Cyclic Vomiting Research Articles

COVID-19-A Guide to Rapid Implementation of Telehealth Services: A Playbook for the Pediatric Gastroenterologist.

COVID-19-A Guide to Rapid Implementation of Telehealth Services: A Playbook for the Pediatric Gastroenterologist.

Chronic vomiting in children: A prospective study reveals rumination syndrome is an important etiology that is underdiagnosed and untreated

The diagnosis of rumination syndrome is frequently overlooked, and under-recognized; children are subjected to unnecessary testing and inappropriate treatment for a condition which can be diagnosed clinically and managed easily. In the first ever systematic exploration of this condition from India, we present a prospective study on children with chronic vomiting in which rumination emerged as the predominant cause. This was a prospective study in which all consecutive children (5-18years) presenting with chronic or recurrent vomiting of at least 2-month duration were enrolled. Clinical history was assessed by a physician-administered questionnaire. All subjects underwent standard testing followed by additional investigations as required. The ROME III criteria were used. Fifty children (28 boys, age 12.2 + 3years) were enrolled. Diagnosis was rumination syndrome 30, cyclical vomiting 8, functional vomiting 6, intestinal tuberculosis 4, intestinal malrotation 1, and superior mesenteric artery syndrome 1. Children with rumination syndrome had a relapsing and remitting (12, 40%) or a chronically symptomatic course (18, 60%). These children received incorrect diagnoses (26, 87%) or no diagnosis (3, 10%) and extensive investigation before referral. Before referral, children with rumination syndrome were treated with a median of four drugs (range 1 to 9); two underwent surgery (appendectomy) for their symptoms while one child was subjected to electroconvulsive therapy. Overall, resolution after treatment was seen in 26 (87%) with a relapse in 8 (27%) children. The diagnosis of rumination syndrome is delayed and these children are often inappropriately treated. Therapy in the form of diaphragmatic breathing has a good success rate.

Cannabis Hyperemesis Syndrome: A Still Under-Recognized Syndrome.

Cannabis is one of the most widely used illicit drugs in the world. Its use is associated with several short- and long-term side-effects such as changes in mood, impaired memory, impaired attention, depression and anxiety, and it is correlated with schizophrenia. Cannabinoid hyperemesis syndrome (CHS) is characterized by chronic cannabis use, cyclic intractable nausea and vomiting, and compulsive hot bathing. Patients are typically diagnosed with CHS only after multiple medical evaluations. Recent research has identified type 1 cannabinoid receptors in the intestinal nerve plexus that have an inhibitory effect on gastrointestinal motility. This effect may explain hyperemesis in cannabis users. The thermoregulatory role of endocannabinoids may be responsible for compulsive hot bathing. We describe the cases of two young men seeking repeated emergency room care with recurrent nausea and vomiting. Abstinence from cannabis led to resolution of vomiting symptoms and abdominal pain.LEARNING POINTSCannabis is one of the most widely used illicit drugs in world.Cannabinoid hyperemesis syndrome is an under-recognized syndrome that can lead to expensive and unrevealing investigations.Abstinence from cannabis led to resolution of symptoms.

Prevalence of cannabis use has significantly increased in patients with cyclic vomiting syndrome.

Cyclic vomiting syndrome (CVS) is a functional gastrointestinal disorder which leads to multiple hospitalizations and causes significant impairment of quality of life. Cannabis use is common in patients with CVS, and there are limited data on the national trends in the prevalence of its use in the United States. We used the National Inpatient Sample (NIS) database from 2005 to 2014 and identified hospitalizations with a primary diagnosis of CVS by utilizing the International Classification of Diseases, 9th revision Clinical Modification (ICD-9 CM) coding system. The primary objective of the study was to analyze the prevalence and trends in cannabis use in CVS patients. We also assessed healthcare resource utilization associated with cannabis use. A total of 129090 hospitalizations with a primary diagnosis of CVS were identified and included in the study. In the United States, the overall rate of cannabis use among these patients was 104 per 1000 hospitalizations (N=13460). Over the last decade, the prevalence of cannabis use increased by 10-fold, from 2.2% in 2005 to 21.2% in 2014. Our analysis of the national database suggests that nearly 1 in 5 CVS hospitalizations have concurrent cannabis use. This prevalence is significantly rising over the last decade, perhaps due to changing legislation and increased utilization of cannabis. Age younger than 35, male gender, African American and Native American race, personal history of alcohol abuse and tobacco use were some of the strongest predictors of cannabis use.

Cyclic vomiting syndrome in children: a single-center experience

Background Cyclic vomiting syndrome (CVS) is a functional disorder characterized by recurrent episodes of intractable vomiting separated by symptom-free periods. The onset starts at any age from infancy to adulthood. Little is known about its etiology. The diagnosis is based on the fulfillment of Rome IV criteria. CVS is usually a misrecognized disorder, and delayed diagnosis is very common. Aim The purpose was to evaluate the prevalence, clinical characteristics, prereferral management, and response to treatment among children with proved CVS in our institution. Patients and methods This was a retrospective study that included all children with CVS attending the Gastroenterology Clinic at Alexandria University Children’s Hospital between January 2016 and the end of June 2019. All patients were followed up for at least 6 months. The diagnosis is based on the fulfillment of Rome IV criteria. The following data were retrieved from the medical records including demographic information, evaluation steps performed for diagnosis, analysis of CVS characteristics, prereferral management, and finally, the treatment algorithm and response to treatment during follow-up. Results The study included 79 patients, and two-thirds of them were females. They constituted 2–5% of the cases referred yearly to our clinic. Evaluation for possible organic cause was indicated in 22.7%. No abnormalities were found in the barium studies. Other investigations including gastroscopies were not diagnostic for other organic causes. The mean age at onset of symptoms was 6±3.3 years. Overall, 25.3% of patients reported specific triggers, and 62.5% reported recognizable prodromes. The episodes were stereotypic among all patients. Overall, 52% experienced the start of the episodes at night. The interval between episodes was 2.5±1.8 months. The mean duration of each episode was 2.4±2 days. Listlessness and pallor were the commonest during the vomiting phase. The vomiting was bilious in 65.8%and contained blood in 50.8%. Personal history of migraine was positive in 9%. Family history of migraine and motion sickness was positive in two-thirds. The mean duration before referral of the patients was 12.5+8 months. Overall, 78% of the episodes were interpreted as episodes of gastroenteritis, food poisoning, or acid peptic disorders. Moreover, 54.4% were admitted at least once. The overall response to the first-line prophylactic therapy is 89.3%, with no significant adverse effects. Conclusion The prevalence and clinical characteristics were similar to other similar reports. Barium studies are not necessary in most of the patients. CVS is prevalent yet an underdiagnosed health problem. Propranolol is effective and safe and may be considered as a first-line prophylaxis in patients older than 5 years of age.

Cannabis hyperemesis syndrome: an update on the pathophysiology and management.

Cannabis hyperemesis syndrome (CHS) is a form of functional gut-brain axis disorder characterized by bouts of episodic nausea and vomiting worsened by cannabis intake. It is considered as a variant of cyclical vomiting syndrome seen in cannabis users especially characterized by compulsive hot bathing/showers to relieve the symptoms. CHS was reported for the first time in 2004, and since then, an increasing number of cases have been reported. With cannabis use increasing throughout the world as the threshold for legalization becomes lower, its user numbers are expected to rise over time. Despite this trend, a strict criterion for the diagnosis of CHS is lacking. Early recognition of CHS is essential to prevent complications related to severe volume depletion. The recent body of research recognizes that patients with CHS impose a burden on the healthcare systems. Understanding the pathophysiology of the endocannabinoid system (ECS) remains central in explaining the clinical features and potential drug targets for the treatment of CHS. The frequency and prevalence of CHS change in accordance with the doses of tetrahydrocannabinol and other cannabinoids in various formulations of cannabis. CHS is unique in presentation, because of the cannabis’s biphasic effect as anti-emetic at low doses and pro-emetic at higher doses, and the association with pathological hot water bathing. In this narrative review, we elaborate on the role of the ECS, its management, and the identification of gaps in our current knowledge of CHS to further enhance its understanding in the future.

Функциональные нарушения пищеварения у детей раннего возраста. Результаты онлайн-анкетирования

Aim: to study the possibilities of online surveys for mothers using a questionnaire on the basis of the Rome IV criteria (2016) as a screening for functional gastrointestinal disorders (FGID) in infants and toddlers. Patients and Methods: an anonymous online survey of 477 mothers was conducted regarding the health condition of their children under the age of 4 years. The survey consisted of 2 question pools. The first pool included general questions regarding the age of the mother at the time of delivery, obstetric and gynecological history, feeding of an infant/toddler at the time of the survey. The second pool included questions regarding FGID in infants and toddlers on three separate topics: functional disorders of the first year of life; diagnosis of cyclic vomiting syndrome; bowel movement disorder. Results: among 130 infants, regurgitation was in 50% of cases (at the age of 6 months — in 75%, at the age of 6 to 12 months — in 35%), baby colic — in 49%. The incidence of functional constipation in children under 6 months was 5.8%, from 6 to 12 months — 7.6%, gradually increasing by 3–4 years to 21.5%. Toilet skills were taught to 15 (12%) children aged 1 year — 1 year 11 months, 58 (59%) — at the age of 2 years — 2 years 11 months, and 119 (98%) — at the age of 3 years — 3 years 11 months. Mothers who were unaware of their child’s physical development and/or defecation problems accounted for 20.1% of those who took part in the survey. Conclusion: online survey results of mothers coincide with modern statistical data on FGID disorder. The survey results generally reflect the anatomical and physiological patterns of the child’s GI development. Online survey on the detection of FGID in infants/toddlers allows to make a preliminary diagnosis, identify existing problems and determine further patient management tactics. KEYWORDS: functional gastrointestinal disorders, infant, toddler, Rome IV criteria, questionnaire for parents, functional constipation, online survey, baby colic, regurgitation, toilet skills. FOR CITATION: Dubrovskaya M.I., Gryaznova E.I. Functional gastrointestinal disorders in infants and toddlers. Online survey results. Russian Medical Inquiry. 2020;4(5):274–281. DOI: 10.32364/2587-6821-2020-4-5-274-281.

Ramosetron as a Treatment for Cyclic Vomiting Syndrome: A Small-Scale Patient Trial.

Ramosetron as a Treatment for Cyclic Vomiting Syndrome: A Small-Scale Patient Trial.

异位胰腺合并周期性呕吐一例

异位胰腺合并周期性呕吐一例

Sumatriptan as abortive treatment in cyclic vomiting syndrome: A cross-sectional study

Cyclic vomiting syndrome (CVS) is characterized by episodic vomiting and shares similarities with migraine headache. Guidelines recommend using triptans as abortive therapy in CVS, but there are limited data on its efficacy. Methods: We thus sought to characterize sumatriptan use and performed a cross-sectional study of adults with CVS episodes within the previous 6 months. Questionnaires about demographics, clinical characteristics, and response to sumatriptan (defined as >50% reduction in symptoms) were administered via e-mail. We investigated differences between responders and nonresponders, using χ 2 and Student’s t test. Results: Of 101 participants (age 41 ± 15 years, 74% female, 83% Caucasian), 39 (38%) used sumatriptan during their last CVS attack. Most reported an improvement in nausea (55%), vomiting (59%), and abdominal pain (43%) within 2 h and at 24 h (67%, 73%, and 67%) respectively. Eighteen (46%) reported that sumatriptan helped them avoid emergency department visits and 20 (51%) avoided being hospitalized. Nonresponse to sumatriptan was associated with depression ( p = 0.01), current cannabis use ( p = 0.02), use of benzodiazepines ( p = 0.04), and opioids (0.02) during an episode. No serious side effects were noted. Conclusions: Sumatriptan use reduced symptoms of CVS but did not abort them. Prospective studies to determine its independent effects are needed.

Coexistencia de desórdenes gastrointestinales funcionales en lactantes y preescolares latinoamericanos

Introducción: se ha descrito la coexistencia de trastornos gastrointestinales funcionales (c-TGF) en lactantes y preescolares (LactPre); sin embargo, hay poca literatura sobre los principales c-TGF y sus características.
 Objetivo: describir la prevalencia y posibles asociaciones de c-TGF en un mismo LactPre latinoamericano.
 Metodología: estudio de prevalencia en LactPre de Colombia, Ecuador, Nicaragua y Panamá de consulta externa y urgencias, a quienes, según los criterios de Roma III en español, se identificaron regurgitación, síndrome de rumiación, síndrome del vómito cíclico, cólico, diarrea funcional, estreñimiento funcional y disquecia. Se tuvieron en cuenta la edad, el sexo y el origen. La estadística incluyó t de Student, chi cuadrado, prueba exacta de Fisher, análisis uni y multivariados y el cálculo de los OR e IC 95%, siendo una p <0,05 significativa.
 Resultados: se analizaron 2417 niños (2,419,8 meses de edad, 51,3% masculinos, con diagnóstico de por lo menos algún TGF del 35,7%). Se presentó c-TGF en el 3,6%, siendo el principal el síndrome de rumiación del lactante (SRL) más estreñimiento funcional (EF). Hubo predomino del género masculino en los lactantes y ser colombiano.
 Conclusión: la principal c-TGF en este grupo de LactPre de Latinoamérica es el SRL más EF, presentándose principalmente en el sexo masculino y en lactantes menores de 24 meses.

CARDIOVASCULAR DISEASES ASSOCIATED WITH PSEUDOEXFOLIATION SYNDROME – A PROSPECTIVE CROSS-SECTIONAL STUDY

Objectives: In recent years, pseudoexfoliation syndrome (PXF) is recognized as a systemic disorder and as an independent risk factor for cardiovascular diseases including hypertension, angina, myocardial infarction, and stroke. We studied the prevalence of cardiovascular diseases associated in patients with PXF.
 Methods: It was a prospective cross-sectional study done over a period of 2 years from January 2017 to December 2018 at the Department of Ophthalmology in Sree Balaji Medical College and Hospital. A total of 100 patients with PXF both male and female above the age of 50 were included in the study. They were given a standard questionnaire to evaluate common cyclic vomiting syndrome symptoms and a history of angina, myocardial infarction, and cerebrovascular accident was noted. All patients underwent blood pressure (BP) measurement and electrocardiogram (ECG) recording.
 Results: In our study which included 100 patients with PXF there were 57 male patients and 43 female patients. Most of the patients (59%) were above 65 years of age and 36 patients were diagnosed with open-angle glaucoma. A total of 62 patients had persistently elevated BP on three different occasions. Only five patients gave a positive history of angina at some point in their lives and among them, only four patients showed demonstrable changes in ECG. One patient gave a history of myocardial infarction (two showed changes in ECG) and none of the patients had cerebrovascular accidents.
 Conclusion: Our study showed that more than 60% of patients with PXF had hypertension; however, a statistically significant association with other conditions was not noted.

Cannabinoid Hyperemesis Syndrome: A Review of the Literature

Background: Cannabinoid Hyperemesis Syndrome (CHS) is characterized by cyclic vomiting and compulsive need to take hot showers in the context of chronic cannabis use. Physicians' lack of knowledge of CHS often results in a diagnostic delay of several years. The purpose of this article is to describe CHS in order to enable physicians, and more particularly psychiatrists, to diagnose it as quickly as possible and thus avoid unnecessary additional invasive examinations. Subjects and methods: Bibliographic search for scientific articles published between 2004 and 2019 in the Cochrane, Medline, PubMed, and Psycinfo databases. Key words used were "hyperemesis", "cannabis", "cannabinoid". Results: CHS is associated with chronic cannabis use and typically manifests as incoercible cyclical vomiting, diffuse abdominal pain, and relief of symptoms by taking hot showers. Patients suffering from CHS generally visit emergency departments very regularly and undergo numerous additional examinations, both invasive and unnecessary. Since no organic cause can explain these symptoms, these patients are referred to the psychiatry department. The only curative treatment is the complete cessation of cannabis use. Conclusion: CHS is an under-diagnosed pathology because it is little known to physicians. This syndrome has unique clinical characteristics. Early recognition of CHS avoids repeated visits to the emergency room and unnecessary follow-up examinations.

2768 Helicobacter pylori Infection: An Important Consideration in Patients With Suspected Cannabinoid Hyperemesis Syndrome

INTRODUCTION: Cannabinoid Hyperemesis Syndrome (CHS) is a clinical diagnosis made by the combination of chronic marijuana use, episodes of cyclic nausea and vomiting, and concurrent stereotypical behavior including use of hot showers for symptom relief during these episodes. CHS represents an emerging problem in part due to the legalization of marijuana in parts of the United States. Despite its recognition, other more common etiologies of chronic, episodic nausea and vomiting should be considered within the correct clinical context. We performed a single center analysis to understand the burden of H. pylori infection in patients diagnosed with CHS. CASE DESCRIPTION/METHODS: We used our electronic medical record to identify all patients 18 years or older with an active diagnosis of CHS from May 2017 to May 2019. Patient charts were reviewed and the presence of H. pylori infection (defined as positive urea breath test, stool antigen, tissue stain or culture) was verified. 30 patients with CHS were identified, and 19 (63%) of these were tested for H. pylori. 6 (32%) of those patients were diagnosed with active infection. All six patients were prescribed standard triple or quadruple therapy, but only one was documented to have completed the therapy in whole. The treated patient was a 52 year-old male who had a longstanding history of episodic nausea and vomiting. Prior upper endoscopy at an outside facility showed duodenal ulcers. He was admitted to the hospital for intractable nausea and vomiting in setting of marijuana abuse. H pylori stool antigen resulted positive during admission. The patient followed-up in outpatient clinic after completing triple therapy and reported complete resolution of nausea and vomiting despite ongoing daily marijuana use. DISCUSSION: This is the first report of the rates of concurrent infection of H. pylori in individuals diagnosed with CHS. The reported prevalence of H pylori in the United States varies widely, with the largest analysis of gastric biopsies revealing a rate of 7.5% with general trends higher in African Americans and populations close to the United States-Mexico border. In CHS patients with H. pylori, compliance issues may contribute to persistent and untreated infection. Our single center analysis suggests that H. pylori rates may be higher than the general population in patients with CHS, but larger patient databases will be needed ascertain true treatment rates, and response to therapy.

Cannabinoid hyperemesis syndrome

Cannabinoid hyperemesis syndrome (CHS) is characterized by severe cyclical nausea, vomiting, and abdominal pain relieved by compulsive hot water bathing in the setting of chronic cannabinoid use. This article reviews the characteristics, proposed pathophysiology, treatment modalities, and role of nurses caring for patients with CHS.

1851 The Ever-Mysterious Cyclical Vomiting Syndrome (CVS) and Abdominal Migraine: Recognition and Successful Management Strategies Illustrated by a Case Report

INTRODUCTION: Cyclical vomiting syndrome (CVS) is a medically and socially disabling, idiopathic disorder characterized by recurrent, stereotypical bouts of vomiting with periods of normal health, occurring in children, adolescents, and recognized in adults. CVS is associated with substantial morbidity. Lack of awareness and recognition leads to tremendous anxiety, cost burden, and delay in diagnosis. Recently updated, Rome IV classification has attempted to highlight the issue to promote early recognition and diagnosis. We present a case of CVS and abdominal migraine in a 27-year-old female whose illness went unrecognized for 8 years and discuss successful management strategies. CASE DESCRIPTION/METHODS: A 27-year-old female with an 8-year history of recurrent episodic abdominal pains, nausea, vomiting, incidental superior mesenteric artery syndrome, status post laparoscopic duodenojejunostomy at 24, after which she had an apparent 6-month relief of symptoms, and history of anxiety and depression was seen for persistent diffuse abdominal pain, nausea, and 7-8 daily episodes of emesis for 3 weeks. Family history was significant for migraines in her mother. Since her initial symptoms at the age of 19, she experienced episodes of incapacitating nausea, vomiting, and abdominal pain lasting 3-4 weeks followed by symptom-free periods of 2-3 months. She had visited many hospitals, primary care physicians, psychiatrists, and gastroenterologists, and undergone repeated work-ups from basic to complex. Treatment with SSIRs, anti-emetics, valproic acid and even marijuana showed no or minimal benefit. Following thorough history and obtainment of records from other institutions, she was diagnosis and started on a combination of amitriptyline, propranolol, and Co-enzyme Q/L-Carnitine. She has been followed by monthly phone calls for about 1-year, remains symptom-free, and compliant with the regimen. DISCUSSION: Cyclic vomiting syndrome (CVS) is characterized by recurrent bouts of nausea and vomiting with periods of normal health. The pathogenesis is multifactorial, with multiple genetic, autonomic, and environmental factors. Often a great delay in diagnosis, on average 2.6 years in children and 8 years in adults leads to unnecessary testing and cumbersome procedures. In the case of our patient, her illness was unrecognized for many years and her symptoms often dismissed, pushing her into anxiety and depression. A multidisciplinary approach as well as prophylactic and abortive pharmacotherapy is needed to address the issue.

What Becomes of the Frequent Hospital Attenders with Centrally Mediated Gastrointestinal Pain Syndrome?

Objective: Centrally mediated gastrointestinal pain syndrome (CAPS) is an infrequently diagnosed functional condition. A small number of patients do, however, become heavy service users due to difficulty in controlling severe symptoms. We aim to review the outcomes of patients who required frequent hospitalisation with CAPS. Methods: Medical records of patients with multiple CAPS presentations during 2015 (n = 18) were further analysed and reviewed until January 1st, 2019. Results: Patients (female 15; male 3) had a median age of 33 (IQR 12) years. Gastrointestinal co-diagnosis was common (88.9%), most frequently irritable bowel syndrome (50%), cyclical vomiting syndrome (27.8%) or gastro-oesophageal reflux disease (16.7%). 66.7% were prescribed regular opiate analgesics. Psychiatric co-morbidity was present in almost all: depression (88.9%); anxiety/panic disorders (38.9%) and post-traumatic stress disorder (27.8%). Social stressors were cited in 33.3%. 27.8% were employed, frequently in healthcare. Over the 4-year study period, 18 identified patients accounted for 2,048 nights in hospital and 672 A+E attendances. In 2015, these patients spent a median of 19 (IQR 34) nights in hospital each with median hospitalisations of between 7 and 10 nights over the following 3 years. Median A+E attendance was 8 per patient (IQR 8) in 2015, remaining relatively constant between 5 and 6 A+E presentations per patient per subsequent year. Conclusion: CAPS is a complicated heterogenous condition resulting from an interplay of physical stimuli with cognitive and emotional factors. As such, management is difficult and requires a multidisciplinary approach with considerable patient ownership of the condition, which is often difficult to achieve.

Cannabinoid Hyperemesis Syndrome in Pregnancy: A Case Report and Treatment Overview

Cannabinoid hyperemesis syndrome (CHS) is characterized by cyclical vomiting, frequent hot water bathing, and chronic cannabis use. Missed diagnosis, especially in pregnancy, may delay treatment and prolong extensive medical assessments. Conventional antiemetics used to control vomiting illnesses are typically ineffective in CHS and pharmacological treatment may be limited due to concern for harm to the fetus during pregnancy. This case report describes a 19-year-old African American female at twenty weeks gestation with CHS. Successful symptom relief was obtained with diphenhydramine, haloperidol, and dronabinol. A literature search identified five case reports regarding cannabinoid hyperemesis syndrome in pregnancy. This case report highlights the importance of recognizing common characteristics of CHS especially in pregnant women with a history of cannabis use. Additionally, the purpose of this article is to review the current literature available for the treatment of CHS and expand recognition of CHS as an increasingly prevalent condition.

Acute Management of Pediatric Cyclic Vomiting Syndrome: A Systematic Review

To synthesize quantitative and qualitative data on pharmacologic interventions of pediatric cyclic vomiting syndrome and their effectiveness in disease management in the acute care setting. Using keywords, 799 studies published up from December 1954 to February 2018 were extracted from MEDLINE via Pubmed, Embase via OVID, CINAHL via EBSCO, and Cochrane Controlled Trials Registry. Studies were evaluated for inclusion and exclusion by 2 independent reviewers using predetermined inclusion and exclusion criteria. The search yielded 84 studies for full review, of which 54 were included in the systematic review. Studies were subsequently separated into 1 group of 6 case series studies containing quantitative data on sumatriptan, ondansetron, phenothiazines, prokinetic agents, carbohydrate, isometheptene, and aprepitant; 1 one group consisting only of qualitative studies containing expert recommendations. Ondansetron has the most quantitative and qualitative evidence to support its inclusion in pediatric emergency department protocols as a rescue therapy. Sumatriptan and aprepitant are potential candidates for inclusion as abortive therapies. Qualitative data from retrospective studies and case reports are not applicable to a larger patient population. This report informs a need for controlled, prospective cohort studies and randomized, controlled trials to optimize current management protocols and to develop new medical interventions.

Psychological intervention in cyclic vomiting syndrome in adolescents: A case series

Objective: Cyclic vomiting syndrome (CVS) is difficult to diagnose, thus there is often a delay in diagnosis or a misdiagnosis. In the absence of an adequate understanding of the pathophysiology of the syndrome, it is under-recognised and treatment is difficult. The present case series aimed to assess and manage three adolescents with CVS.Method: The Children’s Apperception Test was administered on the three Asian adolescents who were referred for the management of CVS to the Department of Clinical Psychology at a tertiary care hospital in New Delhi, India. A treatment module was developed to treat CVS in these adolescents.Results: A strong link was found between the psychological stressors and their physical manifestations in the episodes of vomiting. Therapeutic management with a focus on behavioural modification, adaptive coping skills, and a healthy therapeutic relationship was found to be efficacious in gradually remitting this condition.Conclusions: Thus, the focus of treatment in cases of CVS should be to understand the psychological underpinning and help the adolescents to incorporate healthy coping strategies.