Diagnosis of Cyclic Vomiting Syndrome

How do doctors diagnose cyclic vomiting syndrome?

Doctors diagnose cyclic vomiting syndrome based on family and medical history, a physical exam, pattern of symptoms, and medical tests. Your doctor may perform medical tests to rule out other diseases and conditions that may cause nausea and vomiting.

Family and medical history

Your doctor will ask about your family and medical history. He or she may ask for details about your history of health problems such as migraines, irritable bowel syndrome, and gastroparesis. Your doctor may also ask about your history of mental health problems, use of substances such as marijuana, and cigarette smoking.

Physical exam

During a physical exam, your doctor will

• examine your body
• check your abdomen for unusual sounds, tenderness, or pain
• check your nerves, muscle strength, reflexes, and balance

Pattern or cycle of symptoms in children

A doctor will often suspect cyclic vomiting syndrome in a child when all of the following are present³:

• at least five episodes over any time period, or a minimum of three episodes over a 6-month period
• episodes lasting 1 hour to 10 days and happening at least 1 week apart
• episodes similar to previous ones, tending to start at the same time of day, lasting the same length of time, and happening with the same symptoms and intensity
• vomiting during episodes happening at least four times an hour for at least 1 hour
• episodes are separated by weeks to months, usually with no symptoms between episodes
• after appropriate medical evaluation, symptoms cannot be attributed to another medical condition

Pattern or cycle of symptoms in adults

A doctor will often suspect cyclic vomiting syndrome in adults when all of the following are present⁴:

• three or more separate episodes in the past year and two episodes in the past 6 months, happening at least 1 week apart
• episodes that are usually similar to previous ones, meaning that episodes tend to start at the same time of day and last the same length of time—less than 1 week
• no nausea or vomiting between episodes, but other, milder symptoms can be present between episodes
• no metabolic, gastrointestinal, central nervous system, structural, or biochemical disorders

A personal or family history of migraines supports the doctor’s diagnosis of cyclic vomiting syndrome.

Your doctor may diagnose cyclic vomiting syndrome even if your pattern of symptoms or your child’s pattern of symptoms do not fit the patterns described here. Talk to your doctor if your symptoms or your child’s symptoms are like the symptoms of cyclic vomiting syndrome.

What medical tests do doctors use to diagnose cyclic vomiting syndrome?

Doctors use lab tests, upper GI endoscopy, and imaging tests to rule out other diseases and conditions that cause nausea and vomiting. Once other diseases and conditions have been ruled out, a doctor will diagnose cyclic vomiting syndrome based on the pattern or cycle of symptoms.

Lab tests

Your doctor may use the following lab tests:

• Blood tests can show signs of anemia, dehydration, inflammation, infection, and liver problems.
• Urine tests can show signs of dehydration, infection, and kidney problems.

Blood and urine tests can also show signs of mitochondrial diseases.

Upper GI endoscopy

Your doctor may perform an upper GI endoscopy to look for problems in your upper digestive tract that may be causing nausea and vomiting.

Imaging tests

A doctor may perform one of more of the following imaging tests:

• Ultrasound of the abdomen.
• Gastric emptying test, also called gastric emptying scintigraphy. This test involves eating a bland meal, such as eggs or an egg substitute, that contains a small amount of radioactive material. An external camera scans the abdomen to show where the radioactive material is located. A radiologist can then measure how quickly the stomach empties after the meal. Health care professionals perform gastric emptying tests only between episodes.
• Upper GI series.
• MRI scan or CT scan of the brain.

References