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Rome IV Diagnostic Criteria for Chronic Nausea Vomiting Syndrome (CNVS)
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.