Cannabinoid Hyperemesis CHS & Cyclic Vomiting CVS in Adults ACG

For example, in two recently published series of adult patients with CVS, approximately one third of patients reported daily marijuana use 65,66. Based on the categorization of functional disorders developed by Rome III, chronic marijuana use (CHS) is recognized as a mechanism for nausea and vomiting distinct from CVS 67. Although both conditions share an astonishing similarity, there are several significant differences. For example, CVS patients usually have important psychological comorbidities including depression and anxiety 64,65. In addition, CVS patients have a high prevalence of migraine headaches or a family history of migraines.

Symptoms

The initial approach to evaluate a patient with cyclical vomiting should start by excluding these vast disorders. In this context a comprehensive history along with initial screening tests should be performed to exclude acute conditions and emergencies (e.g pancreatobiliary disease, intestinal obstruction, pregnancy, etc). Cannabinoid hyperemesis syndrome (CHS) can affect people who use cannabis (marijuana) long-term. People with CHS also tend to have a strong urge to take very hot showers or baths. That’s because hot water can help ease cannabinoid hyperemesis syndrome symptoms like nausea.

The importance of quitting cannabis with CHS

These compounds are referred https://ecosoberhouse.com/article/10-useful-sobriety-sayings-that-can-help/ to as endogenous cannabinoids, or endocannabinoids. The best characterized endocannabinoids are anandamide and 2-arachidonylglycerol (2-AG) 9. The endocannabinoids are present in both the central nervous system 8 and enteric nervous system 15.

• Two case series and numerous individual case reports have been published on Cannabinoid Hyperemesis Syndrome (CHS) (Table 1).
• The hot temperature affects a part of the brain called the hypothalamus, which regulates temperature and throwing up.
• On the basis that only a small number of regular and long term users of marijuana develop CHS, some researchers suggest that genetics might play a role.
• In the brain, the cannabinoid system helps regulate several aspects of the endocrine system.

What are the symptoms?

CHS causes you to have repeated episodes of vomiting, severe nausea, stomach pain, and dehydration. You’re more likely to get CHS if you use marijuana at least once a week and have been doing so since you were a teenager. “Cannabinoid” refers to cannabis (marijuana) and “hyperemesis” is a word meaning “prolonged vomiting.” Compulsive hot showering or bathing may be critical in distinguishing CHS from CVS and other conditions with similar symptoms.

THC exhibits an anti-emetic effect in the central nervous system. In animal models, CB1 receptor activation in the dorsal vagal complex of the brainstem mediates this effect 35,36. Dronabinol (synthetic THC) and nabilone (a CB1 receptor agonist) are two commercially available cannabinoids for the treatment of chemotherapy-induced nausea and vomiting 37. CHS is a rare condition that cannabinoid hyperemesis syndrome affects some habitual cannabis users.

• As more states legalize cannabis, more people are learning whether cannabis is right for them.
• Serotonin antagonism in the gastrointestinal tract from medications such as ondansetron, dolasetron, and granisetron likewise have varying levels of efficacy.
• These episodes of vomiting are often separated by weeks or months, and there is a return to baseline between episodes.
• With the widespread use of cannabis, both recreationally and therapeutically, the paradoxical effect of CHS deserves further attention.
• Symptoms are most common in early middle-aged adults who have used cannabis regularly since adolescence.