Coalescent Cyclical Vomiting: A Manifestation of Narcotic Bowel Syndrome?

Abstract

This illustrative case suggests mechanisms that may contribute to disease progression and complications in adults with Cyclical Vomiting Syndrome (CVS). Symptoms initially fol- lowed a characteristic pattern in the context of marijuana use and led to repeated hospitaliza- tions. Escalating opioid use for pain control resulted in coalescence of the syndrome with more frequent and severe emetic episodes, ultimately complicated by an esophageal microperfora- tion. While analgesic therapy may play an important role in management of acute exacerba- tions, ongoing use of narcotics may contribute to the development of refractory CVS. This association of disease progression with opiates suggests that coalescent CVS should be consid- ered a foregut manifestation of narcotic bowel syndrome.