A case of cyclic vomiting syndrome responding to gonadotropin-releasing hormone analogue

Abstract

Cyclic vomiting syndrome (CVS) is a disorder characterized by recurrent episodes of incapacitating nausea and vomiting interspersed with symptom free periods. Common triggers of cyclic vomiting include noxious stress, excitement, fatigue and menstrual period. Here, we report a case of cyclic vomiting syndrome in adult patient characterized by stereotypical vomiting attack, occurring in every menstruation period. Recurrent vomiting episodes began 6 years ago and we treated this patient with subcutaneous injection of goserelin, a gonadotropin-releasing hormone analogue (GnRHa) and oral estrogen. After 4 months of therapy, she was symptom free for the following 5 years, even with the resumed normal menstruation. Recurrence of vomiting attack with same pattern occurred 1 month before readmission. Treatment with intravenous lorazepam aborted vomiting, but could not prevent recurrences of vomiting and epigastric pain. We treated the patient with GnRHa and oral estradiol again which effectively prevented recurrence of the symptoms.

Keywords: Cyclic vomiting syndrome; Gonodotropin-releasing hormone analogue; Menstrual period.

Figure 1

Pedigree of the patient's family. In this pedigree, one patient with cyclic vomiting syndrome (solid circle) and her younger sister who had migraine headache (arrow) were detected.

Figure 2

Upper GI endoscopic findings showing tongue-like mucosal projection just above the esophagogastric junction (A). Neither mucosal abnormality nor luminal narrowing is identified in the stomach (B-D).

Figure 3

Electrogastrogram findings showing normally increased total power at postprandial period (A, B). Neither bradygastria nor tachygastria is identified (C, D).

Figure 4

Gastric emptying scintiscans showing delayed gastric emptying (A-D). Half emptying time (T1/2) is 107 minutes and the percentage retained at 4 hour is 22% (D).