Rome IV Diagnostic Criteria for Cyclic Vomiting Syndrome
Official Rome IV criteria for the diagnosis of cyclic vomiting syndrome.
Use in patients with symptoms suggestive of cyclic vomiting syndrome (CVS) such as stereotypical episodes of vomiting with at least 3 discrete episodes in the prior year and 2 episodes in the past 6 months, occurring at least 1 week apart.
Patients with any of the following features must be evaluated clinically for other diagnoses even though CVS may be present:
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Signs or symptoms of GI bleeding.
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Unexplained iron deficiency anemia.
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Unintentional weight loss.
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Palpable abdominal mass or lymphadenopathy on exam.
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Family history of gastric cancer and no recent upper endoscopy.
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Dysphagia.
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Persistent vomiting.
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Neurologic symptoms.
If diagnostic criteria are not met (negative):
Symptoms are unlikely to be caused by cyclic vomiting syndrome. Consider further assessment for other diseases, or a different functional GI disorder.
If meets diagnosis (positive):
Likely diagnosis of cyclic vomiting syndrome.
Management of cyclic vomiting syndrome may include abortive treatment and prophylactic treatment.
For acute, abortive treatment, management may include:
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Intravenous hydration with 10% dextrose and potassium replenishment as needed.
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Antiemetics (especially serotonin 5-HT3 antagonists).
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Benzodiazepines.
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Triptans if headache is present.
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Opiate agents if severe pain is present.
For preventative, prophylactic treatment, management may include:
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Tricyclic antidepressants and other neuromodulators.
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Topiramate.
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Beta-blockers.
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Co-enzyme Q10.
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Cyproheptadine.
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This calculator should only be used in patients after appropriate organic, systemic, and metabolic causes have been ruled out after careful investigation.
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Note: cannabinoid hyperemesis syndrome should be excluded.