Rome IV Diagnostic Criteria for Cyclic Vomiting Syndrome (CVS)
Rome IV criteria for Cyclic Vomiting Syndrome in adults. Stereotypical recurrent episodes of intense nausea and vomiting with intervening symptom-free periods. Associated with migraine spectrum disorders.
Score interpretation
Insufficient criteria for CVS -- investigate for structural or metabolic causes
→ Exclude organic causes: upper endoscopy; CT abdomen/pelvis; metabolic screen (thyroid, adrenal, porphyria); CNS imaging if neurological symptoms; gastric emptying study for gastroparesis; SMA syndrome. Consider cannabinoid hyperemesis syndrome (cannabis use + hot showers relief = highly suggestive).
Rome IV CVS confirmed -- acute and prophylactic management required
→ Acute episode: IV fluids (aggressive hydration); IV ondansetron 4-8 mg 6-hourly; IV lorazepam 0.02-0.05 mg/kg (for intractable nausea, reduces vomiting); IV haloperidol 0.5-2 mg (emerging evidence -- D2 antagonist, useful for refractory CVS); IV diphenhydramine 25 mg; electrolyte replacement; dark quiet room; IV sumatriptan (6 mg SC) if migraine-CVS variant; Prophylaxis: tricyclic antidepressants (amitriptyline 10-75 mg nocte -- first-line); coenzyme Q10 30 mg TDS; L-carnitine 1 g TDS (mitochondrial support); topiramate 25-100 mg BD; propranolol 10-20 mg TDS; if cannabis-related: complete cessation (cannabinoid hyperemesis -- hot shower compulsive bathing pathognomonic); capsaicin cream topical (evidence emerging for CHS); psychiatric assessment (anxiety, depression, OCD common); gastroenterology follow-up.
Interpretation bands for the Rome IV CVS. Apply clinical judgement and local guidance.
References
- Stanghellini V et al. Gastroduodenal disorders. Gastroenterology. 2016;150(6):1380-1392.
- Venkatesan T et al. Quality of life in adults with cyclic vomiting syndrome: a large web-based study. Eur J Gastroenterol Hepatol. 2010;22(11):1261-1268.
Related
Curated clinical cross-links plus same-class fallbacks.
- Manning Criteria for Irritable Bowel Syndrome · Functional GI Disorders
- Kruis Score for Diagnosis of Irritable Bowel Syndrome · Functional GI Disorders
- Rome IV Diagnostic Criteria for Functional Dyspepsia · Functional GI Disorders
- Rome IV Diagnostic Criteria for Functional Constipation · Functional GI Disorders
- Rome IV Diagnostic Criteria for Functional Chest Pain · Functional GI Disorders
- Rome IV Diagnostic Criteria for Globus · Functional GI Disorders
- Cyclizine (Nausea and Vomiting in Pregnancy) · Antihistamine Antiemetic — Hyperemesis Gravidarum
- Prochlorperazine (Nausea and Vomiting in Pregnancy) · Phenothiazine Antiemetic — Hyperemesis Gravidarum
- Aciclovir 800mg Tablets (Ramsay Hunt Syndrome / Herpes Zoster Oticus) · Antiviral — nucleoside analogue (herpes zoster treatment)
- Pramipexole (Restless Legs Syndrome — Elderly) · Dopamine Agonist (D2/D3 Receptor)
- Nabilone · Synthetic cannabinoid
- Daptomycin · Cyclic Lipopeptide — MRSA / VRE / Bacteraemia / Endocarditis
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.