Cannabis Hyperemesis Syndrome Saint Luke’s Health System

Capsaicin, the active compound in chili peppers, acts on TRPV1 receptors, potentially modulating gastrointestinal sensory pathways and altering intestinal blood flow to provide relief from nausea and vomiting. Certain cannabinoid hyperemesis syndrome therapies, such as taking hot showers or using prescription medications, may help relieve symptoms. Severe nausea, vomiting, and stomach pain are the hallmark symptoms of cannabinoid hyperemesis syndrome (CHS).

• As a somewhat new problem, CHS is often mistaken for other problems with the same symptoms.
• As the utilization of cannabis transcends traditional boundaries, encompassing medical treatments, recreational indulgence, and wellness pursuits, the profound impact of THC and cannabinoids on gastrointestinal physiology is coming to light.

Management of CHS

Let your doctor know how much marijuana you use and how often you use it. Although it was considered to be rare, the number of cases has increased with the legalization of marijuana in many places and the opening of retail stores to easily get it. This has increased both the number of people using the drug and the "high" in the available weed. It’s a serious medical problem that can cause major health issues if you leave it untreated. If you have any symptoms of severe dehydration, like dizziness, confusion and a rapid heartbeat, call 911 right away. Along with the discovery of the CB1 and CB2 receptors has been the identification of endogenous arachidonic acid derivatives that bind to these receptors (Figure 1).

Unveiling the Complexities of Cannabinoid Hyperemesis Syndrome: Mechanisms Underlying CHS

(Recreational use and sale of cannabis in Canada was legalized starting in 2018). It's not clear what percentage of all heavy marijuana users have experienced CHS. In the brain, the cannabinoid system helps regulate several aspects of the endocrine system. CB1 receptor activation in the hypothalamus and pituitary gland results in modulation of all hypothalamic-pituitary axes [38]. Receptor activation leads to inhibitory effects on the release of growth hormone, thyroid hormone, prolactin, and luteinizing hormone [38].

• An electrocardiogram may be useful to assess the patient’s QTc interval, especially in the context of antipsychotic medication use, as well as before the administration of certain antiemetics, which may prolong the QTc interval to extreme lengths.
• This activity introduces the pathophysiology, clinical manifestation, and management of cannabis hyperemesis.
• 11-OH-COOH is a psychotropic metabolite that is equipotent to THC in terms of producing psychic effects and lowering intraocular pressure [25].
• When cannabinoids bind with brain receptors, they tend to prevent nausea and vomiting.
• On every check during the previous 8 years, the patient’s UDS was positive for THC.

Patients & Families

A thorough history, physical examination and directed testing of differential diagnoses may assist in ruling out these diagnoses. The Rome IV criteria provide some objectivity to help with the diagnosis by placing CHS under the heading of functional gut-brain disorders, and consider it as a variant of CVS (Table 2). Venkatesan et al have proposed a new criterion for CHS with the use of clinical features, cannabis use patterns including duration and frequency, and symptoms resolution after at least 6 months of cessation [48].

CHS Symptoms

• Nabilone, sold under the brand name Cesamet©, is a synthetic cannabinoid with therapeutic use as an antiemetic and as an adjunct analgesic for neuropathic pain.
• CHS develops in heavy, longtime consumers of cannabis; there is generally daily use in excess of three to five times a day for many years before the appearance of symptoms.
• In the gastrointestinal system, CB1 receptors are found on both intrinsic and extrinsic neurons, with the enteric nervous system serving as the major site of action [9].
• This evolution has been accompanied by a concerning uptick in cases of Cannabinoid Hyperemesis Syndrome (CHS), characterized by distressing bouts of nausea and vomiting with varying degrees of severity.

The RCT conducted by Dean et al. [22] presented with overall a low risk of bias; however, there were some concerns related to attrition bias, as one individual ended their involvement early. Despite the appropriate statistical methods used in the study conducted by Wagner et al. [24], the subgroup analysis presented a serious risk of bias due to a small sample that may contain unbalanced prognostic factors. The retrospective cohort conducted by Yusuf et al. [25] had a moderate bias in selecting patients in the ED, as there was selective reporting of patient outcomes, as only the LOS in the ED was measured. Nabilone, sold under the brand name Cesamet©, is a synthetic cannabinoid with therapeutic use as an antiemetic and as an adjunct analgesic for neuropathic pain. Nabilone mimics THC, the primary psychoactive compound found naturally occurring in cannabis. This may be difficult if marijuana is being used as an appetite stimulant or for treatment of chemotherapy-induced nausea and vomiting.

Or they might think it’s something else, since repeated throwing up is a sign of many health problems. You may need to see a gastroenterologist, a doctor who specializes in the digestive tract, for a proper diagnosis. CHS is a very rare syndrome and is easily cured by stopping the consumption of cannabis. This should not, by any means, hurt marijuana’s reputation for being the safest recreational drug around, but people need to be aware of the syndrome’s existence.

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