Cyclic Vomiting Syndrome Differential Diagnoses

Updated: Oct 31, 2018
  • Author: Thangam Venkatesan, MD; Chief Editor: Carmen Cuffari, MD  more...
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Diagnostic Considerations

In addition to the conditions listed in the differential diagnosis, a number of other disorders should be considered in suspected cases of cyclic vomiting syndrome (CVS).

Gastrointestinal (GI) disorders to be considered include the following:

Neurologic disorders to be considered include the following:

  • Abdominal migraine with vomiting

  • Migraine headaches with vomiting

  • Chronic sinusitis

  • Subtentorial neoplasm (cerebellar medulloblastoma or brainstem glioma)

  • Chiari malformation

  • Familial dysautonomia (Riley-Day syndrome)

Renal disorders to be considered include the following:

  • Acute hydronephrosis secondary to uteropelvic junction obstruction

  • Nephrolithiasis

Metabolic disorders to be considered include the following:

  • Disorders of fatty acid oxidation

  • Urea cycle defects

  • Mitochondriopathy

  • Acute intermittent porphyria

Endocrine disorders to be considered include the following:

  • Addison disease

  • Diabetes mellitus with ketoacidosis

  • Hyperemesis gravidarum

Psychological disorders to be considered include the following:

Other conditions to be considered include the following:

Allen et al reported 19 CVS cases associated with chronic cannabis use; 10 of the 19 were not included in follow-up, but most of the remaining 9 who abstained from marijuana experienced symptomatic relief. [41] Other cases of cannabinoid hyperemesis have been published, though no long-term follow-up is reported for most of them. [42]

Evidence implicating marijuana use as the actual cause of vomiting is insufficient; no clear temporal relation between the onset of vomiting and the actual initiation of marijuana use has been established. It is possible that these patients already have CVS and are using marijuana for its antiemetic properties.

Although the role of marijuana in CVS has not been well established, a report by McCallum et al found chronic marijuana use to be a risk factor for lack of response to the tricyclic antidepressants used to treat this disorder. Thus, complete abstinence from marijuana may be recommended in patients with CVS. [43]

In a study comparing patients with CVS and those with functional vomiting, patients with CVS were more likely to be younger and male and used marijuana more frequently. [44] In a retrospective review of 31 published case reports and a case series of 98 patients with CVS, cyclic vomiting was associated with chronic daily marijuana use. [45, 46] However, the long duration (2-10 years) of marijuana use before the onset of symptoms and the short follow-up (< 3 months) argued against marijuana as a cause of the vomiting.

Differential Diagnoses