Cannabinoid hyperemesis syndrome (CHS) is a disorder characterized by severe and recurrent episodes of vomiting (emesis).
This rare disorder is only seen in chronic, long term, and daily marijuana users. The first cases described in the literature date back just over a decade and therefore CHS is a relatively new disorder that can often go undiagnosed—or misdiagnosed—for many years.
The past few years has seen expanding use of marijuana in the United States, particularly since the advent of the decriminalization and now legalization of the drug. Young adults comprise the largest consumers and are thus highest at risk for the disorder which only affect a minority of marijuana users. CHS typically only occurs in patients who have used the substance chronically and consistently for several years.
While challenging to diagnose as it can sometimes mimic other motility disorders, a careful history and exam are essential to shorten the time to diagnosis and, ultimately, therapy.
Symptoms
The most common symptoms of CHS include:
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- Prodromal Phase: often nausea in the early morning accompanied by abdominal pain but no change in appetite. This can be a time when people consume more marijuana to control the nausea, with poor results.
- Hyperemetic Phase: near constant nausea with severe episodes of vomiting. This is usually accompanied by significant abdominal pain, poor appetite, weight loss, and symptoms of dehydration. This is the phase when hot baths or showers appear to help and may provide a clue to the underlying mechanism of the disorder.
- Recovery Phase: Symptoms resolve or abate and the person can start eating almost normally again. However, with ongoing marijuana use, a repeat cycle of attacks and associated phases is likely.
Causes
In addition to THC, Marijuana contains numerous other active substances (more than 400). When some of these substances bind to specific receptors in the brain, they exert the classic effects of marijuana—the high, calm sensation, and increased appetite, among others. However, these receptors are also located along the digestive tract where they exert different effects to that of the brain. Some of these include delayed gastric emptying, worsening reflux, and through yet unclear mechanisms, the signs and symptoms of CHS.
Prevention
The only reliable and definitive way of managing and treating the disorder is cessation of marijuana use. This can sometimes take several weeks, even 2-3 months to fully take effect. During that period, there are some medicines and supplements that can be used to reduce the severity of attacks and manage symptoms. Cognitive behavioral therapy has also been shown to be beneficial in assisting with marijuana cessation. If all use stops, the symptoms do not typically recur.
Complications
The complications from CHS are mainly related to the vomiting episodes. These include irritation to the esophageal lining from stomach acid and disruption from the sometimes violent retching. Dehydration can become quite severe and even lead to some degree of renal failure, low blood pressure, muscle cramps, dizziness, and even syncope (fainting). Dental erosion from stomach acid can also be seen, particularly when the attacks are frequent.
Consultations
If you have signs or symptoms suggestive of CHS, please contact your physician or the Neurogastroenterology and Motility Center at 475.210.4727 for a consultation.
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