Pearl of the Day: Cannabinoid Hyperemesis Syndrome

Cannabinoid Hyperemesis Syndrome (CHS) Background - prodromal phase (months to years): early morning nausea, fear of vomiting, abdominal discomfort - hyperemetic phase (24 - 48 hours): paroxysms of intense vomiting and abdominal pain, can have marked weight loss - recovery phase (days to months): normal eating patterns, regular weight gain - can be confused with cyclic vomiting syndrome, which is usually more associated with increased gastric emptying rates, psychological comorbidities, history of migraine headaches - in GI tract, cannabinoids activate CB1 receptors -> inhibits gastric acid secretion, relaxes lower esophageal sphincter relaxation, reduces gastric motility, delays gastric emptying

Signs and Symptoms - recurrent episodes of nausea, vomiting, dehydration - begins several years after start of chronic marijuana abuse, usually with daily use and often > 3 - 5 times per day

Diagnosis - proposed clinical criteria: long-term weekly cannabis use, abdominal pain, severe cyclic nausea and vomiting, relief of symptoms with hot showers

Treatment - may require hospitalization during hyperemetic phase for supportive therapy - traditional antiemetic therapy provides minimal improvement - hot showers provide relief through unknown mechanism (one theory:  heat corrects cannabis-induced disequilibrium of thermoregulatory system of hypothalamus) - topical capsaicin cream to abdomen has successfully treated CHS in multiple case reports - capsaicin binds to TRPV1 receptors with high specificity -> impairs substance P signaling - most effective treatment:  cessation

Resources Galli JA, Sawaya RA, Friedenberg FK. Cannabinoid Hyperemesis Syndrome. Current drug abuse reviews. 2011;4(4):241-249.


Related Reading