Introduction: Cyclic Vomiting Syndrome (CVS) in adults is underdiagnosed because it is not well recognized by physicians although it accounts for up to 20% of patients referred to a GI practice for evaluation of unexplained vomiting and abdominal pain. Goals of therapy are to induce remission while also addressing the predisposing “trigger” factors. The purposes of this study are to provide an analysis of the clinical profile, treatment responses, and outcomes based on managing adult CVS at a GI motility center. Methods: Our adult CVS database identified 18 patients, 10 female, of ages ranging from 22-60, who were initially diagnosed at our center, received treatment, and had long term follow up of 1 to 4 years by one of the authors. Results: Onset of symptoms ranged from 1-15 years prior to diagnosis (mean of 4). The mean number of yearly ER visits or hospitalizations was 5.8. Weight loss ranged from 5-50 pounds. Ten patients underwent a 4 hour standardized radionuclide gastric emptying test: 6 had rapid emptying and. Six major “triggers” were identified (some patients having >1): anxiety in 17, post-traumatic stress disorder in 2, migraines in 5, chronic marijuana use in 5, poorly controlled diabetes in 5, and menses in 4. All patients were treated with tricyclic antidepressants. Amitriptyline was the first choice, starting at 10mg at night, increasing by 10mg every 2-3 weeks until CVS improved. Two patients were switched to doxepin due to side effects; their max doses were 100mg and 200mg. At the same time the “trigger” factors were aggressively addressed. With this treatment strategy 4 patients (22%) were able to stop their CVS medications and have remained asymptomatic for over 1 year. In addition, 11 patients (61%) responded remarkably with a reduction in the mean number of annual ER visits or hospitalizations from 5.8 to 0.6 and were fully functional. Three patients (17%) reported ongoing, approximately monthly, episodes and had unresolved trigger factors and medication noncompliance. Conclusion: 1) Adult CVS is a treatable and reversible entity; 2) The treatment consisting of high dose TCA & addressing the “trigger factors” was able to prevent cycles in 83% of patients, including 22% that were effectively cured and able to taper off medications without recurrence; 3) The approximately 17% of patients who have ongoing cycles require better control of the predisposing factors as well as reinforcing compliance with the treatment regimen.