Further, these behaviors could also be noted in CVS, preadolescents, cannabinoid hyperemesis syndrome and adolescents with no prior exposure to cannabis 8. These changes from hot bathing are probably not specific to CHS but can be seen across all functional nausea and vomiting disorders, including CVS, and are probably aggravated by cannabis use 9. Thus, hot shower bathing may be more closely related to CHS, but is neither specific nor sensitive in its diagnosis.
- This leads to an important question, especially in light of our gradual societal paradigm shift toward liberalizing marijuana.
- Oncology patients may be advised to use cannabinoids to relieve chemotherapy-induced nausea and vomiting, only to develop CHS over time.
- Diagnosis begins with a thorough physical examination and history for all patients presenting with nausea, vomiting, and abdominal pain.
- People with CHS describe their symptoms as overwhelming and incapacitating, according to a 2011 study published in the journal Current Drug Abuse Reviews.
- CHS is classified as a type of functional gut–brain disorder and a variant of cyclic vomiting syndrome (CVS) per the Rome IV structured framework.
- Some patients require a gradual increase in their maintenance dose to maintain stability, as dose tolerance leads to ‘breakthrough’ vomiting episodes.
Care at Cleveland Clinic
The PPI pantoprazole provides this information on its labeling, but it is not widely appreciated among clinicians since there are no known published case studies of this in the literature 76. In a case study of a 13-year-old girl who was treated with pantoprazole for CVS, a urine test was positive for cannabinoids but a subsequent gas chromatography-mass spectrometry test returned negative 76. The patient Alcoholics Anonymous had CVS, not CHS, despite a false-positive for marijuana. Since there are no laboratory or radiographic examinations that can be used to diagnose CHS, CHS should be diagnosed based on symptoms and patient behaviors. In some cases, CHS is a diagnosis of exclusion after other hyperemetic conditions (such as hyperemesis gravidarum, psychogenic vomiting PV, or CVS) are ruled out.
Practice Management
The patient discontinued haloperidol on her own after 3 weeks and was subsequently lost to follow-up 113. While clinicians and most regular marijuana users regard CHS as a rare condition − if they have heard of it at all − the literature suggests otherwise. Many cases of CHS are likely misdiagnosed or not medically treated at all.
Management
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 https://ecosoberhouse.com/article/is-cannabidiol-addictive-the-effects-of-cbd/ 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.
How Common Is CHS?
Mood disorders such as anxiety and depression often coexist in patients with CHS 98. Many times, presentation during the hyperemesis phase may be similar to panic disorder. This similarity could be the reason why CHS tends to respond well to benzodiazepines, especially during these acute episodes. It is essential to treat the underlying mood disorder to achieve cannabis discontinuation and CHS remission. The Hamilton Rating Scale for Anxiety is commonly used to assess anxiety, while the Zung Depression Inventory is employed to evaluate depression severity 99,100.
Shortcomings in our knowledge of CHS and areas for future research
- Although its prevalence is unknown, numerous publications have preliminarily established its unique clinical characteristics.
- With more online usage among youngsters, social media campaigns and videos can spread information and awareness of CHS in this population.
- Because so little is known about Cannabinoid Hyperemesis Syndrome and its causes, few treatment approaches have been developed.
- With liberalization of marijuana laws and favorable public opinion about the healing properties of cannabis, CHS may be more frequently observed in clinical practice.
- There exists no epidemiological data regarding the incidence and prevalence of CHS among chronic marijuana users.
If you do use cannabis, quitting can ward off future episodes of CHS. Researchers are still trying to figure out exactly what causes CHS in some people who regularly use cannabis but not others. Still, recent studies have opened up a new possibility—that genetics are the reason why CHS hits some cannabis consumers but not others. What has never been clear was why only some heavy users of cannabis seem to be affected.
