Current understanding of the etiology of cyclic vomiting syndrome and therapeutic strategies in its management

ABSTRACT

Introduction

Cyclic vomiting syndrome (CVS) is a chronic-debilitating disorder of the gut–brain interaction and is characterized by recurrent episodes of nausea and vomiting.

Recent studies indicate that it is common and affects 2% of the US population. Unfortunately, there is significant heterogeneity in the management of these patients in the medical community. This review article aims to bridge this gap and reviews the epidemiology and etiology with a focus on the management of CVS.

Areas covered

This article reviews the epidemiology and pathophysiology of CVS and its impact on patients. It also discusses management based on recent guidelines intended for the busy clinician. A literature search was done using PubMed, and keywords ‘cyclic vomiting,’ ‘management,’ ‘etiology,’ and pathophysiology were used to identify articles of importance.

Expert opinion

CVS is a complex, poorly understood disorder of gut–brain interaction and has a significant negative impact on patients, families, and the healthcare system. Recent guidelines recommend a multidisciplinary approach to management using prophylactic therapy for moderate–severe CVS and abortive medication for acute flares. However, more research is needed to better understand the pathophysiology and develop targeted therapies for CVS.

KEYWORDS:

• cyclic vomiting
• nausea
• amitriptyline
• aprepitant
• management
• pathophysiology

Article highlights

• CVS is a common chronic DGBI) with a prevalence of 2% of adults in the US.

• The etiology of CVS is not known, but multiple factors including genetic factors such as polymorphisms in the cannabinoid receptor gene, mitochondrial DNA, and environmental factors, such as stress are thought to play a role.

• CVS is diagnosed using clinical criteria called the Rome IV criteria as it lacks biomarkers.

• Treatment of CVS should be based on a biopsychosocial model of care including pharmacotherapy and strategies to address underlying psychological comorbidities, such as anxiety and depression, which are common.

Declaration of interest

T Venkatesan has disclosed being a consultant for Takeda Pharmaceuticals and study funding from Alnylam. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.