Psychiatric management of pediatric cyclic vomiting syndrome using nonpharmacological interventions from a gut-brain...

Cyclic vomiting syndrome (CVS) is a chronic disorder of gut-brain interaction characterized by recurrent, stereotyped episodes of severe nausea and vomiting with symptom-free intervals. Although traditionally managed as a gastrointestinal condition, increasing evidence highlights the role of psychological stressors in symptom precipitation. Consistent with the 2025 North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) guidelines, which prioritize stress reduction and behavioral interventions as first-line abortive strategies, this case highlights the central role of psychological approaches in CVS management.

A 10-year-old Ethiopian boy presented with a four-year history of recurrent, intractable vomiting episodes occurring every three to six months. Episodes were abrupt in onset, stereotypical, and frequently preceded by frontal headaches. Emotional stressors, particularly anger and interpersonal conflict, consistently triggered symptoms. Extensive investigations, including upper gastrointestinal (GI) endoscopy, abdominal and brain imaging, and laboratory studies, revealed no structural, metabolic, or neurological abnormalities. The condition led to repeated hospitalizations, significant school absenteeism, and declining academic performance. The patient was diagnosed with somatic symptom disorder, unspecified (DSM-5-TR) and received structured psychiatric care over nine months, including anger management, emotional regulation strategies, coping skills training, and family psychoeducation. Vomiting episodes progressively decreased and ultimately ceased. At follow-up, the patient remained symptom-free with improved emotional regulation, reduced school-related anxiety, and improved academic functioning.

This case demonstrates that targeted nonpharmacological psychiatric interventions can achieve sustained remission and meaningful functional improvement in children with CVS, supporting the integration of psychological care within a biopsychosocial, multidisciplinary management framework for this disorder globally.