Tu2086 The Endocannabinoid System (ECS) and the Hypothalamic-Pituitary-Adrenal (HPA) Axis in Adults With Cyclic Vomiting Syndrome (CVS)

Venkatesan, Thangam; Samuel, Erica A.; Kumar, Nilay; Sengupta, Jyotirmoy; Ali, Muhammad; Faddis, MacKenzie; Raff, Hershel; Hillard, Cecilia J.

doi:10.1016/s0016-5085(13)63441-1

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“…Kim et al demonstrated a near doubling of the prevalence of CVS following legalization of cannabis in Colorado (prevalence ratio 1.92, 95% confidence interval [CI] = 1.33 to 2.79), and these patients were more likely to have cannabis use documented (OR = 3.59, 95% CI = 1.44-9.00) [5]. Additionally, five observational studies were identified which reported a significant prevalence of cannabis use and compulsive hot baths/showers among CVS patients (see Table 4) [175][176][177][178][179]. For example, Venkatesan et al found that among 437 CVS patients, 81% were cannabis users and 67% reported using hot showers for symptom relief [179].…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, five observational studies were identified which reported a significant prevalence of cannabis use and compulsive hot baths/showers among CVS patients (see Table 4) [175][176][177][178][179]. For example, Venkatesan et al found that among 437 CVS patients, 81% were cannabis users and 67% reported using hot showers for symptom relief [179]. Bathing behavior was associated with cannabis use (OR 2.54, 95% CI = 1.2-4.3, P = 0.0006).…”

Section: Discussionmentioning

confidence: 99%

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Cannabinoid Hyperemesis Syndrome: Diagnosis, Pathophysiology, and Treatment—a Systematic Review

et al. 2016

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Cannabinoid hyperemesis syndrome (CHS) is a syndrome of cyclic vomiting associated with cannabis use. Our objective is to summarize the available evidence on CHS diagnosis, pathophysiology, and treatment. We performed a systematic review using MEDLINE, Ovid MEDLINE, Embase, Web of Science, and the Cochrane Library from January 2000 through September 24, 2015. Articles eligible for inclusion were evaluated using the G r a d i n g a n d R e c o m m e n d a t i o n s A s s e s s m e n t , Development, and Evaluation (GRADE) criteria. Data were abstracted from the articles and case reports and were combined in a cumulative synthesis. The frequency of identified diagnostic characteristics was calculated from the cumulative synthesis and evidence for pathophysiologic hypothesis as well as treatment options were evaluated using the GRADE criteria. The systematic search returned 2178 articles. After duplicates were removed, 1253 abstracts were reviewed and 183 were included. Fourteen diagnostic characteristics were identified, and the frequency of major characteristics was as follows: history of regular cannabis for any duration of time (100%), cyclic nausea and vomiting (100%), resolution of symptoms after stopping cannabis (96.8%), compulsive hot baths with symptom relief (92.3%), male predominance (72.9%), abdominal pain (85.1%), and at least weekly cannabis use (97.4%). The pathophysiology of CHS remains unclear with a dearth of research dedicated to investigating its underlying mechanism. Supportive care with intravenous fluids, dopamine antagonists, topical capsaicin cream, and avoidance of narcotic medications has shown some benefit in the acute setting. Cannabis cessation appears to be the best treatment. CHS is a cyclic vomiting syndrome, preceded by daily to weekly cannabis use, usually accompanied by symptom improvement with hot bathing, and resolution with cessation of cannabis. The pathophysiology underlying CHS is unclear. Cannabis cessation appears to be the best treatment

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