MDCalc

Rome IV Diagnostic Criteria for Chronic Nausea Vomiting Syndrome (CNVS)

Official Rome IV criteria for the diagnosis of chronic nausea vomiting syndrome (CNVS).

Use in patients with symptoms suggestive of chronic nausea and vomiting syndrome (CNVS), such as bothersome nausea and vomiting for at least 6 months. 

Patients with any of the following features must be evaluated clinically for other diagnoses even though CNVS may be present:

  • Signs or symptoms of GI bleeding.

  • Unexplained iron deficiency anemia.

  • Unintentional weight loss.

  • Palpable abdominal mass or lymphadenopathy on exam.

  • Family history of GI cancer and no recent abdominal imaging.

  • Acute change in GI symptoms.

  • Dysphagia.

Must have the following:

For the last 3 months with symptom onset ≥6 months ago

Diagnostic Result

Please fill out required fields.
Advice

If diagnostic criteria are not met (negative):

Symptoms are unlikely to be caused by chronic nausea and vomiting syndrome. Consider further assessment for other diseases, or a different nausea and vomiting disorder.

If meets diagnosis (positive):

Likely diagnosis of chronic nausea and vomiting syndrome.

Management

Management of chronic nausea and vomiting syndrome may include:

  • Antiemetics:

    • H1 antagonists.

    • M1 antagonists.

    • D2 antagonists.

    • 5-HT3 antagonists.

    • NK1 antagonists.

    • Cannabinoids.

  • Tricyclic antidepressant.

  • Mirtazapine.

  • Olanzapine.

  • Behavioral therapy.

Critical Actions

  • This calculator should only be used in patients after appropriate organic, systemic, and metabolic causes have been ruled out after careful investigation, which includes upper endoscopy, particularly if the patient has alarm features.

  • Self-induced vomiting, eating disorders, regurgitation, and rumination should be excluded.