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Rome IV Diagnostic Criteria for Chronic Nausea Vomiting Syndrome (CNVS)
Diagnostic checklist for chronic nausea and vomiting syndrome in adults.
Rome IV Diagnostic Criteria for Chronic Nausea Vomiting Syndrome (CNVS)
Bothersome nausea occurring at least 1 day per week
≥1 vomiting episode per week
No self-induced vomiting
No eating disorder
No rumination syndrome
No major psychiatric disorder per DSM-5 explaining the symptoms
No cannabis use pattern suggestive of cannabinoid hyperemesis syndrome
Supportive screening item — cannabinoid hyperemesis is a mimic to exclude clinically, but is not itself part of the formal Rome IV CNVS diagnostic criteria.
Criteria fulfilled for the last 3 months with symptom onset ≥6 months before diagnosis
Symptoms not attributable to another disease after appropriate work-up
ResultCriteria not met
CNVS requires bothersome nausea ≥1 day/week and/or ≥1 vomiting episode/week, exclusion of self-induced vomiting, eating disorder, rumination and major psychiatric disease, for ≥3 months (onset ≥6 months prior).
- Cannabis pattern suggestive of cannabinoid hyperemesis
- Present — consider cannabinoid hyperemesis syndrome instead
When to use
- Evaluating chronic unexplained nausea and/or vomiting in an adult without cyclical (episodic) pattern.
Formula
Bothersome nausea ≥1 day/week and/or ≥1 vomiting episode/week, without self-induced vomiting, eating disorder, rumination syndrome, or major psychiatric disease, for the last 3 months with onset ≥6 months before diagnosis. Cannabis use pattern should be assessed as a mimicking condition (cannabinoid hyperemesis syndrome) but is not itself a formal diagnostic criterion.
Pearls and pitfalls
- Always ask about cannabis use pattern and hot-shower relief, which suggest cannabinoid hyperemesis syndrome rather than CNVS.