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

Hot showers have emerged as an intriguing phenomenon in assuaging the symptoms of Cannabis Hyperemesis Syndrome (CHS), offering a peculiar yet effective avenue for relief. While the precise physiological mechanisms underpinning this phenomenon continue to be explored, several theories shed light on why hot showers might hold therapeutic value for CHS patients. Notably, a hallmark behavior observed in CHS cases is the propensity for pathologic hot bathing or showering. While not exclusive to individuals with CHS, the act of hot bathing or showering manifests in approximately 80-90% of patients with this condition. If you need help quitting, speak to a healthcare provider or connect with your local addiction treatment services.

Clinical Presentation, work up and differential diagnosis of Cannabinoid Hyperemesis Syndrome

These compounds are alcohol rehab referred to as endogenous cannabinoids, or endocannabinoids. The best characterized endocannabinoids are anandamide and 2-arachidonylglycerol (2-AG) 9. The endocannabinoids are present in both the central nervous system 8 and enteric nervous system 15. Anandamide and 2-AG are released locally on demand by neurons, are present in small quantities, and undergo rapid inactivation 8. Endocannabinoids are thought to act as either neuromodulators or neurotransmitters 11. Anandamide and 2-AG possess similar biochemical structures, but each has a distinct pathway for biosynthesis and degradation.

• These usually happen for 3 to 4 days but can last as long as 1 week in bad cases.
• 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.
• The diagnostic criteria for CHS were ill-defined prior to the establishment of the Rome IV criteria of 2016.2223 Per the Rome IV criteria, all 3 of the following must be met to be diagnosed with CHS.
• Addiction rehab programs or CBT may be helpful resources for quitting cannabis.
• Probably, a crucial factor in the genesis of CHS is the composition of cannabis.
• You’re more likely to get CHS if you use marijuana at least once a week and have been doing so since you were a teenager.
• CHS causes you to have repeated episodes of vomiting, severe nausea, stomach pain, and dehydration.

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• Patients with CVS also have times where they are feeling sick to the stomach and can also throw up for between 12 hours to about a week.
• The most effective treatment during the hyperemetic phase of CHS is the use of hot showers by patients.
• Studies have demonstrated the efficacy of outpatient treatment options such as cognitive behavioral therapy and motivational enhancement therapy for marijuana dependence 73.

Darmani has suggested that cannabis increases the core body temperature while concomitantly decreasing skin temperature thus increasing blood flow to the skin and dissipating excess core body heat 72. Patients with CHS usually remain misdiagnosed for a considerable time period. In one case series the average number of emergency room visits (7.1 ± 4.3) prior to diagnosis and the delay in diagnosis (for up to 9 years) was substantial 62. Not surprisingly, the early identification of patients with CHS leads to a reduction in morbidity and costs 6.

The Effects of Cannabinoids in the Brain

“Cannabinoid” refers to cannabis (marijuana) and “hyperemesis” is a word meaning “prolonged vomiting.” Cannabinoid Hyperemesis Syndrome is a new and under recognized clinical entity. Although its prevalence is unknown, numerous publications have preliminarily established its unique clinical characteristics.

A recent review has explored numerous potential explanations regarding various pharmacokinetic and pharmacodynamic factors of the cannabinoids 72. The cannabis plant contains over four hundred different chemicals, with sixty possessing cannabinoid structures 76. The pro-emetic effects of two of these cannabinoids, CBD and CBG, have been discussed in this review and could conceivably play a role in the development of CHS. Additional pharmacological research is needed regarding the pro-emetic effects of additional cannabinoids and their metabolites. Another proposed explanation is that in susceptible individuals the pro-emetic effect of cannabis on the gut (e.g. delayed gastric emptying) overrides its anti-emetic CNS properties 62.

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Most people with CHS who stop using cannabis have relief from symptoms within 10 days. The pain is usually around the belly button and can get better with hot shower/baths. Some patients use hot water bags across the center of their belly and can burn the skin if done a lot.

CHS Symptoms

Researchers are still trying to figure out exactly what causes CHS in some people who regularly use cannabis but not others. In refractory CHS cases, experimental therapies such as benzodiazepines, tricyclic antidepressants, and dopaminergic agents like haloperidol have been explored. While the evidence supporting their efficacy is limited, these options could be considered in specific scenarios where conventional treatments prove inadequate. Despite the scarcity of randomized controlled trials (RCTs) on optimal treatment approaches for CHS, a holistic care plan can significantly enhance patient outcomes chs symptoms and signs and well-being. Most people end up having an abdominal ultrasound, upper scope, and a test to see how fast stuff gets out of the stomach before we figure out that their problem is CVS or CHS. Our mission is to inform, assist, and support people affected by gastrointestinal disorders.Our original content is authored specifically for IFFGD readers, in response to your questions and concerns.

How soon after cannabis hyperemesis syndrome treatment will I feel better?

Patients must be informed that habitual cannabis use can result in cannabinoid accumulation in adipose tissue, leading to prolonged or recurrent symptoms that may take weeks to completely resolve. Preventing a recurrence necessitates complete abstinence to facilitate recovery. Interestingly, patients dealing with Cyclical Vomiting Syndrome (CVS) also frequently mention this behavior. Yet, with the evolving comprehension of CHS, there is a likelihood that some cases attributed to CVS might actually be undiagnosed instances of CHS, marking it as pathognomonic. This underscores the critical need to correlate symptoms with cannabis consumption, ruling out overlapping diagnoses that could be mistaken for CVS.

• Dronabinol (synthetic THC) and nabilone (a CB1 receptor agonist) are two commercially available cannabinoids for the treatment of chemotherapy-induced nausea and vomiting 37.
• In the brain, CB1 receptors are localized to the cerebral cortex, hypothalamus, anterior cingulate gyrus, hippocampus, cerebellum, and basal ganglia 8.
• Tetrahydrocannabinol (THC) and cannabidiol (CBD) are the main cannabinoids in marijuana products.
• (Recreational use and sale of cannabis in Canada was legalized starting in 2018).

What are the risk factors for cannabinoid hyperemesis syndrome?

And a 2022 Canadian study found that ER visits for CHS-related problems had increased 13-fold between 2014 and 2021. (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.

Cannabis is the most commonly used illicit drug in the United States with over 16.7 million users in 2009 1. The 18–25 year old age group has the highest prevalence of marijuana use 1. The majority of these individuals are less than nineteen years of age 2. Similarly in Europe, cannabis use is prominent among young adults, with a prevalence that has increased from 5% in 1990 to 15% in 2005 3. While the overall prevalence of marijuana use has remained stable in the United States at 4%, the prevalence of cannabis use disorders (i.e. cannabis dependence, cannabis abuse) has continued to rise 4. Risk factors for developing cannabis use disorders include male race, lower income, living in a Western culture, and being separated, divorced, or widowed 5.