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Cyclic Vomiting Syndrome and Cannabinoid Hyperemesis Syndrome

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Essential Medical Disorders of the Stomach and Small Intestine

Abstract

Cyclic vomiting syndrome (CVS) and cannabinoid hyperemesis syndrome (CHS) are related disorders characterized by stereotypical episodes of persistent, repetitive vomiting, separated by relatively asymptomatic periods. CVS and CHS often remain unrecognized for several years before patients are diagnosed, leading to extensive healthcare utilization and unnecessary diagnostic testing. Although the pathophysiology of CVS and CHS remains incompletely understood, convergent evidence points to a neurophysiological basis of these disorders. This chapter focuses on our current understanding of the contributing pathophysiological mechanisms in CVS and CHS, the clinical recognition of symptom patterns needed for diagnosis, and currently available therapeutic approaches.

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Essential Reading

  • Abell TL, Adams KA, Boles RG, Bousvaros A, Chong SK, Fleisher DR, et al. Cyclic vomiting syndrome in adults. Neurogastroenterol Motil. 2008 Apr;20(4):269–84.

    Article  CAS  Google Scholar 

  • 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;3:20.

    Article  Google Scholar 

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    Article  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Michael J. Kingsley & David J. Levinthal

  2. Department of Medicine, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA

    Michael J. Kingsley

Authors
  1. Michael J. Kingsley
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  2. David J. Levinthal
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Corresponding author

Correspondence to David J. Levinthal .

Editor information

Editors and Affiliations

  1. Mayo Clinic, Jacksonville, FL, USA

    Brian E. Lacy

  2. Mayo Clinic, Scottsdale, AZ, USA

    John K. DiBaise

  3. Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Mark Pimentel

  4. Leeds Teaching Hospitals NHS Trust, Leeds Gastroenterology Institute, Leeds, UK

    Alexander C. Ford

Self-Test

Self-Test

  • Question 1. Which of the following clinical patterns of CVS attack frequency and duration would not warrant the use of daily prophylactic medications?

    1. A.

      Six attacks per year, typically 5 days per episodes, all of which have led to ED visits and/or hospital admission

    2. B.

      Eight attacks per year, typically 3 days per episode, with the ability to abort most attacks at home using sumatriptan

    3. C.

      Three attacks per year, typically 12–18 h per episode, none of which have led to ED visits or hospital admission

    4. D.

      Four attacks per year, typically 4 days per episode, with the ability to abort most attacks in the ED using IV ondansetron, alprazolam, and diphenhydramine

    5. E.

      Five attacks per year, typically 2 days per episode, with the ability to generally avoid ED visits using home treatments that include alprazolam, ondansetron, hot showers, and rest

  • Question 2. Which of the following medications is not recognized as a useful prophylactic agent for CVS?

    1. A.

      Topiramate

    2. B.

      Nortriptyline

    3. C.

      Levetiracetam

    4. D.

      Alprazolam

    5. E.

      Coenzyme Q10

  • Question 3. Which of the following medical disorders is the most closely associated comorbidity in those with CVS?

    1. A.

      Epilepsy

    2. B.

      Hypertension

    3. C.

      GERD

    4. D.

      Migraine

    5. E.

      Type II diabetes

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Kingsley, M.J., Levinthal, D.J. (2019). Cyclic Vomiting Syndrome and Cannabinoid Hyperemesis Syndrome. In: Lacy, B., DiBaise, J., Pimentel, M., Ford, A. (eds) Essential Medical Disorders of the Stomach and Small Intestine. Springer, Cham. https://doi.org/10.1007/978-3-030-01117-8_4

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  • DOI: https://doi.org/10.1007/978-3-030-01117-8_4

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-01116-1

  • Online ISBN: 978-3-030-01117-8

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