Cyclic vomiting syndrome: a brain-gut disorder

Cyclic vomiting syndrome (CVS), a severe, recurrent vomiting disorder affecting both children and adults is diagnosed by the consensus criteria of 1994. Despite its episodic nature, CVS causes a high degree of academic and work morbidity, and medical costs for sufferers. Although the differential diagnosis cuts across numerous systems, most cases have a link to clinical migraine. Empiric pharmacologic therapy involves prophylactic and abortive antimigraine, anti-emetic, and anti-epileptic agents. Current theories on pathogenesis include known migraine electrophysiologic events, predisposing cellular energy deficits, potential mediating role of corticotropin-releasing factor, and altered autonomic regulation in the brain stem.