THE POWER OF GUT FEELINGS

Purpose: Cyclic vomiting syndrome (CVS) is a perplexing disease, and is often a delayed diagnosis. As such, it leads to considerable distress in individual patients, and mounts a significant burden on the medical financial system. This report illustrates a case of its presentation, diagnosis, and management. Methods: A 29 year old female with a past medical history of migraines, borderline personality disorder, and depression presented with a 5 day history of intractable abdominal pain, nausea and vomiting. She admitted to experiencing these episodes, usually lasting from 5-7 days, about once a month for the past 8 years. Labs, imaging studies, and a gastric emptying study revealed no abnormalities. A toxicology screen was positive for marijuana, which the patient stated abstinence from for the past 2 months. Results: She was treated symptomatically, and counseled on the identification of possible triggers for vomiting episodes. She was discharged on a daily regimen of aripiprazole, topiramate, ranitidine, and flexeril. At a follow up visit 2 months later, she reported no recurrence of vomiting episodes or migraines. Conclusions: Cyclic vomiting syndrome represents a perplexing entity of the mind-gut continuum, and must be distinguished from cannabis hyperemesis in applicable patients. Associated with migraine headaches, it is a condition characterized by intractable vomiting episodes lasting from 1 hour to 10 days, with a return to normal health between episodes. Although cannabis hyperemesis differs in presentation with a noncyclic pattern, marijuana cessation is required for diagnosis. As CVS is a disease process proposed to have both physical and emotional contributions, successful treatment may require pharmacologic measures in conjunction with an awareness and avoidance of triggers.