Cannabinoid hyperemesis syndrome in two French emergency departments: a prospective cohort

Abstract

Chronic cannabis use can be associated with uncontrollable vomiting and abdominal pain. Diagnostic criteria for cannabinoid hyperemesis syndrome (CHS) were defined in 2012 by Simonetto et al. The objectives of this study were to describe the prevalence of CHS, the patients' epidemiological characteristics, and to show the difficulties encountered in caring for these patients in emergency departments, the extent of health care and an unsuitable follow‐up in general practices. A prospective cohort of patients with CHS was recruited among a target population of patients leaving the adult emergency services of the Marseille hospitals Nord and La Timone between October 2017 and July 2018, with abdominal pain syndrome of unidentified etiology. Inclusion criteria for the CHS cohort were chronic cannabis use associated with nausea and vomiting. There were 48 patients included in the CHS cohort who took cannabis daily, in a target population of 2 848 patients (i.e. 1.6%). A hot shower was the most effective symptomatic treatment in 54.2% of cases. Patients suffering from CHS spent significantly more hours in emergency departments (11 vs. 6.5), and, on average, visits were more frequent (4.9 vs. 3). 20.3% of them were hospitalized to continue pain medication. Once out of hospital, follow‐up was limited, and weaning off cannabis, the only etiological treatment, was difficult to set up. Informing patients about CHS is essential, and a hot shower could be systematically proposed, thus limiting an unnecessary extent of health care. CHS is genuine, medical staff should be made aware of it in occupational training, and it should be seriously considered in health policies.

Cannabinoid hyperemesis syndrome in North America: evaluation of health burden and treatment prevalence

“…CHS remains a poorly studied disorder, with very little data available globally on incidence trends. Increased emergency department visits for vomiting in the US 12 and France, 13 as well as anecdotal clinical impressions from the authors' gastroenterology and emergency medicine practices suggest the prevalence may be widespread. Conversely, a questionnaire‐based study from North America and the UK suggests that CHS is uncommon when strict Rome IV criteria are used 14 .…”

Síndrome de hiperemesis cannabinoide en el servicio de urgencias. Una revisión

“…También algunos de ellos (menos del 70% de los casos) han presentado de forma paralela una reducción ponderal de al menos 5 kg de peso 32 , debido a que se desarrolla una asociación cognitiva negativa entre la ingesta de alimentos y la potencial aparición de náuseas, que conlleva una disminución de dichas ingestas y la aparición de un temor a la comida. En esta fase aparece un patrón de conducta (casi como patognomónico) 8,27,[33][34][35] : los pacientes se duchan con agua caliente, varias veces al día o una sola vez, aunque de duración muy prolongada, de forma estereotipada y repetitiva, manteniendo esta conducta idiosincrática. Esta conducta es considerada por algunos autores como una «bandera roja» de esta entidad nosológica 36 .…”

“…En el contexto de la atención en el servicio de urgencias, el tratamiento del episodio agudo de SHC es sintomático y los baños en agua caliente (en su mayoría baños compulsivos) constituyen una conducta aprendida que alivia los síntomas de náuseas y ansiedad. En diferentes publicaciones se ha propuesto que se acepte esta conducta como parte del tratamiento 7,35,41,42 . Sin embargo, no existe evidencia actual sobre la eficacia de los baños calientes como tratamiento, pero se sugiere proporcionar a los pacientes acceso a ducharse o bañarse con agua caliente para aliviar los síntomas, si el área de urgencias cuenta con los recursos para brindarlas.…”

Cannabinoid hyperemesis syndrome in two French emergency departments: a prospective cohort

“…Finally, as mentioned in this study [1], CHS has also been described in synthetic cannabinoid (SC) users. Although the prevalence of SC consumption is low in the general population, greater medical attention is required compared to botanical cannabis.…”

“…In this issue of Fundamental and Clinical Pharmacology , Weiss et al [1] contribute an original article entitled ‘Cannabinoid hyperemesis syndrome in two French emergency departments: a prospective cohort’, which reminds that cannabinoid hyperemesis syndrome (CHS) should be considered in the differential diagnosis of any patient presenting in the Emergency Department (ED) [2] with intractable nausea and vomiting, especially if the patient demonstrates regular and chronic cannabis use.…”