Doctors Urge Patients With Chronic Vomiting to Not Suffer in Silence

In an attempt to raise awareness, the American Gastroenterological Association has issued new guidance on cyclic vomiting syndrome.
CVS is a chronic, debilitating condition characterized by sudden episodes of intense nausea and vomiting. Kleber Cordeiro/Shutterstock
By Emma Suttie, D.Ac, AP
Updated:
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The American Gastroenterological Association (AGA) has issued new clinical guidance on cyclic vomiting syndrome (CVS), a disorder that causes sudden, severe episodes of nausea and vomiting. The guidance aims to help clinicians and patients more effectively identify the signs and symptoms of CVS, leading to faster diagnosis and better treatment options.

The AGA Clinical Practice Update was published today in Gastroenterology.

“Most patients with cyclic vomiting syndrome (CVS) can benefit substantially from currently available treatments, but this disorder remains poorly recognized by clinicians,” author Dr. David Levinthal told The Epoch Times.

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“Thus, there remains a very large ‘treatment gap’ for adults that continue to suffer needlessly without access to effective therapy. We hope that this clinical practice update will draw attention to CVS and educate the medical community about how to diagnose and treat this disorder,” he said.

Dr. Levinthal is the director of the Neurogastroenterology and Motility Center at the University of Pittsburgh Medical Center and one of the authors of the AGA Clinical Practice Update.

Dr. Levinthal explained how the new guidelines will enhance and build upon their predecessor—which he helped to shape—and were released in 2019.
“In the 5 years since the release of the ANMS-CVSA guidelines, we have continued to learn more about CVS,” he said. “This practice update is meant to be of high clinical value to physicians across a wide spectrum of disciplines—primary care providers, gastroenterologists, emergency medicine physicians, and others—who are on the front lines seeing patients with CVS.”

What Is CVS?

Cyclic vomiting syndrome is a common, debilitating condition affecting up to two percent of the population. According to the press release, most patients can go for years without receiving a diagnosis and effective treatment.
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Although there are effective treatments for CVS, the condition often remains undiagnosed and, as a result, is not treated correctly. According to the press release, CVS is frequently misdiagnosed as stomach flu or food poisoning, and the new guidelines state that many patients undergo years of delays, unnecessary testing, and even surgical procedures.

Cyclic vomiting syndrome is a long-term condition involving the gut and brain, which is marked by sudden bouts of severe nausea, vomiting, and retching, followed by periods that are free of symptoms.

CVS can be categorized as mild—with fewer than four episodes per year, each lasting less than two days—or moderate to severe—with more than four episodes per year, each lasting over two days, and often requiring emergency room visits or hospital stays. Between episodes, patients typically do not experience repeated vomiting, but they may have mild symptoms like nausea, indigestion, and occasional vomiting.

Who Is At Risk?

While CVS can affect anyone, it is more prevalent in women and young adults.
The new guidelines state that in adults, CVS is often associated with mood disorders like anxiety, depression, and panic disorder, which, collectively, are found in 50 to 60 percent of patients. Additionally, a significant number of adult CVS patients experience migraines (20 to 30 percent), and about 3 percent experience seizure disorders, indicating these episodic conditions may share a common underlying mechanism.

Better Care for Patients

Dr. Levinthal shared with The Epoch Times his insights on how the new guidelines will inform patient care moving forward:
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“We sought to make this clinical practice update as practical as possible—highlighting what is typical in CVS-related care, while also recognizing some of the challenges to management. We hope that this guidance helps clinicians work with their CVS patients to implement the best care possible.”

He says this includes educating patients about lifestyle interventions that can positively impact the condition, what medications can be taken and when, and which CVS patients could most benefit.

“We have tried to create a ‘state of the art’ guide for CVS management, and hopefully, this really will impact patient care,” he said.

While the new guidelines aim to increase awareness of CVS among both clinicians and patients, Dr. Levinthal emphasized that further research is necessary because some aspects of CVS remain unclear.

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“Although CVS is classified as a ‘disorder of gut-brain interaction,’ we truly do not understand the pathophysiologic basis of this disorder. The future for CVS care hinges on research that uncovers disease mechanisms that can be targeted and form basis for personalized medicine approaches,” he said, adding, “There is plenty of need for research in CVS.”

Increased Awareness, Diagnosis, and Treatment

Dr. Levinthal highlights that the updated guidelines include several important points.

“The key to improving the diagnostic gap for CVS is to recognize the defining episodic nature of the illness. And CVS is often responsive to treatment. In essence, improving the clinical recognition of CVS will serve to improve health for adults suffering for years without relief.”

He said that approximately 50 percent of adult CVS patients visit the emergency department annually due to inadequate access to effective treatment and that enhancing access to treatment for adults with CVS will enhance patients’ quality of life and significantly alleviate strain on the health care system.

Support and Resources for Patients

If you have CVS or suspect you may have the condition, please visit the Cyclical Vomiting Syndrome Association website for more information.
Emma Suttie
Emma Suttie
D.Ac, AP
Emma is an acupuncture physician and has written extensively about health for multiple publications over the past decade. She is now a health reporter for The Epoch Times, covering Eastern medicine, nutrition, trauma, and lifestyle medicine.
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