Chronic Functional Vomiting


Chronic Functional Vomiting, Chronic Vomiting, Chronic Nausea Vomiting Syndrome, Cyclic Vomiting Syndrome

  • Definitions
  1. Chronic Nausea and Vomiting
    1. Nausea and Vomiting persisting longer than one month
  • Epidemiology
  1. Chronic Functional Vomiting Prevalence 3% in U.S.
  • Types
  • Chronic Functional Vomiting
  1. Chronic Nausea Vomiting Syndrome
    1. Bothersome Nausea or Vomiting weekly for 3 months or more AND
    2. No other organic or psychological cause identified despite thorough evaluation including endoscopy
  2. Cyclic Vomiting Syndrome
    1. Discrete, recurrent Vomiting episodes
    2. Episodes are often preceded by Nausea, and may be accompanied with Diarrhea, dipahoresis
    3. Vomiting follows Nausea and last up to 7 days
  3. Cannabinoid Hyperemesis Syndrome
    1. See Cannabinoid Hyperemesis
    2. May be a subset of Cyclic Vomiting Syndrome
  • History
  1. See Vomiting History
  2. Red Flags and Risks for Serious Causes of Chronic Vomiting
    1. Age >55 years
    2. Early satiety
    3. Feculent Vomiting
    4. Persistent Vomiting >7 days
    5. Dysphagia (esp. progressive)
    6. Severe Abdominal Pain
    7. Unintentional Weight Loss (>5%)
  • Exam
  1. See Vomiting
  2. Red Flags and Risks for Serious Causes of Chronic Vomiting
    1. Abdominal peritoneal findings
    2. Altered Level of Consciousness or focal neurologic deficits
    3. Gastrointestinal Bleeding
    4. Jaundice
    5. Palpable abdominal mass
  • Labs
  1. See Vomiting for acute laboratory testing (e.g. comprehensive metabolic panel, serum Lipase)
  2. Additional labs to consider for Chronic Vomiting
    1. Thyroid Stimulating Hormone (TSH)
    2. Serum Cortisol (for Addison disease)
    3. Urine Drug Screen
      1. Consider in suspected Cannabinoid Hyperemesis Syndrome
  • Imaging
  1. Upper endoscopy
    1. Consider for the evaluation of gastroduodenal disorders
  2. CT Abdomen and Pelvis
    1. Consider for evaluation of Small Bowel Obstruction, mass
  3. CT Head
    1. Consider for CNS mass lesions
  4. Other second-line advanced diagnostic testing
    1. MR Enterography
    2. Gastric emptying study
    3. Gastric manometry
    4. Esophageal pH
    5. Rare metabolic disorder evaluation (e.g. organic acids, ammonia levels)
  • Evaluation
  • Persistent Unexplained Vomiting
  1. Complete history, physical, diagnostics completed
  2. Consider dysmotility evaluation
    1. Consider possible Gastroparesis causes
    2. Consider empiric prokinetic
  3. Consider functional causes or Psychogenic Vomiting
  4. Consider longterm symptomatic therapy