Journal: Cannabinoid Hyperemesis Syndrome: Diagnosis, Pathophysiology, and Treatment— a Systematic Review

Reasoning:

• Abdominal pain and nausea/vomiting likely attributable to chronic, daily marijuana use
• Patient education important in improving symptoms and in making lifestyle modifications

Purpose:

• The purpose of this systematic review is to discuss the diagnosis, pathophysiology, and treatment behind cannabinoid hyperemesis syndrome (CHS)

Methods:

• Databases utilized included: PubMed/Medline, Ovid Medline, Embase, Web of Science, and Cochrane Library to screen though 2178 initial articles to include 183 final studies with particular focus on gender, age at presentation, age of first cannabis use, presence of cyclic vomiting/abdominal pain, weight loss, presence of compulsive baths/showers, response to trial of abstinence, and time to improvement of symptoms afterwards

 Key Points:

• According to the United Nations, 277 million people use cannabis worldwide (4.9% of total world population)
• Over the past several years, more states are legalizing recreational use and have expanded cannabis to treat nausea/vomiting from chemo, appetite stimulation in HIV/AIDS, chronic pain, multiple sclerosis, and depression
• CHS is one of the more common adverse effects, consisting of cyclic vomiting in chronic, high-dose users who take compulsive hot showers to control symptoms
• Patients frequently present with intractable nausea/vomiting
  • Undergo expensive testing, severe cases may require admission
  • Is currently under-recognized due to vague presentation, stigma associated with cannabis use, underreporting
  • One observational study showed median charge for ED visits/hospital admissions was $95,023
• Major diagnostic characteristics
  • History of regular cannabis use for 1+ year
  • Severe nausea/vomiting
  • Vomiting that recurs in cyclic pattern over months
  • Resolution of sx after stopping cannabis use
  • Compulsive hot showers with sx relief
  • Male predominance
  • Abdominal pain
  • At least weekly cannabis use
  • History of daily cannabis use
  • Age less than 50 at time of evaluation

• Pathophysiology
  • CHS is thought to be caused by dysregulation of endocannabinoid system located in brain, GI tract, PNS, immune system responsible for GI motility, appetite, nausea/vomiting, inflammation, mood, sleep, pain
• Abstinence is the only definitive treatment
  • Patients may also present with moderate to severe dehydration + acute renal failure, requiring aggressive fluid resuscitation + antiemetics
  • Limited evidence supporting dopamine antagonists (Haldol) or application of capsaicin cream to abdomen

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