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Lapoint J. Capsaicin cream for treatment of cannabinoid hyperemesis syndrome (abstract 51). Investigators sought to create a consensus guideline for rapid identification and opioid-sparing treatment of patients with CHS. In IBD, like Crohn’s or ulcerative colitis, cannabis’s anti-inflammatory edge stands out.

Diagnostic Process

There is also some evidence to suggest that cannabinoids interact directly with CB-1 receptors in the gastrointestinal tract and alter gastrointestinal motility 16, 92, 95, 132–134. Animal studies lend some credibility to this theory; however, results are not consistently reproducible in human studies. Additionally, many inferential hypotheses were identified that attribute different aspects of CHS to a myriad of dysregulatory issues at CB-1 receptors throughout the body (brain, gastrointestinal tract, and vasculature) 97, 98, 102, 105, 133, 135–137.

• It’s not just about late-night snacks; it’s about harnessing its therapeutic potential thoughtfully.
• Furthermore, in cases where patients resumed cannabis use after a period of abstinence, the same symptoms reemerged 5.
• Additionally, the prolonged use of certain antiemetics, such as ondansetron, may have limited benefit in CHS, further highlighting the need for individualized management plans.

Assessment of Study Quality

Yet, its relationship with appetite and digestion is far more nuanced, offering potential benefits for weight management, https://ecosoberhouse.com/ digestive comfort, and overall wellness. This complexity arises from the endocannabinoid system (ECS), a network of receptors and signaling molecules that regulates hunger, metabolism, and gut function. Through compounds like THC, CBD, and THCV, along with aromatic terpenes, cannabis can stimulate or suppress appetite, ease nausea, or support a healthy gut microbiome. Patients may deny cannabis use as a cause of their symptoms and fail to follow-up or seek medical care at other facilities resulting in repeated testing and resource utilization 8. Therefore, substance abuse experts should be involved when the diagnosis is made. CBD (cannabidiol), non-psychoactive and widely available, may actually temper appetite.

• These studies were analyzed and synthesized to provide an overview of CHS, its clinical features, and the evolving understanding of its relationship to chronic cannabis use.
• Initial reports describe an average of 7.1 emergency department visits, 3.1 hospitalizations, and 5.0 clinic visits prior to diagnosis 12, but as the syndrome is recognized more and cannabis availability increases, more rapid diagnosis is likely.
• Given the rise of CHS cases in regions with legalized cannabis markets, public health agencies should prioritize research funding to fill these gaps and inform future policy.
• There is a wide range of studies included in the analyses with no major limitations, there is little variation between studies, and the summary estimate has a narrow confidence interval.
• Supportive care with IV fluids and anti-emetics is the mainstay of treatment in the acute phase of illness.
• Imaging should be avoided, especially in the setting of a benign abdominal examination, as there are no specific radiological findings suggestive of the diagnosis.

POINT-OF-CARE EMERGENCY CLINICAL SUMMARY

Although laboratory examinations and advanced imaging studies (e.g., CT scans, ultrasounds) are often negative, they play a crucial role in ruling out other conditions. The lack of significant diagnostic findings in CHS patients underscores the importance of a thorough patient history and clinical suspicion. Despite negative workups, physicians must consider CHS when standard treatments fail and patients continue to present with persistent symptoms related to cannabis use. The difficulty in diagnosing CHS arises because its symptoms overlap with other gastrointestinal and metabolic disorders, such as gastroparesis, cyclic vomiting syndrome, or peptic ulcer disease. Overlapping symptoms such as abdominal pain and cyclic vomiting are especially difficult to pinpoint to a specific illness. Hear from author Dr. Michael Camilleri as he shares what clinicians should know about the phases of cyclical vomiting syndrome that are also present in cannabinoid hyperemesis syndrome and how best to provide care and treatment.

• As noted earlier, hot baths or showers provide temporary relief for many patients.
• CHS episodes generally last a few days but can persist for up to seven to 10 days.
• CBD (cannabidiol), non-psychoactive and widely available, may actually temper appetite.

Presentation to care during the prodromal or hyperemetic phases of CHS can prompt a variety of short- and long-term outcomes, from repeated ED visits with catastrophic sequelae to successful symptom control and patient-centric connection with long-term care. When pediatricians are aware, CHS symptoms can be the canary in the coal mine, leading patients to multidisciplinary support, insight, motivation, and long-term recovery. Brief intervention can include motivational interviewing toward reducing harm and/or use.

TREATMENT OF CHS

As cannabis becomes more potent and widely available, CHS is increasingly prevalent. Many patients are hesitant to consider cannabis as the cause of their symptoms, which can delay diagnosis and hinder further research. Moving forward, physicians should be aware of rising cannabis use and identify potential CHS cases to ensure proper treatment and investigation. Further research, particularly at the microscopic level, is essential to better understand this condition. Public health responses to CHS are hampered by a lack of comprehensive data and research. The rapid expansion of cannabis legalization has outpaced the research into its health impacts, particularly regarding conditions like CHS.

Additionally, studies that did not discuss cannabis use in relation to CHS symptoms were not considered. Cannabis, commonly referred to as marijuana, is a plant from the Cannabis sativa species that has been cultivated and consumed for medicinal, industrial, and recreational purposes for thousands of years. The plant’s psychoactive and medicinal effects are attributed to its cannabinoids, chemical compounds that interact with the body’s endocannabinoid system. Among these cannabinoids, tetrahydrocannabinol (THC) is the most well-known for its ability to induce euphoria, alter perception, and stimulate appetite. Cannabidiol (CBD), another major cannabinoid, has gained attention for its potential therapeutic properties, including anti-inflammatory, anxiolytic, and neuroprotective effects 1. Cannabis is the third most commonly used substance among adolescents in the United States.36 Potency and societal acceptance are rising, with use increasing further during the COVID-19 pandemic.37 CHS is one serious consequence.

Clinical Guidance

Researchers are currently studying several treatment options to manage the hyperemetic phase of CHS. Members receive our weekly newsletter, AGA eDigest, which is packed with clinical education updates, career development opportunities, member news and more. While the opioid epidemic has garnered much attention, other forms of substance use disorders (SUD) heroin addiction continue to have significant impacts on health and wellness. Globally, alcohol use disorder (AUD) is the most prevalent SUD with over 100 million estimated cases in 2016. Cannabis use disorder (CUD) is the third most prevalent SUD with an estimated 22 million cases worldwide (following opioid use disorder at 26 million cases).