Coalescent Cyclical Vomiting: A Manifestation of Narcotic Bowel Syndrome?

Abstract

This illustrative case suggests mechanisms that may contribute to disease progression
and complications in adults with Cyclical Vomiting Syndrome (CVS). Symptoms initially followed
a characteristic pattern in the context of marijuana use and led to repeated hospitalizations.
Escalating opioid use for pain control resulted in coalescence of the syndrome with more
frequent and severe emetic episodes, ultimately complicated by an esophageal microperforation.
While analgesic therapy may play an important role in management of acute exacerbations,
ongoing use of narcotics may contribute to the development of refractory CVS. This
association of disease progression with opiates suggests that coalescent CVS should be considered
a foregut manifestation of narcotic bowel syndrome.