Cyclic Vomiting Syndrome – a global perspective

Review by Prof. Eamonn Quigley (USA)

Study Summary 

Cyclic vomiting syndrome (CVS) is thought to be a relatively uncommon but disabling condition. It remains poorly understood. For the most part, its epidemiology is relatively poorly defined, and treatment remains largely empiric and unguided by high quality clinical trials. In this manuscript, the authors accessed data obtained through the Rome Foundation Global Epidemiology Study to examine global trends in CVS. Among 54,127 survey respondents the overall prevalence of CVS was 0.3% being most common in Brazil at 1% and lowest in Germany and Japan where no subjects reported being affected by CVS (as defined by Rome IV clinical criteria). CVS was more common among women (57% vs 44%), and the mean age of CVS sufferers was 36.7 years. CVS was associated with anxiety, depression, somatization and impaired quality of life (both medical and physical components). CVS sufferers were much more likely to seek medical attention and to consume analgesics.

Commentary 

Clinicians will readily recognize the characteristic features of the CVS sufferer as identified in this study; young, female with co-morbid anxiety and depression and experiencing significant disruption in their daily lives because of CVS symptoms. Not surprisingly, given its links to migraine, headaches were more than 4-fold more common among CVS sufferers than controls; thus, presumably, explaining their recourse to analgesics. Why were there such dramatic variations in prevalence (10-fold) between countries? This remains unexplained and deserves further study. The level of awareness of the entity together with the lack of a diagnostic test or biomarker resulting in reliance of clinical criteria could contribute to variations in prevalence and its differentiation from other causes of recurrent vomiting such as gastroparesis is certainly challenging and lead to misclassification. These results emphasize that CVS, though not very common, is certainly not rare and is undoubtedly disabling. To help these sufferers we need  a much better understanding of its etiology and effective management strategies.

Citation

Izagirre A, Sarasqueta C, Flores-Arriaga J, et al. Worldwide prevalence and description of cyclic vomiting syndrome according to the results of the Rome Foundation Global Epidemiology Study. Am J Gastroenterol 2025;120:1108-1115.

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