Cyclic vomiting syndrome: Pathophysiology, comorbidities, and future research directions

William L. Hasler*, David J. Levinthal, Sally E. Tarbell, Kathleen A. Adams, B. U.K. Li, Robert M. Issenman, Irene Sarosiek, Safwan S. Jaradeh, Ravi N. Sharaf, Shahnaz Sultan, Thangam Venkatesan

*Corresponding author for this work

Research output: Contribution to journalReview article

2 Scopus citations

Abstract

Cyclic vomiting syndrome (CVS) is characterized by severe episodic emesis in adults and children. Cannabinoid hyperemesis syndrome is an increasingly recognized CVS-like illness that has been associated with chronic cannabis use. There are significant gaps in our understanding of the pathophysiology, clinical features, comorbidities, and effective management options of CVS. Recommendations for treating CVS are based on limited clinical data, as no placebo-controlled, randomized trials have yet been conducted. Diseases associated with CVS, including migraine, mitochondrial disorders, autonomic dysfunction, and psychiatric comorbidities, provide clues about pathophysiologic mechanisms and suggest potential therapies. We review our current understanding of CVS and propose future research directions with the aim of developing effective therapy. Establishing a multicenter, standardized registry of CVS patients could drive research on multiple fronts including developing CVS-specific outcome measures to broaden our understanding of clinical profiles, to serve as treatment end points in clinical trials, and to provide a platform for patient recruitment for randomized clinical trials. Such a robust database would also facilitate conduct of research that aims to determine the underlying pathophysiological mechanisms and genetic basis for CVS, as well as identifying potential biomarkers for the disorder. Soliciting government and industry support is crucial to establishing the necessary infrastructure and achieving these goals. Patient advocacy groups such as the Cyclic Vomiting Syndrome Association (CVSA), which partner with clinicians and researchers to disseminate new information, to promote ongoing interactions between patients, their families, clinicians, investigators, to support ongoing CVS research and education, must be an integral part of this endeavor.

Original languageEnglish (US)
Article numbere13607
JournalNeurogastroenterology and Motility
Volume31
Issue numberS2
DOIs
Publication statusPublished - Jun 2019

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Keywords

  • Cannabinoids
  • cyclic vomiting
  • migraine headaches
  • multicenter registry
  • psychosocial dysfunction

ASJC Scopus subject areas

  • Physiology
  • Endocrine and Autonomic Systems
  • Gastroenterology

Cite this

Hasler, W. L., Levinthal, D. J., Tarbell, S. E., Adams, K. A., Li, B. U. K., Issenman, R. M., ... Venkatesan, T. (2019). Cyclic vomiting syndrome: Pathophysiology, comorbidities, and future research directions. Neurogastroenterology and Motility, 31(S2), [e13607]. https://doi.org/10.1111/nmo.13607