Navigating the Intricacies of Cannabinoid Hyperemesis Syndrome CHS: Understanding the Unseen Challenges

It’s a condition that can lead to serious health complications if you don’t get treatment for it. The aim of this review was to compare the patterns of disease of CVS and CHS. The similarities of both syndromes indicated the need for development of a pragmatic approach towards both CVS and CHS, applicable to a broad range of clinical settings. The only way to prevent CHS is to avoid using any form of marijuana. It’s still possible to develop CHS if you use cannabis for many years without having any problems.

What causes cannabis hyperemesis syndrome?

Five patients agreed to work with the addiction team and discontinued the use of marijuana, but 2 patients refused and resisted the notion that they should give up marijuana [130]. CHS may be confused with hyperemesis gravidarum, so an accurate diagnosis is important to avoid costly and time-consuming diagnostic cannabinoid hyperemesis syndrome steps and to avoid prolonging the patient’s suffering as these two conditions respond to different treatments [121]. Pregnant women may not be forthcoming about their marijuana use, which can complicate diagnosis [121]. Maternal cannabinoid use alone does not necessarily mean that hyperemesis is CHS.

• An intriguing point to keep in mind is that the Rome IV criteria include the phrase “resembling cyclical vomiting syndrome.” In that regard, it is important to distinguish between the two.
• In some cases, lorazepam may be helpful to counteract the anxiety suffered by the patient, but lorazepam as treatment for CHS is generally not effective [116].
• When you do this, your symptoms usually start to go away in few days to a few months.
• Many clinicians and the general public − including avid marijuana users − are unaware of the existence of CHS, and many patients undergo unnecessary tests, scans, and procedures to get at the root of their sometimes debilitating symptoms.
• It appears from the current literature that the prevalence of cannabis hyperemesis syndrome (CHS) is higher in the US compared to Canada and the United Kingdom, although the prevalence of cannabis use is similar in these countries [7,8].
• Treatment that helps prevent dehydration and loss of electrolytes can help reduce your risk of many of these problems.
• We performed a literature review using the LIVIVO search portal for life sciences to develop a pragmatic approach towards these two syndromes.

Is cannabis hyperemesis syndrome (scromiting) permanent?

However, Mallory-Weiss lesions, oesophagitis and gastritis may be detected in some cases of both syndromes [1], [2]. Rapid gastric emptying indicates CVS whereas delayed gastric emptying is more frequently found in CHS patients [13], [14]. Awareness of CVS and/or CHS and detailed history of the patient is the key to suspicion and diagnosis in patients presenting with nausea and vomiting (Figure 1 (Fig. 1)). The cyclic vomiting syndrome in infants and children has an estimated prevalence of 0.04–2% [3], [4].

Complications Secondary to CHS

• “Give the science behind cannabinoids, we understand how [CHS] works in theory,” Vakharia adds.
• With cannabis use increasing throughout the world as the threshold for legalization becomes lower, its user numbers are expected to rise over time.
• This factor is a key distinguishing feature from cannabis hyperemesis syndrome, where the toxicokinetics of cannabis itself influence the course of the disease.
• Since THC is stored in your body fat, it can take weeks to months before all the symptoms go away and you notice a difference.

During episodes, patients may display (psycho-)vegetative symptoms, e.g. sweating, irritability or agitation [1], [5], [8]. Vomiting from an empty stomach seems to be more painful than vomiting from a water-filled stomach which results in excessive oral intake of water leading to waterish-foamy vomits in numerous patients [1]. However, all other forms of vomit were reported from different cases [1], [11]. The cannabinoid hyperemesis syndrome (CHS) and the cyclic vomiting syndrome in adults (CVS) are both characterized by recurrent episodes of heavy nausea, vomiting and frequently abdominal pain.

• 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.
• A computed tomography (CT) scan of his abdomen and pelvis with contrast was unremarkable.
• While the evidence supporting their efficacy is limited, these options could be considered in specific scenarios where conventional treatments prove inadequate.
• Only one CHS patient returned to the ED within 3 days after receiving topical capsaicin; capsaicin was administered again, and the patient reported rapid relief and was discharged without further treatment [96].

The mechanism of action of topical capsaicin likely involves TRPV1 receptors. In other words, topical capsaicin opens the TRPV1 channels, which has an antiemetic effect. Endogenous cannabinoids or endocannabinoids may also play a role in CHS.