Which Specialty Manages Cyclic Vomiting Syndrome
Gastroenterology is the primary specialty that evaluates and manages cyclic vomiting syndrome (CVS), as evidenced by the American Gastroenterological Association's comprehensive guidelines on diagnosis and treatment. 1, 2
Primary Specialty Responsibility
- Gastroenterologists lead the diagnostic workup and treatment of CVS, applying Rome IV criteria to establish the diagnosis and implementing both prophylactic and abortive therapy regimens 1, 2
- The American Gastroenterological Association has published extensive management guidelines covering all phases of CVS care, from initial diagnosis through long-term prophylaxis 1, 2
Multidisciplinary Collaboration Required
While gastroenterology serves as the primary specialty, CVS management frequently requires collaboration with other specialists due to high comorbidity rates:
Psychiatry/Psychology Consultation
- Screen all CVS patients for anxiety, depression, and panic disorder, as these psychiatric comorbidities are present in 50-60% of patients 1, 2
- Treating underlying anxiety can decrease CVS episode frequency, making psychiatric referral essential for many patients 1, 2
- Cognitive-behavioral therapy may help manage psychological triggers 2
Neurology Involvement
- A personal or family history of migraine is present in 20-30% of CVS patients, supporting the migraine-CVS connection and potentially guiding treatment selection 1
- Neurologists may be consulted given the shared pathophysiology between CVS and migraines 3
Additional Specialist Referrals
- Sleep specialists may be needed, as sleep deprivation is a common trigger and regular sleep schedules are essential for management 1, 2
- Substance use specialists are necessary when screening reveals cannabis use >4 times weekly for >1 year, which suggests cannabinoid hyperemesis syndrome rather than CVS 1, 2
Pediatric Considerations
- In children, pediatric gastroenterology manages CVS, with the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHN) providing consensus guidelines 4
- Pediatric neurology may co-manage given the neurological connections, as evidenced by joint task force recommendations from Italian pediatric gastroenterology and neurology societies 5
Common Pitfall to Avoid
- Do not misattribute CVS to primary psychiatric disease—while psychiatric comorbidities are extremely common (50-60%), they are comorbid conditions rather than the cause of CVS, and patients often experience diagnostic delays of several years due to this misunderstanding 2