Cyclic vomiting syndrome

Prevalence: 0.04 to 1.9 % of the pediatric population less than 10 years of age: after 10 years of age, 75 % of the cases are evolving towards a migraine syndrome. It is part of the "episodic symptoms associated with migraines" as well:

-        benign paroxysmal vertigo

-        abdominal migraine

-        paroxysmal torticollis.

Intractable vomiting crises last from a few hours to a few days, interspaced by asymptomatic periods. In some cases, these crises are repetitive at regular intervals. Parents are often able to detect the triggering event (stress, fatigue). Diagnosis is difficult because no sign or test is specific.

The so-called Rome IV diagnosis criteria are:

1 - at least 2 episodes of intense and continuous nausea associated with vomiting episodes for a few hours to a few days during the last 6 months

2 - stereotyped episodes in each patient

3 - episod at thees separated by a few weeks to a few months with return to the initial state of patient's health

4 - on the basis of a well conducted medical assessment, these symptoms can not be attributed to any other disorder

The cause of this condition is unknown: migrainous equivalent ? Mitochondrial anomaly ? calcium channels anomaly ? disorder of intestinal motility?

Different pahses:

-        prodromal phase: feeling sick with slight abdominal pain, lethargy

-        state phase: intense vomiting with neurovegetative signs: photo - phonophobia, headache, paleness...

-        recovery phase: sleep onset and disappearance of nausea.

Various treatments have been tried with relative success: in acute phase: tryptans, setrons, IV rehydration. In some cases the administration of benzodiazepine early when the crisis starts can shorten the duration. Prophylaxis in frequent cases: cyproheptadine, amitriptyline, valproic acid, ß-blocker, carnitine. ...


Anesthetic implications:

in principle, propofol total intravenous anesthesia, but there exists no anesthetic data on this subject. Antiemetic prophylaxis. Ensure that hydration, blood sugar and electrolytes are normal.

Differential diagnosis: adrenal insufficiency, acute intermittent porphyria crisis (see this term)


References :

-                Brezin F, Wiedemann A, Feillet F.
Le syndrome des vomissements cycliques de lenfant.
Arch Pédiatr 2017 ; 27 : 1129-36.


Updated: October 2017