What is the prognosis of cyclic vomiting syndrome (CVS)?

Updated: Oct 31, 2018
  • Author: Thangam Venkatesan, MD; Chief Editor: Carmen Cuffari, MD  more...
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Answer

Most published series indicate that CVS lasts an average of 2.5-5.5 years, resolving in late childhood or early adolescence. A few patients continue to be symptomatic through adulthood.

As early as 1898, clinicians observed that some patients went on to develop migraine headaches. That some children with CVS progress to abdominal migraines and then to migraine headaches implies that there may be a sequential progression of age-dependent manifestations of migraine.

A survey by Abu-Arafeh et al found the mean ages of children with CVS, abdominal migraines, and migraine headaches to be 5.3 years, 10.3 years, and 11.5 years, respectively. [31] This finding supports the developmental progression from vomiting to abdominal pain to headache. In unpublished data, Li and Hayes determined that nearly one third of patients develop migraines after resolution of CVS and predicted that nearly 75% would develop migraines by age 18 years.

A study of 31 patients with CVS by Hikita et al found that the median overall duration of the disorder was 66 months and that 44% of the patients seen for follow-up (25 patients) developed migraine. The authors also found abnormally high adrenocorticotropic hormone and antidiuretic hormone levels among the 25 patients for whom follow-up data were available. Significant correlations between attack duration and adrenocorticotropic hormone levels and attack duration and antidiuretic hormone levels were noted. [33]

Although patients are well about 90% of the time, CVS can be medically and socially disabling. More than 50% of patients require intravenous (IV) fluids, compared with less than 1% of patients with rotavirus gastroenteritis. The average annual cost of testing, treatment, and absenteeism totals $17,000. Children miss an average of 24 school days per year and often need home tutoring or, occasionally, home schooling. Additionally, because of its frequency during times of excitement, CVS has ruined many birthdays, holidays, and vacations. [30]

In adults, substantial morbidity is associated with CVS, perhaps because of lack of awareness and resultant delays in diagnosis. In a study of 41 CVS patients, Fleisher found that 32% were completely disabled at the time of diagnosis. [8] A total of 293 procedures were performed in the 41 patients, and none were indicative of organic etiology. In addition, 17 surgical procedures, including 10 cholecystectomies, appendectomies, exploratory laparotomies, a pyloroplasty, and a hysterectomy, were performed without any therapeutic benefit.

Adults and children with CVS also have multiple emergency department (ED) visits (see Table 1 below), and the diagnosis is often unrecognized. [34]

Table 1. Characteristics of Emergency Department Visits in Patients With Cyclic Vomiting Syndrome (Open Table in a new window)

Characteristic

Adults

(n = 104)

Children

(n = 147)

Number of ED visits per patient with CVS (median)

15 (range, 1-200)

10 (range, 1-175)

Number of ED visits before diagnosis of CVS (median)

7 (range, 1-150)

5 (range, 0-65)

Diagnosis not made in ED

89 (93%)

119 (93%)

Diagnosis not recognized in ED in patients with established diagnosis of CVS

84 (88%)

97 (80%)

Number of different EDs visited (mean ± SD)

4.69 ± 4.72

2.6 ± 2.42

CVS = cyclic vomiting syndrome; ED = emergency department; SD = standard deviation.


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