Cannabinoid hyperemesis syndrome
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|Cannabinoid hyperemesis syndrome|
Cannabinoid hyperemesis syndrome is characterized by recurrent nausea, vomiting and crampy abdominal pain. These symptoms have been reported to be improved temporarily by taking a hot shower or bath or more fully by stopping the use of cannabis.
The syndrome was described by Allen and colleagues (2004), and Sontineni and colleagues (2009) who offer simplified clinical diagnostic criteria. A subsequent, larger study reported a case series of 98 subjects with cannabinoid hyperemesis syndrome, confirming the earlier reported findings.
Signs and symptoms
|Essential||Cannabis use for years|
|Major||Severe nausea and vomiting
Vomiting that recurs in a cyclic pattern over months
Resolution of symptoms after stopping cannabis use.
|Supportive||Compulsive hot baths with symptom relief
Colicky abdominal pain
No evidence of gall bladder or pancreatic inflammation
|Essential||Long-term cannabis use|
|Major||Severe cyclic nausea and vomiting
Resolution with cannabis cessation
Relief of symptoms with hot showers or baths
Abdominal pain, epigastric or periumbilical
Weekly use of marijuana.
|Supportive||Age less than 50 y
Weight loss of >5 kg
Morning predominance of symptoms
Normal bowel habits
Negative laboratory, radiographic, and endoscopic test results
Sontineni and colleagues in 2009 discussed the cannabinoid hyperemesis syndrome to offer guidelines for the clinical diagnosis.
Various pathogenic mechanistic theories attempting to explain symptoms have been put forward. These theories fall into two themes: 1) dose dependent buildup of cannabinoids and related effects of cannabinoid toxicity, and 2) the functionality of cannabinoid receptors in the brain and particularly in the hypothalamus (which regulates body temperature and the digestive system). But the mechanisms by which cannabis causes or controls nausea and the adverse consequences of long-term cannabis toxicity remain unknown and organic disease should not be ruled out as a possible cause.
The neurobiology of the compound has led to the discovery of an endogenous cannabinoid system. The therapeutic potential of cannabinoids has been recognized and these compounds are utilized as antiemetics. Several studies have demonstrated the therapeutic effects of cannabinoids for nausea and vomiting in the advanced stages of illnesses such as cancer and AIDS.
The number of people affected is unclear as of 2015. Cannabis is by far the most widely cultivated, trafficked and used illicit substance. In the present decade, cannabis use has grown more rapidly than cocaine and opiate use. The most rapid growth in cannabis use since the 1960s has been in developed countries in North America, Western Europe and Australia. Cannabis has become more closely linked to youth culture and the age of initiation is usually lower than for other illicit drugs.
Many traditional medications for nausea and vomiting are ineffective. However, treatment with lorazepam or haloperidol has provided relief for some people. Assessing for dehydration due to vomiting and hot showers is important as it can lead to cannabinoid hyperemesis acute renal failure (CHARF), and this is easily treated with IV fluids. Treatment is otherwise supportive and focuses on stopping cannabis use.
Acute episodes of cannabinoid hyperemesis typically last for 24–48 hours and the problem often resolves with long term stopping of cannabis use. Improvement can take one to three months to occur.
Relapses are common, and this is thought to be possibly secondary to a lack of education as many people use or increase their use of cannabis to treat their symptoms of nausea and vomiting.
- Allen, J H; De Moore, GM; Heddle, R; Twartz, JC (2004). "Cannabinoid hyperemesis: Cyclical hyperemesis in association with chronic cannabis abuse". Gut. 53 (11): 1566–70. doi:10.1136/gut.2003.036350. PMC 1774264. PMID 15479672.
- Sontineni, Siva-P; Chaudhary, S; Sontineni, V; Lanspa, SJ (2009). "Cannabinoid hyperemesis syndrome: Clinical diagnosis of an underrecognised manifestation of chronic cannabis abuse". World Journal of Gastroenterology. 15 (10): 1264–6. doi:10.3748/wjg.15.1264. PMC 2658859. PMID 19291829.
- Simonetto, Douglas A.; Oxentenko, Amy S.; Herman, Margot L.; Szostek, Jason H. (2012). "Cannabinoid Hyperemesis: A Case Series of 98 Patients". Mayo Clinic Proceedings. 87 (2): 114–9. doi:10.1016/j.mayocp.2011.10.005. PMC 3538402. PMID 22305024.
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- World health Organization, Cannabis - epidemiology.
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