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Functional nausea and vomiting

Abstract

Although functional vomiting (FV), cyclic vomiting syndrome (CVS) and chronic idiopathic nausea (CIN) are fairly rare disorders, it has been increasingly recognized that these conditions can be highly disabling. Traditionally, FV, CVS and CIN have been under-investigated; however, interest in the cause and treatment of these disorders has increased, particularly with regard to their pathophysiology and the evaluation of new treatment approaches. This article presents a literature-based review of the nomenclature, pathophysiology, clinical presentation and management of CIN, CVS and FV. There is a dearth of randomized, controlled trials of treatments for these disorders, owing mainly to their low prevalence. Consequently, referral centers that see a large number of patients with these challenging disorders are working together to share their experience, so that the most productive treatment strategies can be used to help patients. Our knowledge of the treatment of FV, CVS and CIN, as best we know it, is presented here.

Key Points

  • Cyclic vomiting syndrome (CVS) is characterized by stereotypical and incapacitating attacks of nausea and vomiting; the prodromal phase often includes a distinct aura that precedes emesis

  • Attacks of CVS often have specific triggers and are associated with severe abdominal pain, pallor, phonophobia, excessive salivation and intense thirst

  • Avoidance of triggers, treatment with prophylactic antimigraine agents, 5-HT3 antagonists, benzodiazepines and 5-HT1 agonists (sumatriptan), with supportive therapy, are the cornerstones of management for patients with CVS

  • Unexplained vomiting at least once per week that is not cyclical is classified as functional vomiting

  • Chronic idiopathic nausea is characterized by nausea occurring several times per week in the absence of an identifiable organic cause

  • Reassurance and an ongoing and supportive physician–patient relationship, along with use of low-dose tricyclic antidepressants, can be beneficial in caring for patients with functional vomiting and chronic idiopathic nausea

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Figure 1: One possible management algorithm for cyclic vomiting syndrome.

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Correspondence to Kevin W Olden.

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Olden, K., Chepyala, P. Functional nausea and vomiting. Nat Rev Gastroenterol Hepatol 5, 202–208 (2008). https://doi.org/10.1038/ncpgasthep1094

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