A Need to Raise Awareness for Cyclic Vomiting Syndrome: An Underdiagnosed Clinical Entity 1843

• Published in: The American journal of gastroenterology Vol. 113; no. Supplement; pp. S1047 - S1048
• Main Authors: Alam, Loba, Bhurwal, Abhishek, Franzese, John
• Format: Journal Article
• Language: English
• Published: New York Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins 01-10-2018
• Subjects: Anxiety; Gastroenterology; Metabolism; Thyroid gland; Vomiting; Young adults
• ISSN: 0002-9270; 1572-0241
• DOI: 10.14309/00000434-201810001-01843

Background: Cyclic Vomiting Syndrome (CVS) is characterized by recurrent episodes of severe nausea and vomiting separated by symptom free intervals that may last from days to months. The increasing prevalence in adults coupled with lack of awareness makes the diagnosis challenging. We describe a case of otherwise healthy young female with a delayed recognition of CVS leading to unnecessary health care utilization. The aim of this case report is to raise physician and patient awareness for early recognition and management. Case Report: A 23-year-old female with a past medical history of anxiety presented to the clinic with intermittent nausea, vomiting, and abdominal pain for the last two years. These episodes were exacerbated by stress and anxiety. Review of systems were negative for all other complaints including weight loss, changes in dietary habits, or bowel movements. She took no medications other than alprazolam for her anxiety. She denied using tobacco, alcohol, and illicit drugs. She was treated with a proton pump inhibitor, sucralfate, and dietary modifications with no symptomatic relief. She underwent several non-diagnostic endoscopies, serological tests, and radiological investigations. She was seen at our clinic for a second opinion. Physical exam was unremarkable. Her complete blood count, basic metabolic panel, liver chemistries, amylase, lipase, thyroid function tests, and celiac panel were normal. An abdominal ultrasound, gastric emptying study, and repeat EGD were unremarkable. Based upon history and exclusion of alternative diagnosis (pregnancy, thyroid, biliary, pancreatic, metabolic, motility, and medication related conditions), she was diagnosed with CVS. Supportive therapy including antiemetics and antacids was initiated. She was counseled on managing triggers such as stress and anxiety. Discussion:CVS is an increasingly prevalent and underdiagnosed clinical entity that affects young adults. Physicians should have a high index of suspicion for CVS in an otherwise healthy young adult with unexplained vomiting after a thorough unrevealing diagnostic workup. We suggest a clinical algorithm which aids in early diagnosis of CVS (Figure 1). An early recognition of CVS would have prevented multiple and repeated investigations in our patient. A widespread physician and patient awareness is needed for early diagnosis and treatment of CVS to prevent unnecessary workup, emergency room visits, and inpatient admissions, as in our patient.