Cannabinoid hyperemesis syndrome

Ruffle, James K.; Bajgoric, Sanjin; Samra, Kiran; Chandrapalan, Subashini; Aziz, Qasim; Farmer, Adam D.

doi:10.1097/meg.0000000000000489

Cited by 22 publications

(10 citation statements)

References 42 publications

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“…Approximately 9% of individuals who use cannabis report dependence at some point in their use [ 5 ]. Cannabis can paradoxically act as an antiemetic during acute ingestion at low doses, whereas persistent high-dose ingestion could result in vomiting, a behavior similar to cyclical vomiting [ 6 ]. It appears from the current literature that the prevalence of cannabis hyperemesis syndrome (CHS) is higher in the US compared to Canada and the United Kingdom, although the prevalence of cannabis use is similar in these countries [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Cannabis hyperemesis syndrome: an update on the pathophysiology and management

Perisetti

Gajendran

Dasari

et al. 2020

aog

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Cannabis hyperemesis syndrome (CHS) is a form of functional gut-brain axis disorder characterized by bouts of episodic nausea and vomiting worsened by cannabis intake. It is considered as a variant of cyclical vomiting syndrome seen in cannabis users especially characterized by compulsive hot bathing/showers to relieve the symptoms. CHS was reported for the first time in 2004, and since then, an increasing number of cases have been reported. With cannabis use increasing throughout the world as the threshold for legalization becomes lower, its user numbers are expected to rise over time. Despite this trend, a strict criterion for the diagnosis of CHS is lacking. Early recognition of CHS is essential to prevent complications related to severe volume depletion. The recent body of research recognizes that patients with CHS impose a burden on the healthcare systems. Understanding the pathophysiology of the endocannabinoid system (ECS) remains central in explaining the clinical features and potential drug targets for the treatment of CHS. The frequency and prevalence of CHS change in accordance with the doses of tetrahydrocannabinol and other cannabinoids in various formulations of cannabis. CHS is unique in presentation, because of the cannabis’s biphasic effect as anti-emetic at low doses and pro-emetic at higher doses, and the association with pathological hot water bathing. In this narrative review, we elaborate on the role of the ECS, its management, and the identification of gaps in our current knowledge of CHS to further enhance its understanding in the future.

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Section: Introductionmentioning

confidence: 99%

Cannabis hyperemesis syndrome: an update on the pathophysiology and management

Perisetti

Gajendran

Dasari

et al. 2020

aog

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“…CHS is a variant of cyclic vomiting syndrome associated with chronic cannabis use, which was first described by Allen et al in 2004 [4]. Symptoms of CHS overlap significantly with conditions such as cyclic vomiting syndrome (CVS), psychogenic vomiting, viral gastroenteritis, functional dyspepsia, and bulimia nervosa [5]. Therefore, diagnosis of CHS can be challenging and is often delayed, resulting in more frequent emergency department (ED) visits for nausea and vomiting [6].…”

Section: Introductionmentioning

confidence: 99%

Emerging Role of Aprepitant in Cannabis Hyperemesis Syndrome

Parvataneni

Varela

Vemuri-Reddy

et al. 2019

Cureus

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Cannabis hyperemesis syndrome (CHS) is a clinical syndrome associated with prolonged and regular cannabis use. CHS is characterized by recurrent episodes of intractable nausea and vomiting. Given the overlap with other medical conditions and the frequent delay in diagnosis, finding an effective anti-emetic regimen for symptomatic control of CHS can be challenging. We report a case study where aprepitant (Emend) was successfully used as an anti-emetic in the treatment of CHS when all other common anti-emetics failed.

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“…A retrospective case series from the UK reported on 10 cases of CHS which had originally been diagnosed with alternative conditions (4 with CVS, and one each with PV, Ehlers-Danlos syndrome, multiple sclerosis, viral gastroenteritis, functional dyspepsia, and bulimia nervous) [120]. There were 5 men and 5 women included, mean age 27 years (range 19–51 years) with symptoms of abdominal pain, nausea, and hyperemesis refractory to medical therapy.…”

Section: Clinical Considerationsmentioning

confidence: 99%

“…In a retrospective case series from the UK, 10 CHS patients were followed for a median of 9.5 months (range 1–20 months) following counseling to stop using marijuana to avoid symptoms. Seven of the patients abstained from marijuana during this time and had no further episodes; 3 patients resumed their use of marijuana and had further episodes [120]. …”

Section: Treatmentmentioning

confidence: 99%

“…In this group, 9 patients smoked marijuana for recreation, while the other patient had been prescribed synthetic cannabinoids (nabilone 2 mg twice a day) to treat multiple sclerosis. The approximate consumption of THC per day was a mean of 70.3 ± 40.8 mg. Seventy percent of pa tients reported symptoms typically began in the morning [120]. …”

Section: Clinical Considerationsmentioning

confidence: 99%

See 1 more Smart Citation

Cannabinoid Hyperemesis

Pergolizzi Jr.,

LeQuang,

Bisney

2018

Med Cannabis Cannabinoids

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Cannabinoid hyperemesis syndrome (CHS) is a paradoxical condition in which a long-term cannabis user suffers an episode of intractable vomiting that may last days separated by longer asymptomatic periods of weeks or months. Cannabinoids are often utilized for their antiemetic properties, so CHS can be a puzzling condition, and the diagnosis of CHS may be disputed by patients. Unlike other cyclic vomiting syndromes, CHS can be relieved by hot showers or topical capsaicin. Abstinence from cannabinoids causes CHS to resolve, sometimes in a matter of days or hours. Marijuana users as well as many clinicians are not aware of CHS, and patients may undergo unnecessary tests, scans, and other procedures to get an accurate diagnosis. Symptoms may be severe enough to require hospitalization. With liberalization of marijuana laws and favorable public opinion about the healing properties of cannabis, CHS may be more frequently observed in clinical practice.

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Cannabinoid hyperemesis syndrome

Cited by 22 publications

References 42 publications

Cannabis hyperemesis syndrome: an update on the pathophysiology and management

Cannabis hyperemesis syndrome: an update on the pathophysiology and management

Emerging Role of Aprepitant in Cannabis Hyperemesis Syndrome

Cannabinoid Hyperemesis

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