Cannabinoid Hyperemesis Syndrome

Hinton, Kristina L.; Chui, Jennifer S.; McWhorter, Karen A.; Jallad, Rima H.; Siple, Jolene

doi:10.1177/1060028016660719

Cited by 5 publications

(5 citation statements)

References 5 publications

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“…Our review of the literature identified a total of 25 case series (n = 271) and 105 individual case reports of patients identified with CHS (Table ) . Most of the reported case series and case studies predated the publication of Rome IV criteria for CHS.…”

Section: Resultsmentioning

confidence: 99%

Role of chronic cannabis use: Cyclic vomiting syndrome vs cannabinoid hyperemesis syndrome

Venkatesan

Levinthal

et al. 2019

Neurogastroenterology Motil

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Cannabis is commonly used in cyclic vomiting syndrome (CVS) due to its antiemetic and anxiolytic properties. Paradoxically, chronic cannabis use in the context of cyclic vomiting has led to the recognition of a putative new disorder called cannabinoid hyperemesis syndrome (CHS). Since its first description in 2004, numerous case series and case reports have emerged describing this phenomenon. Although not pathognomonic, a patient behavior called “compulsive hot water bathing” has been associated with CHS. There is considerable controversy about how CHS is defined. Most of the data remain heterogenous with limited follow‐up, making it difficult to ascertain whether chronic cannabis use is causal, merely a clinical association with CVS, or unmasks or triggers symptoms in patients inherently predisposed to develop CVS. This article will discuss the role of cannabis in the regulation of nausea and vomiting, specifically focusing on both CVS and CHS, in order to address controversies in this context. To this objective, we have collated and analyzed published case series and case reports on CHS in order to determine the number of reported cases that meet current Rome IV criteria for CHS. We have also identified limitations in the existing diagnostic framework and propose revised criteria to diagnose CHS. Future research in this area should improve our understanding of the role of cannabis use in cyclic vomiting and help us better understand and manage this disorder.

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Section: Resultsmentioning

confidence: 99%

Role of chronic cannabis use: Cyclic vomiting syndrome vs cannabinoid hyperemesis syndrome

Venkatesan

Levinthal

et al. 2019

Neurogastroenterology Motil

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“…For these case series, the following CHS pharmacologic treatments were reported as helpful: benzodiazepines (six), topical capsaicin (five), haloperidol (five), and olanzapine (one) . The 44 level‐5 case reports involved 44 patients . For these case reports, the following CHS pharmacologic treatments were reported as effective: benzodiazepines (five), metoclopramide (four), haloperidol (four), ondansetron (two), morphine (two), and topical capsaicin (two) .…”

Section: Resultsmentioning

confidence: 99%

“…Medications ineffective with exception of fentanyl patches Case report 67 Morphine, ondansetron 5 1 Medications ineffective Case report 68 Ondansetron, promethazine 5 1 Medications ineffective (continued) complexity of the endocannabinoid system and hypothalamic-pituitary-adrenal (HPA) axis regulation of nausea and emesis, it is not surprising that no one consistently effective class of antiemetics was cited for the treatment of CHS. 12 Endogenous cannabinoids bind to the G protein-coupled cannabinoid receptors CB1 and CB2.…”

Section: Medications Ineffectivementioning

confidence: 99%

Pharmacologic Treatment of Cannabinoid Hyperemesis Syndrome: A Systematic Review

et al. 2017

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Cannabinoid hyperemesis syndrome (CHS) has become more prevalent with increasing cannabis use. CHS is often resistant to standard antiemetics. The objective of this study is to review the current evidence for pharmacologic treatment of CHS. Medline, PsycINFO, DARE, OpenGrey, Google Scholar, and the Cochrane Library were searched from inception to February 2017. Articles were selected and reviewed independently. Evidence was graded using Oxford Center for Evidence-Based Medicine guidelines. The search resulted in 1262 articles with 63 of them eligible for inclusion (205 human subjects). There were 4 prospective level-2, 3 retrospective level-3 studies, 12 level-4 case series, and 44 level-5 case reports. Among level-2 studies (64 subjects), tricyclic antidepressants (TCAs) and lorazepam were discussed as effective long- and short-term treatments, respectively, in two studies. Ondansetron, promethazine, diphenhydramine, and opioids were also mentioned, but the authors did not comment on their efficacy. Among level-3 studies (43 subjects), one reported effective treatment with antiepileptics zonisamide and levetiracetam, but not TCAs. Another reported favorable response to morphine, ondansetron, and lorazepam but did not specify the actual number of patients receiving specific treatment. Among the level-4 case series (54 subjects), benzodiazepines, haloperidol, and capsaicin were reported as helpful. For level-5 case reports (44 subjects), benzodiazepines, metoclopramide, haloperidol, ondansetron, morphine, and capsaicin were reported as effective. Effective treatments mentioned only once included fentanyl, diazepam, promethazine, methadone, nabilone, levomepromazine, piritramide, and pantoprazole. Hot showers and baths were cited in all level-4 and -5 articles as universally effective. High-quality evidence for pharmacologic treatment of CHS is limited. Benzodiazepines, followed by haloperidol and capsaicin, were most frequently reported as effective for acute treatment, and TCAs for long-term treatment. As the prevalence of CHS increases, future prospective trials are greatly needed to evaluate and further define optimal pharmacologic treatment of patients with CHS.

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“…33,34 Do ponto de vista social, o recurso excessivo a banhos quentes pode gerar tensão junto do agregado que coabita com o doente. 32 A frequência dos vómitos per se pode, nos casos mais graves, levar a desequilíbrios hidroeletrolíticos, lacerações esofágicas e até mesmo rutura esofágica. Está também descrita a ocorrência de pneumomediastino, associado aos vómitos incoercíveis.…”

Section: Complicaçõesunclassified

Síndrome da Hiperémese dos Canabinoides: Uma Revisão Prática para Clínicos

Ferreira

Oliveira

Dehanov

et al. 2020

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A primeira descrição clínica da síndrome da hiperémese dos canabinoides advém de um artigo de Allen et al publicado em 2004. Desde então, várias publicações têm-se focado na sua conceptualização e abordagem clínica, embora se mantenha pouco conhecida na comunidade médica. Esta síndrome é caracterizada pela tríade de consumo crónico de canabinoides, hiperémese cíclica, e banhos ou duches quentes compulsivos como forma de alívio sintomatológico. Podem ainda ocorrer dor abdominal e outros sintomas. A sua verdadeira prevalência é desconhecida, embora se acumule evidência de que é mais frequente do que outrora julgado. Foram aventadas várias hipóteses para a sua patogénese, nomeadamente relacionadas com recetores canabinoides e vaniloides, o eixo hipotálamo-hipófise-adrenal e o sistema nervoso simpático. Em termos terapêuticos, justificam-se medidas de suporte (p.e. hidratação) na fase aguda, existindo evidência para a utilização de benzodiazepinas (nomeadamente lorazepam), haloperidol ou capsaicina tópica para alívio sintomático. A única intervenção que interrompe o quadro é a abstinência dos consumos, devendo ser feita psicoeducação e orientação adequadas do doente. O conhecimento relativo a esta patologia encontra-se em crescimento. A falta de sensibilização para a doença pode conduzir a testes de diagnóstico invasivos e dispendiosos, inúmeras idas ao serviço de urgência e manutenção do quadro clínico sem resolução sintomatológica. O presente artigo visa sistematizar as linhas de intervenção clínica e fomentar uma maior consciencialização dos profissionais de saúde sobre esta entidade, permitindo uma melhor identificação e abordagem terapêutica deste quadro.

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Cannabinoid Hyperemesis Syndrome

Cited by 5 publications

References 5 publications

Role of chronic cannabis use: Cyclic vomiting syndrome vs cannabinoid hyperemesis syndrome

Role of chronic cannabis use: Cyclic vomiting syndrome vs cannabinoid hyperemesis syndrome

Pharmacologic Treatment of Cannabinoid Hyperemesis Syndrome: A Systematic Review

Síndrome da Hiperémese dos Canabinoides: Uma Revisão Prática para Clínicos

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