Diagnosis of Cyclical Vomiting Syndrome
Diagnosis of cyclical vomiting syndrome is largely clinical, based on the patient’s medical history and pattern of symptoms. There is no single test that confirms the diagnosis of cyclical vomiting syndrome, which often leads to delays in identification. Doctors must rule out other causes of recurrent vomiting before confirming CVS.
Medical History
A thorough history is the cornerstone of diagnosis:
Recurrent episodes of vomiting, separated by periods of normal health
Each episode follows a similar pattern in terms of duration, frequency, and intensity
Triggers such as stress, infections, or specific foods may be identified
Family history of migraines or gastrointestinal disorders is common
Diagnostic Criteria | Diagnosis of Cyclical Vomiting Syndrome
Doctors often use the Rome IV criteria, which are guidelines for diagnosing functional gastrointestinal disorders:
At least three episodes in the past year
Each episode involves intense nausea and vomiting lasting less than one week
Complete resolution between episodes
No other condition explains the symptoms
These criteria are useful in both children and adults.
Physical Examination
During the symptom-free phase, physical exams are usually normal. However, during an episode, signs may include:
Dehydration
Lethargy or weakness
Abdominal tenderness
Increased heart rate or low blood pressure
Tests to Rule Out Other Conditions
To exclude other causes of vomiting, the following may be ordered:
Blood tests: To check for infection, electrolyte imbalances, or kidney issues
Urinalysis: To rule out urinary infections or metabolic disorders
Abdominal ultrasound or CT scan: To identify structural problems like blockages
Endoscopy: To examine the oesophagus and stomach if reflux or ulcers are suspected
Neurological evaluation: Especially if migraines or seizures are part of the history
Referral to Specialists
Children are often referred to a paediatric gastroenterologist, while adults may be seen by a gastroenterologist or neurologist if migraine association is suspected.
In summary, diagnosis of cyclical vomiting syndrome involves recognising consistent symptom patterns and ruling out other medical conditions. Early identification allows for appropriate management and prevention of further complications.
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