Cyclical Vomiting Syndrome, also known as CVS, is a rare disease defined by The National Institute of Diabetes and Digestive and Kidney Diseases as: “A disorder that causes sudden, repeated attacks -called episodes— of severe nausea and vomiting. Episodes can last from a few hours to several days. Episodes alternate with longer periods of no symptoms.”
FACTS ABOUT CVS
- Doctors are unsure what causes CVS, but it is sometimes linked to migraines.
- It is considered both a neurological and gastrointestinal syndrome.
- Triggers can include greasy food, cheese, chocolate, caffeine, too much excitement and stress.
- Children can grow out of the disease, but 75% will grow up to have migraines.
- The most notable fact is perhaps that there is no cure for CVS— just symptom control.
DEMOGRAPHICS FOR CVS PATIENTS
- Prevalence is the same in both adults and children, with a total of 6 new cases per year amongst less than 200,000 people total in the US.
- Among adults 6 out of 10 patients are Caucasian with the other 4 spread evenly among other ethnicities.
- CVS is more common in female patients.
- Children with CVS miss an average of 3 weeks of school per year, while adults vary on whether they can work at all to missing that same amount of work.
CURRENT CVS TREATMENTS
- Anti-nausea medications
- Pain relief medication
- Medications that suppress stomach acid
- Antidepressants (these help to stabilize mood changes, which can initiate an episode)
- Antiseizure medication
FUTURE CVS TREATMENTS
- Currently 16 clinical trials are underway studying CVS, including but not limited to Topical Capsaicin, Droperidol, Q10 Coenzyme, Auricular Neurostimulation and Staccato Granisetron.
- Topical Capsaicin is an ointment used to treat minor aches and pains.
- Droperidol is an IV or IM drug used as an antiemetic.
- Q10 Coenzyme is an enzyme found naturally in the body and this pill is used to help replace it in CVS patients.
- Auricular neurostimulation is an alternative non-invasive procedure that helps reduce GI issues in children and may replace the effects of morphine.
- Staccato Granisetron is currently used during IV chemotherapy and is an antiemetic as well.
CODING OF CVS
- Code R11.15 cyclical vomiting syndrome unrelated to migraine
- Code G43.A1 cyclical vomiting, in migraine, intractable when it is with migraine
Cyclical vomiting syndrome is a disease few have heard of and even fewer know about. It is a disease that impacts both the patient and the patient’s family. CVS is a disease with promising treatments but no cure.
CVS awareness matters because it is a rare disease and awareness has an impact on research. CVS matters to me because my 5-year-old daughter lives with this rare disease, but it does not define her. Please help raise awareness for CVS and share this blog.
Alicia R. Blamble, RHIA
Managing Auditor