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

Sorensen, Cecilia; DeSanto, Kristen; Borgelt, Laura M.; Phillips, Kristina T.; Monte, Andrew A.

doi:10.1007/s13181-016-0595-z

Cited by 270 publications

(296 citation statements)

References 142 publications

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“…Hence, the key to developing effective, personalized treatments for CVS hinges on recognizing disease triggers and mechanisms and raising the individual threshold for developing symptoms. The diversity of pathways may either reflect the presence of specific subtypes of CVS (eg, catamenial, hypothalamic surge, and CHS), distinct genetic predispositions (eg, RYR2 gene encoding a stress‐induced neuronal calcium channel polymorphisms), and/or a sensitivity to distinct symptom triggers (eg, psychological stressors and hypoglycemia) . In order to develop targeted CVS therapies, future research needs to define CVS subtypes based on mechanistic definitions, rather than solely on symptom criteria.…”

Section: Pathophysiology and Comorbid Conditionsmentioning

confidence: 99%

Cyclic vomiting syndrome: Pathophysiology, comorbidities, and future research directions

Hasler

Levinthal

Tarbell

et al. 2019

Neurogastroenterology Motil

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Cyclic vomiting syndrome (CVS) is characterized by severe episodic emesis in adults and children. Cannabinoid hyperemesis syndrome is an increasingly recognized CVS‐like illness that has been associated with chronic cannabis use. There are significant gaps in our understanding of the pathophysiology, clinical features, comorbidities, and effective management options of CVS. Recommendations for treating CVS are based on limited clinical data, as no placebo‐controlled, randomized trials have yet been conducted. Diseases associated with CVS, including migraine, mitochondrial disorders, autonomic dysfunction, and psychiatric comorbidities, provide clues about pathophysiologic mechanisms and suggest potential therapies. We review our current understanding of CVS and propose future research directions with the aim of developing effective therapy. Establishing a multicenter, standardized registry of CVS patients could drive research on multiple fronts including developing CVS‐specific outcome measures to broaden our understanding of clinical profiles, to serve as treatment end points in clinical trials, and to provide a platform for patient recruitment for randomized clinical trials. Such a robust database would also facilitate conduct of research that aims to determine the underlying pathophysiological mechanisms and genetic basis for CVS, as well as identifying potential biomarkers for the disorder. Soliciting government and industry support is crucial to establishing the necessary infrastructure and achieving these goals. Patient advocacy groups such as the Cyclic Vomiting Syndrome Association (CVSA), which partner with clinicians and researchers to disseminate new information, to promote ongoing interactions between patients, their families, clinicians, investigators, to support ongoing CVS research and education, must be an integral part of this endeavor.

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Section: Pathophysiology and Comorbid Conditionsmentioning

confidence: 99%

Cyclic vomiting syndrome: Pathophysiology, comorbidities, and future research directions

Hasler

Levinthal

Tarbell

et al. 2019

Neurogastroenterology Motil

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“…In a systematic review of CHS patients, 179 patients, 25.1% reported that they used cannabis for ≤1 year, 36.3% for 2–5 years, 16.8% for 6–10 years, and 21.8% for ≥11 years. In this same study, frequency of cannabis use ( n = 211) was reported as: 23.7% used more than once a day, 47.9% used daily, 19.4% used weekly, 2.4% used less than once a week, and 6.6% did not specify [80]. Just as patients may not disclose their marijuana use, others may admit to “occasional” marijuana use, but downplay its duration or frequency.…”

Section: Resultsmentioning

confidence: 99%

Cannabinoid Hyperemesis

Pergolizzi Jr.,

LeQuang,

Bisney

2018

Med Cannabis Cannabinoids

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Cannabinoid hyperemesis syndrome (CHS) is a paradoxical condition in which a long-term cannabis user suffers an episode of intractable vomiting that may last days separated by longer asymptomatic periods of weeks or months. Cannabinoids are often utilized for their antiemetic properties, so CHS can be a puzzling condition, and the diagnosis of CHS may be disputed by patients. Unlike other cyclic vomiting syndromes, CHS can be relieved by hot showers or topical capsaicin. Abstinence from cannabinoids causes CHS to resolve, sometimes in a matter of days or hours. Marijuana users as well as many clinicians are not aware of CHS, and patients may undergo unnecessary tests, scans, and other procedures to get an accurate diagnosis. Symptoms may be severe enough to require hospitalization. With liberalization of marijuana laws and favorable public opinion about the healing properties of cannabis, CHS may be more frequently observed in clinical practice.

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“…Although the clinical toxidromes associated with synthetic cannabinoids can differ from those of natural cannabinoids, synthetic cannabinoids interact with the CB1 receptor [4] and since these cases meet our criteria for CHS diagnosis [5], we believe that these cases should be labeled as CHS and treated as such.…”

mentioning

confidence: 93%

In Reply: “The importance of recognizing cannabinoid hyperemesis syndrome from synthetic marijuana use”

et al. 2017

Self Cite

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We thank Drs. Yoo, Liu, and Villamagna for reading our recently published article and appreciate their insights regarding the difficult nature of diagnosing cannabinoid hyperemesis syndrome (CHS) in patients using synthetic cannabinoids and the potentially large health burden of this illness.Our systematic review identified the three referenced case reports of CHS [1][2][3] secondary to synthetic cannabinoid use and we included them in our synthesis. Although the clinical toxidromes associated with synthetic cannabinoids can differ from those of natural cannabinoids, synthetic cannabinoids interact with the CB1 receptor [4] and since these cases meet our criteria for CHS diagnosis [5], we believe that these cases should be labeled as CHS and treated as such.Certainly, questioning about synthetic cannabinoids is warranted when CHS is suspected. Given that many patients do not consider synthetic cannabinoids a Bdrug,^it may be prudent to query the use of all Bherbal products^in a thorough evaluation of cyclic vomiting in an otherwise well individual in whom other etiologies of cyclic vomiting have been ruled out.It is unclear how many cases of CHS are attributable to synthetic versus naturally occurring cannabinoids. Clearly, synthetic cannabinoids are the fastest growing and most abused class of new psychoactive substances [6]. The failure to capture this drug class by traditional drug screens paired with the rising popularity should prompt clinicians to consider synthetic cannabinoids as a cause of CHS.

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

Cited by 270 publications

References 142 publications

Cyclic vomiting syndrome: Pathophysiology, comorbidities, and future research directions

Cyclic vomiting syndrome: Pathophysiology, comorbidities, and future research directions

Cannabinoid Hyperemesis

In Reply: “The importance of recognizing cannabinoid hyperemesis syndrome from synthetic marijuana use”

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