Furthermore, LOS in the ED was used to measure the stabilization of N/V symptoms; however, it was not a marker of CHS cure. In addition to the lack of controlled studies, most of the articles published on CHS were descriptive case reports [20, 23, 26, 29, 30, 31, 33, 34, 35]. This anecdotal evidence is important clinically; however, CHS and its management options need to be viewed in the broader context of controlled research. Many different treatments and dosages have been reported among case studies, which may not be generalized to the wider population.
- Information regarding changes to the TRPV1 system and function of capsaicin following chronic cannabis exposure, and TRPV1 receptor function in individuals with CHS is still needed to confirm its contribution to CHS symptoms.
- The metabolism of THC occurs mainly in the liver via oxidation and hydroxylation reactions.
- In CHS, receptors that bind to the different components of marijuana can become altered.
- CHS causes you to have repeated episodes of vomiting, severe nausea, stomach pain, and dehydration.
Pre-disposing factors
Many people with CHS will compulsively shower or bathe — often for hours every day — to relieve CHS symptoms. In one 2018 study, a group of researchers surveyed 2,127 U.S. adults between the ages of 18 and 49 at an emergency department in New York. Of those surveyed, 155 met the criteria of smoking cannabis at least 20 days per month. A 2017 review of studies found that 97.4 percent of people who developed CHS reported using cannabis at least weekly.
Topical Capsaicin
The hot temperature affects a part of the brain called the hypothalamus, which regulates temperature and throwing up. Two case series and numerous individual case reports have been published on Cannabinoid Hyperemesis Syndrome (CHS) (Table 1). Patients present with recurrent episodes of nausea, vomiting, and dehydration with frequent visits to the emergency department. Patients are typically young adults with a long history of cannabis use. In nearly all cases there is a delay of several years in the onset of symptoms preceded by chronic marijuana abuse [6].
- The Rome IV diagnostic criteria of CHS require cannabinoid use and persistence of N/V symptoms for at least the past 6 months.
- For example, in two recently published series of adult patients with CVS, approximately one third of patients reported daily marijuana use [65,66].
- The recent body of research recognizes that patients with CHS impose a burden on the healthcare systems.
- Certain individuals may have a genetic polymorphisms in the cytochrome P450 enzymes responsible for the metabolism of the cannabinoids [62,72].
CHS Symptoms
The mechanism by which cannabis induces hyperemesis is presently unknown. 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].
Hyperemetic phase
Inclusion criteria were established in line with the study objective, where relevant articles underwent data extraction and analysis. Serotonin antagonism in the gastrointestinal tract from medications such as ondansetron, dolasetron, and granisetron likewise have varying levels of efficacy. Drugs with an anticholinergic effect may likewise block medullary mediated vomiting, though they may have minimal impact on visceral stimulation, cannabinoid hyperemesis syndrome including the crippling abdominal cramping pain that patients with CHS experience. Opioids, while often prescribed for the patient’s debilitating abdominal pain, are not appropriate for CHS, as they may, in fact, worsen nausea and vomiting. People with CHS also tend to have a strong urge to take very hot showers or baths. That’s because hot water can help ease cannabinoid hyperemesis syndrome symptoms like nausea.
Because CHS is a fairly new medical condition, not all doctors know about it. 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.
