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    Rome IV Diagnostic Criteria for Child Cyclic Vomiting Syndrome

    Official Rome IV criteria for the diagnosis of child cyclic vomiting syndrome.

    INSTRUCTIONS

    Use in patients with symptoms suggestive of cyclic vomiting such as intense, paroxysmal, stereotypical episodes of vomiting, separated by weeks or months of usual health.

    Patients with any of the following alarm features must be evaluated clinically for other diagnoses even though cyclic vomiting may be present:

    • Severe abdominal pain.
    • Persistent right upper or right lower quadrant pain.
    • Pain radiating to the back.
    • Dysphagia or odynophagia.
    • Persistent or bilious vomiting.
    • Gastrointestinal blood loss.
    • Chronic, unexplained or nocturnal diarrhea.
    • Involuntary weight loss.
    • Deceleration of linear growth.
    • Delayed puberty.
    • Recurrent or unexplained fever.
    • Dysuria or hematuria.
    • Personality changes.
    • Severe headaches.
    • Ataxia.
    • Altered mental status.
    • Any neurologic abnormality.
    When to Use
    Pearls/Pitfalls
    Why Use

    Children or adolescents presenting with symptoms suggestive of cyclic vomiting for at least 6 months. The diagnosis of cyclic vomiting syndrome should be made by clinical history, positive symptom criteria, physical examination, and minimal testing. Additional diagnostic testing should be done as clinically indicated.

    • CVS presents as paroxysmal and stereotypical vomiting episodes which are clearly separated by weeks or months of usual health. Most patients are asymptomatic between episodes, while some may still experience mild, chronic baseline gastrointestinal symptoms.

    • Patients are typically quite ill during episodes and unable to participate in normal activities.

    • Extent of diagnostic evaluation depends on clinical judgement.

    • While bilious vomiting and severe abdominal pain can occur during a CVS episode, such symptoms should always prompt consideration for further diagnostic evaluations. 

    • A Brain MRI should be considered in case of an abnormal neurologic exam. 

    • Metabolic testing can be considered in young children age <2 years, if vomiting episodes are associated with fasting, illness or increased protein intake, or in the presence of any neurological findings.

    • Chronic cannabis use can be associated with repeated episodes of severe vomiting, nausea and abdominal pain, known as cannabinoid hyperemesis syndrome (CHS). Compulsive hot showering is often reported in patients with CHS but no longer considered pathognomonic. 

    • Triggers for CVS episodes include psychological stress, prolonged fasting, sleep deprivation, menses, motion sickness, or dietary triggers (high protein meal, chocolate, cheese, other food allergies). It is important to identify patient-specific triggers so they can be avoided.

    • Used to establish the diagnosis of cyclic vomiting syndrome in patients who present with episodic vomiting episodes.

    • Helps to differentiate from other functional disorders presenting with nausea and vomiting. 

    • Making a diagnosis will help avoid unnecessary testing, allows for appropriate education and for targeted treatment early on.

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    Next Steps
    Evidence
    Creator Insights
    Dr. Douglas Drossman

    About the Creator

    Douglas Drossman, MD, is professor emeritus of medicine and psychiatry at the University of North Carolina School of Medicine. He is founder, President Emeritus and Chief of Operations of the Rome Foundation. He is also the founder of the Drossman Center for the Education and Practice of Biopsychosocial Care and Drossman Consulting, LLC. Dr. Drossman has written over 500 articles and book chapters, has published two books, a GI procedure manual and a textbook of functional GI disorders (Rome I-IV), and serves on six editorial and advisory boards.

    To view Dr. Douglas Drossman's publications, visit PubMed

    Dr. Lin Chang

    About the Creator

    Lin Chang, MD is responsible for the oversight and coordination of the Rome IV calculators on MDCalc. She is a Professor of Medicine at the Vatche and Tamar Manoukian Division of Digestive Diseases at UCLA and is a member of the Rome Foundation Board of Directors.

    To view Dr. Lin Chang's publications, visit PubMed

    The Rome Foundation

    About the Creator

    The Rome Foundation is an independent not for profit 501(c) 3 organization that provides support for activities designed to create scientific data and educational information to assist in the diagnosis and treatment of Disorders of Gut-Brain Interaction (DGBI), also known as functional gastrointestinal (GI) disorders. Their mission is to improve the lives of people with DGBI. Over the last 3 decades, the Rome organization has sought to legitimize and update our knowledge of the DGBIs. This has been accomplished by bringing together scientists and clinicians from around the world to classify and critically appraise the science of GI function and dysfunction. This knowledge permits clinical scientists to make recommendations for diagnosis and treatment that can be applied in research and clinical practice. Diagnosis is based on the use of symptom-based criteria which are used in clinical trials and daily practice. The list of Rome IV categories and the Chair and Co-Chair of each chapter committee are listed below.

    Committees Chair Co-Chair
    Esophageal Disorders Ronnie Fass, MD John Pandolfino, MD
    Gastroduodenal Disorders Nicholas J. Talley, MD, PhD, FRACP Vincenzo Stanghellini, MD
    Bowel Disorders Fermin Mearin, MD Brian Lacy, MD, PhD
    Gallbladder and Sphincter of Oddi Disorders Grace Elta, MD Peter Cotton, MD
    Centrally Mediated Disorders of Gastrointestinal Pain Peter J. Whorwell, MD Laurie Keefer, PhD
    Anorectal Disorders Adil E. Bharucha, MD, MBBS Satish S. C. Rao, MD, PhD, FRCP
    Childhood Functional Gastrointestinal Disorders: Neonate/Toddler Sam Nurko, MD Marc A. Benninga, MD
    Childhood Functional Gastrointestinal Disorders: Child/Adolescent Carlo Di Lorenzo, MD Jeffrey S. Hyams, MD

    Rome IV Diagnostic Criteria Chapters, Chairs and Co-Chairs

    Rome IV Editorial Board: Douglas A. Drossman, MD, Senior Editor, Lin Chang, MD, William D. Chey, MD, John Kellow, MD, Jan Tack, MD, PhD, and William E. Whitehead, PhD.

    To view The Rome Foundation's publications, visit PubMed

    Content Contributors
    • Beate Beinvogl, MD, MPH
    Reviewed By
    • Samuel Nurko, MD, MPH
    About the Creator
    Dr. Douglas Drossman
    Dr. Lin Chang
    The Rome Foundation
    Content Contributors
    • Beate Beinvogl, MD, MPH
    Reviewed By
    • Samuel Nurko, MD, MPH