Treatment
The treatment of CVS is a difficult area, with relatively little research to support one form of treatment over another. Treatment often progresses in an empirical manner, by trial and error on an individual basis. However, in recent years medical expert panels have reviewed the evidence and published their views on the current best practice for treating both adults and children. These can be very helpful in guiding treatment options.
Guidelines
Guidelines for treatment of childhood CVS were agreed by a study group of medical expert paediatricians and published here:
North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Consensus Statement on the Diagnosis and Management of Cyclic Vomiting Syndrome
JPGN 47:379–393, 2008
B U.K. Li, Frank Lefevre, Gisela G. Chelimsky, Richard G. Boles, Susanne P. Nelson, Donald W. Lewis, Steven L. Linder, Robert M. Issenman, and Colin D. Rudolph
Guidelines for treatment of adult CVS were agreed by a study group of medical expert paediatricians and published here:
Guidelines on management of cyclic vomiting syndrome in adults by the American Neurogastroenterology and Motility Society and the Cyclic Vomiting Syndrome Association
Neurogastroenterology & Motility. 2019;31(Suppl. 2):e13604.
Thangam Venkatesan, David J. Levinthal, Sally E. Tarbell,Safwan S. Jaradeh. William L. Hasler, Robert M. Issenman, Kathleen A. Adams, Irene Sarosie, Christopher D. Stave, Ravi N. Sharaf, Shahnaz Sultan, B U. K. Li
Other
Treatment is otherwise supportive. During an episode it is often helpful to provide a dark, quiet environment. Intravenous fluids may be needed if the sufferer has become dehydrated, early use and monitoring are essential. Treatment with a range of anti-emetic and other drugs has been used. An individual may find a treatment that works for them, but there is nothing approaching a universal treatment regime. Between episodes a variety of treatments have been tried. Some can work well for some individuals, reducing frequency, duration or severity of an episode, but the same drug may provide no benefit to others. In most cases the evidence is anecdotal, relying on the opinion of the sufferer or parent, or the doctor.
With the increasing use of potent drugs, e.g. chemotherapeutic agents to fight cancer, the problem of drug induced vomiting also increased. Many cancer patients suffer severe vomiting in response to some treatments. This has led to research and development of better anti-emetic drugs. Use of these in CVS is quite common, but generally ad hoc, without trials to test the true effectiveness.
“Alternative” treatments
Along with many other charities we are often asked about “alternative” treatments. Whilst people can be frustrated at the slow pace of finding a treatment, or desperate as they or someone they know is so ill, we urge caution. To help patients, their family and friends weigh up claims about bogus treatments and ‘miracle cures’, patients, medical charities and Sense About Science are launching a new version of their guide “I’ve got nothing to lose by trying it”. The guide explores unproven treatments, ‘wonder drugs’ and ‘breakthrough’ therapies, to provide a tool for people who feel pressure to try things despite the lack of evidence to support them, but don’t know how to say no. The guide can empower them to ask critical questions about the evidence behind claims.
You can download the guide here.