lovett-Barr MR, Preston A, Li BU, Adams K (2010) Treatment of cyclic vomiting syndrome with co-enzyme Q10 and amitriptyline, a retrospective study. BMC Neurol 10:10
Borsook D, Maleki N, Becerra L, McEwen B (2012) Understanding migraine through the lens of maladaptive stress responses: a model disease of allostatic load. Neuron 73(2):219–234
Bowman BR, Kumar NN, Hassan SF, McMullan S, Goodchild AK (2013) Brain sources of inhibitory input to the rat rostral ventrolateral medulla. J Comp Neurol 521(1):213–232
Bradford K, Shih W, Videlock EJ, Presson AP, Naliboff BD, Mayer EA, Chang L (2012) Association between early adverse life events and irritable bowel syndrome. Clin Gastroenterol Hepatol 10:385–390
Buajordet I, Naess A, Jacobsen D, Brørs O (2004) Adverse events after naloxone treatment of episodes of suspected acute opioid overdose. Eur J Emerg Med 11:19–23
Burioka N, Fukuoka Y, Koyanagi S, Miyata M, Takata M, Chikumi H et al (2010) Asthma: chronopharmacotherapy and the molecular clock. Adv Drug Deliv Rev 62(9–10):946–955
Cameron AA, Khan IA, Westlund KN, Willis WD (1995) The efferent projections of the periaqueductal gray in the rat: a phaseolus vulgaris-leucoagglutinin study II. Descending projections. J Comp Neurol 351(4):585–601
Chandola T, Ferrie J, Perski A, Akbaraly T, Marmot M (2010) The effect of short sleep duration on coronary heart disease risk is greatest among those with sleep disturbance: a prospective study from the Whitehall II cohort. Sleep 33:739–744
Chelimsky T, Chelimsky G (2007) Autonomic abnormalities in cyclic vomiting syndrome. J Pediatr Gastroenterol Nutr 44:326–330
Chelimsky G, Madan S, Alshekhlee A, Heller E, McNeeley K, Chelimsky T (2009) A comparison of dysautonomias comorbid with cyclic vomiting syndrome and with migraine. Gastroenterol Res Pract 2009:701019
Chong SK (1999) Electrogastrography in cyclic vomiting syndrome. Dig Dis Sci 144(8 Suppl):64S–73S
Choung R, Locke G, Lee R, Schleck C, Zinsmeister A, Talley N (2012) Cyclic vomiting syndrome and functional vomiting in adults: association with cannabinoid use in males. Neurogastroenterol Motil 24:20-e1
Copersino M, Boyd S, Tashkin D, Huestis M, Heishman S, Dermand J et al (2010) Sociodemographic characteristics of cannabis smokers and the experience of cannabis withdrawal. Am J Drug Alcohol Abuse 36:311–319
Cupini L, Santorelli F, Iani C, Fariello G, Calabresi P (2003) Cyclic vomiting syndrome, migraine, and epilepsy: a common underlying disorder? Headache 43:407–409
Danese A, McEwen BS (2012) Adverse childhood experiences, allostasis, allostatic load, and age-related disease. Physiol Behav 106(1):29–39
Dimsdale JE (2008) Psychological stress and cardiovascular disease. J Am Coll Cardiol 51(13):1237–1246
Diniz L, dos Santos TB, Britto LR, Céspedes IC, Garcia MC, Spadari-Bratfisch RC, Medalha CC, de Castro GM, Montesano FT, Viana MB (2013) Effects of chronic treatment with corticosterone and imipramine on fos immunoreactivity and adult hippocampal neurogenesis. Behav Brain Res 238:170–177
Donnino MW, Cocchi MN, Miller J, Fisher J (2011) Cannabinoid hyperemesis: a case series. J Emerg Med 40(4):e63–e66
Drossman DA (1999) Review article: an intergrated approach to the irritable bowel syndrome. Aliment Pharmacol Ther 13(Suppl 2):3–14
Fleisher D (1997) Cyclic vomiting syndrome: a paroxismal disorder of brain-gut interaction. J Pediatr Gastroenterol Nutr 25:S13–S15
Fleisher DR, Gornowicz B, Adams K, Burch R, Feldman EJ (2005) Cyclic vomiting syndrome in 41 adults: the illness, the patients, and problems of management. BMC Med 3:20
Gori S, Morelli N, Maestri M, Fabbrini M, Bonanni E, Murri L (2005) Sleep quality, chronotypes and preferential timing of attacks in migraine without aura. J Headache Pain 6:258–260
Grassi G, Bombelli M, Seravalle G, Dell’Oro R, Quarti-Trevano F (2010) Diurnal blood pressure variation and sympathetic activity. Hypertens Res 33:381–385
Gupta A, Shetty H (2005) Circadian variation in stroke: a prospective hospital-based study. Int J Clin Pract 59(11):1272–1275
Hejazi R, McCallum R (2011) Review article: cyclic vomiting syndrome in adults-rediscovering and redefining an old entity. Aliment Pharmacol Ther 34:263–273
Hejazi R, Lavenbarg T, Foran P, McCallum R (2010) Who are the non-responders to standard treatment with tricyclic antidepressant agents for cyclic vomiting syndrome in adults? A large single center experience. Aliment Pharmacol Ther 31(999A):295–301
Holm JE, Lokken C, Myers TC (1997) Migraine and stress: a daily examination of temporal relationships in women migraineurs. Headache 37:553–558
Jia E, Xu Z, Cai H, Guo C, Li L, Zhu T et al (2012) Time distribution of the onset of chest pain in subjects with acute ST-elevation myocardial infarction: an eight-year, single-center study in China. PLoS ONE 7:e32478
Juster R-P, McEwen BS, Lupien SJ (2010) Allostatic load biomarkers of chronic stress and impact on health and cognition. Neurosci Biobehav Rev 35(1):2–16
Juster R-P, Sindi S, Marin M-F, Perna A, Hashemi A, Pruessner JC et al (2011) A clinical allostatic load index is associated with burnout symptoms and hypocortisolemic profiles in healthy workers. Psychoneuroendocrinology 36(6):797–805
Kalsbeek A, van der Spek R, Lei J, Endert E, Buijs RM, Fliers E (2012) Circadian rhythms in the hypothalamo-pituitary-adrenal (HPA) axis. Mol Cell Endocrinol 349:20–29
Kawano Y, Tochikubo O, Minamisawa K, Miyajima E, Ishii M (1994) Circadian variation of haemodynamics in patients with essential hypertension: comparison between early morning and evening. J Hypertens 12:1405–1412
Levin K, Copersino M, Heishman S, Liu F, Kelly D, Boggs D et al (2010) Cannabis withdrawal symptoms in non-treatment-seeking adult cannabis smokers. Drug Alcohol Depend 111:120–127
Li B, Lefevre F, Chelimsky G, Boles R, Nelson S, Lewis D et al (2008) North American society for pediatric gastroenterology, hepatology, and nutrition consensus statement on the diagnosis and management of cyclic vomiting syndrome. J Pediatr Gastroenterol Nutr 47:379–393
Lisowski Pl, Lisowski Pl, Juszczak GR, Goscik J, Stankiewicz AM, Wieczorek M, Zwierzchowski L, Swiergiel AH (2013) Stress susceptibility-specific phenotype associated with different hippocampal transcriptomic responses to chronic tricyclic antidepressant treatment in mice. BMC Neurosci 14:144
McDonald T, Hoffman W, Berkowitz R, Cunningham F, Cooke B (1999) Heart rate variability and plasma catecholamines in patients during opioid detoxification. J Neurosurg Anesthesiol 11:195–199
McEwen BS (2012) Brain on stress: how the social environment gets under the skin. Proc Natl Acad Sci USA 109(Suppl 2):17180–17185
McEwen BS, Gianaros PJ (2011) Stress- and allostasis-induced brain plasticity. Annu Rev Med 62:431–445
Meerlo P, Sgoifo A, Suchecki D (2008) Restricted and disrupted sleep: effects on autonomic function, neuroendocrine stress systems and stress responsivity. Sleep Med Rev 12:197–210
Muller J, Stone P, Turi Z, Rutherford J, Czeisler C, Parker C et al (1985) Circadian variation in the frequency of onset of acute myocardial infarction. N Engl J Med 313:1315–1322
Namin F, Patel J, Lin Z, Sarosiek I, Foran P, Esmaeili P, McCallum R (2007) Clinical, psychiatric and manometric profile of cyclical vomiting syndrome in adults and response to tricyclic therapy. Neurogastroenterol Motil 19:196–202
Napier LD, Stanfill A, Yoshishige DA, Jackson KE, Barron BA, Caffrey JL (1998) Autonomic control of heart rate in dogs treated chronically with morphine. Am J Physiol 275(6):H2199–H2210
Pavlova M, Woo LJ, Yilmaz F, Dworetzky B (2012) Diurnal pattern of seizures outside the hospital: is there a time of circadian vulnerability? Neurology 78:1488–1492
Prakash C, Clouse RE (1999) Cyclic vomiting syndrome in adults: clinical features and response to tricyclic antidepressants. Am J Gastroenterology 94:2855–2860
Price JL, Amaral DG (1981) An autoradiographic study of the projections of the central nucleus of the monkey amygdala. J Neurosci 1(11):1242–1259
Puente N, Elezgarai I, Lafourcade M, Reguero L, Marsicano G, Georges F, Manzoni OJ, Grandes P (2010) Localization and function of the cannabinoid CB1 receptor in the anterolateral bed nucleus of the stria terminalis. PLoS On 5(1):e8869
Rashed H, Abell T, Familoni B, Cardoso S (1999) Autonomic function in cyclic vomiting syndrome and classic migraine. Dig Dis Sci 44:74S–78S
Rinaldo P (1999) Mitochondrial fatty acid oxidation disorders and cyclic vomiting syndrome. Dig Dis Sci 44:97S–102S
Schmid K, Schonlebe J, Drexler H, Mueck-Weymann M (2010) The effects of cannabis on heart rate variability and well-being in young men. Pharmacopsychiatry 43:147–150
Sterling P (2012) Allostasis: a model of predictive regulation. Physiol Behav 106(1):5–15
Taché Y (1999) Cyclic vomiting syndrome: the corticotropin-releasing-factor hypothesis. Dig Dis Sci 44(8 Suppl):79S–86S
Taché Y, Perdue MH (2004) Role of peripheral CRF signalling pathways in stress-related alterations of gut motility and mucosal function. Neurogastroenterol Motil 16(Suppl 1):137–142
Tack J, Talley NJ, Camilleri M, Holtmann G, Hu P, Malagelada J-R et al (2006) Functional gastroduodenal disorders. Gastroenterology 130(5):1466–1479
Taupin P (2006) Neurogenesis and the effect of antidepressants. Drug Target Insights 1:13–17
Tjen-A-Looi SC, Li P, Longhurst JC (2009) Processing cardiovascular information in the vlPAG during electroacupuncture in rats: roles of endocannabinoids and GABA. J Appl Physiol 106(6):1793–1799
To J, Issenman RM, Kamath MV (1999) Evaluation of neurocardiac signals in pediatric patients with cyclic vomiting syndrome through power spectral analysis of heart rate variability. J Pediatr 153:363–366
van der Kooy D, Koda LY, McGinty JF, Gerfen CR, Bloom FE (1984) The organization of projections from the cortex, amygdala, and hypothalamus to the nucleus of the solitary tract in rat. J Comp Neurol 224(1):1–24
van Oosterhout F, Lucassen EA, Houben T, vanderLeest HT, Antle MC, Meijer JH (2012) Amplitude of the SCN clock enhanced by the behavioral activity rhythm. PLoS ONE 7(6):e39693
Van Oudenhove L, Vandenberghe J, Geeraerts B, Vos R, Persoons P, Fischler B, Demyttenaere K, Tack J (2008) Determinants of symptoms in functional dyspepsia: gastric sensorimotor function, psychosocial factors or somatisation? Gut 57(12):1666–1673
Venkatesan T, Prieto T, Barboi A, Li B, Schroeder A, Hogan W et al (2010) Autonomic nerve function in adults with cyclic vomiting syndrome: a prospective study. Neurogastroenterol Motil 22:1303–1307
Videlock EJ, Adeyemo M, Licudine A, Hirano M, Ohning G, Mayer M, Mayer EA, Chang L (2009) Childhood trauma is associated with hypothalamic-pituitary-adrenal axis responsiveness in irritable bowel syndrome. Gastroenterology 137:1954–1962
Wang Q, Ito M, Adams K, Li B, Klopstock T, Maslim A et al (2004) Mitochondrial DNA control region sequence variation in migraine headache and cyclic vomiting syndrome. Am J Med Genet A 131:50–58
Webb I, Patton D, Landry G, Mistlberger RE (2010) Circadian clock resetting by behavioral arousal: neural correlates in the midbrain raphe nuclei and locus coeruleus. Neuroscience 166:739–751
Wilson-Poe AR, Morgan MM, Aicher SA, Hegarty DM (2012) Distribution of CB1 cannabinoid receptors and their relationship with mu-opioid receptors in the rat periaqueductal gray. Neuroscience 213:191–200
Yan J, Li J, Yan J, Sun H, Wang Q, Chen K, Sun B, Wei X, Song L, Zhao X, Wei S, Han L (2013) Activation of μ-opioid receptors in the central nucleus of the amygdala induces hypertonic sodium intake. Neuroscience 233:28–43
Zaki E, Freilinger T, Klopstock T, Baldwin E, Heisner K, Adams K et al (2009) Two common mitochondrial DNA polymorphisms are highly associated with migraine headache and cyclic vomiting syndrome. Cephalalgia 29(7):719–728
Zhong X, Hilton HJ, Gates GJ, Jelic S, Stern Y, Bartels MN, Demeersman RE, Basner RC (2005) Increased sympathetic and decreased parasympathetic cardiovascular modulation in normal humans with acute sleep deprivation. J Appl Physiol (1985) 98(6):2024–2032
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Levinthal, D.J., Bielefeldt, K. Adult cyclical vomiting syndrome: a disorder of allostatic regulation?. Exp Brain Res 232, 2541–2547 (2014). https://doi.org/10.1007/s00221-014-3939-4
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DOI: https://doi.org/10.1007/s00221-014-3939-4