Summary about Disease
Bilious vomiting syndrome (BVS), also sometimes referred to as cyclic vomiting syndrome (CVS) with bilious emesis, is characterized by episodes of intense nausea and vomiting where the vomit contains bile, a digestive fluid produced by the liver. Bile is normally present in the small intestine, but its presence in vomit indicates that the vomiting is forceful or prolonged enough to draw it back up the digestive tract. While "BVS" isn't a formally recognized, distinct medical condition with its own ICD code, the term is often used to describe vomiting containing bile, often related to an underlying issue like gastrointestinal obstruction, ileus, or in the context of CVS. True CVS is a functional gastrointestinal disorder, meaning there is no identifiable structural or biochemical abnormality to explain the symptoms. It typically presents with discrete episodes of intense nausea and vomiting separated by symptom-free intervals.
Symptoms
Nausea: Intense feeling of wanting to vomit.
Vomiting: Frequent episodes of vomiting, containing yellow or green bile.
Abdominal pain/discomfort: May be present, but not always.
Lethargy/Fatigue: Feeling tired and weak.
Dehydration: Caused by fluid loss from vomiting.
Headache: Sometimes associated with the vomiting episodes.
Inability to eat or drink: Due to nausea and vomiting.
Other symptoms associated with underlying cause: If the bilious vomiting is due to something other than CVS, there may be other associated symptoms, such as fever (in case of infection).
Causes
The causes of bilious vomiting depend on the underlying issue.
Cyclic Vomiting Syndrome (CVS): The exact cause of CVS is not well understood, but it may involve gut-brain interactions, mitochondrial dysfunction, and hormonal factors.
Gastrointestinal Obstruction: A blockage in the small intestine can cause bile to back up and be vomited.
Ileus: A temporary lack of normal muscle contractions in the intestines can also lead to bilious vomiting.
Infections: Some infections can cause severe vomiting, potentially with bile.
Medications: Certain medications can trigger vomiting.
Other Gastrointestinal Disorders: Conditions such as gastroparesis (delayed stomach emptying) can contribute.
Medicine Used
The medications used depend on the cause of the vomiting and the specific diagnosis. This is NOT intended as medical advice, Consult with a medical professional
Anti-emetics: Medications to reduce nausea and vomiting (e.g., ondansetron, promethazine).
Acid-reducing medications: Proton pump inhibitors (PPIs) or H2 receptor antagonists, if acid reflux is a contributing factor.
Pain relievers: For associated abdominal pain or headaches.
IV fluids: To treat dehydration.
Medications specific to the underlying cause: If the bilious vomiting is due to a specific condition like an infection, medications to treat that condition are needed.
Tricyclic antidepressants (TCAs) or Cyproheptadine: Used for the prophylactic treatment of CVS, to reduce the frequency of episodes.
Mitochondrial supplements (e.g., CoQ10, L-carnitine, riboflavin): May be used if mitochondrial dysfunction is suspected in CVS.
Is Communicable
Bilious vomiting itself is not communicable. It is a symptom of an underlying issue, and whether the underlying issue is communicable depends on what's causing the vomiting. If it's due to CVS, it's not communicable. If it's due to a viral infection, then that infection could be communicable.
Precautions
Stay hydrated: Drink small amounts of clear fluids frequently to prevent dehydration.
Avoid trigger factors: If the bilious vomiting is related to CVS, identify and avoid any known triggers (e.g., stress, certain foods).
Rest: Get plenty of rest to allow the body to recover.
Maintain a bland diet: Eat easily digestible foods (e.g., crackers, toast, bananas) during recovery.
Good hygiene: Wash hands frequently to prevent the spread of infection if that's the underlying cause.
Seek medical attention: If the vomiting is severe, persistent, or accompanied by other concerning symptoms (e.g., fever, severe abdominal pain), seek medical advice promptly.
How long does an outbreak last?
The duration of an episode of bilious vomiting varies depending on the underlying cause.
Cyclic Vomiting Syndrome (CVS): Episodes typically last from a few hours to several days (usually 1-5 days).
Gastrointestinal Obstruction/Ileus: Duration depends on the severity and treatment of the obstruction or ileus. It can persist until the underlying problem is resolved.
Infections: Duration depends on the specific infection and its treatment course.
How is it diagnosed?
Diagnosis involves:
Medical history: Detailed questioning about the symptoms, frequency, triggers, and associated conditions.
Physical examination: Assessing the patient's overall condition and looking for signs of dehydration or other abnormalities.
Blood tests: To check for dehydration, electrolyte imbalances, infection, and organ function.
Urine tests: To assess hydration status and rule out other conditions.
Imaging studies: X-rays, CT scans, or ultrasounds may be used to look for gastrointestinal obstruction or other structural abnormalities.
Endoscopy/Colonoscopy: May be performed to visualize the digestive tract and rule out other causes of vomiting.
Gastric Emptying Study: May be helpful to evaluate for gastroparesis.
Diagnosis of Exclusion: In cases of suspected CVS, other possible causes of vomiting need to be ruled out first.
Timeline of Symptoms
The timeline of symptoms varies depending on the underlying cause, particularly if related to Cyclic Vomiting Syndrome (CVS):
Prodrome phase (sometimes): In CVS, some people experience a period of anxiety, pallor, or abdominal discomfort before the onset of vomiting.
Vomiting phase: This phase is characterized by intense nausea and frequent vomiting, often containing bile. It can last hours to days.
Recovery phase: Vomiting gradually subsides, and appetite slowly returns.
Inter-episodic phase (asymptomatic): This is a symptom-free period between episodes of vomiting. The length of this phase varies greatly. For other causes (obstruction, infection), the timeline depends on the specific condition and its treatment.
Important Considerations
Dehydration: Bilious vomiting can lead to severe dehydration, which can be life-threatening, especially in children. Prompt medical attention is needed.
Underlying cause: Identifying and treating the underlying cause of the bilious vomiting is crucial for effective management.
Cyclic Vomiting Syndrome (CVS): CVS can be a chronic condition that requires long-term management and preventative strategies.
Differential Diagnosis: It's important to rule out other causes of vomiting before diagnosing CVS.
Psychological Impact: Chronic vomiting can have a significant impact on a person's quality of life. Psychological support and counseling may be beneficial.
Medication Side Effects: Be aware of potential side effects of medications used to treat nausea and vomiting.
Consult with Specialists: Management of BVS, especially when related to CVS, often benefits from a multidisciplinary approach involving gastroenterologists, neurologists, and psychologists.