Cyclic vomiting syndrome and functional vomiting in adults: association with cannabinoid use in males

Abstract

Background Cyclic vomiting syndrome (CVS) is characterized by stereotypical episodes of vomiting separated by symptom-free intervals. However, the difficulty encountered in the management of patients with CVS may be a reflection of a deficiency in our understanding of the disorder. We aimed to evaluate whether clinical or gastric emptying (GE) data discriminate patients labeled as having CVS from functional vomiting (FV) or IBS. Methods The medical records of patients diagnosed with any vomiting (including CVS, FV) over a 13-year period (1993–2006) at our institution were carefully reviewed. Disease controls were age and gender matched subjects with IBS. GE was performed by scintigraphy (99mTc-egg meal). The associations of clinical factors and gastric emptying data with patient status (CVS vs. FV or IBS) were analyzed. Key Results A total of 82 patients with CVS and 62 FV patients were identified. Younger age (per 10 years, OR=0.7 [0.5, 0.9]), male gender (OR=0.4 [0.2, 0.9]), and cannabinoid use (OR=2.9 [1.2, 7.2]) were significantly associated with CVS compared to FV. However, there were no significant associations between patient status (CVS vs. FV) and age, BMI, smoking, alcohol use, gastrointestinal symptoms, or GE. The proportion of cannabinoid users was significantly higher in subjects with CVS compared to subjects with IBS, while proportions for headaches and psychiatric disease were higher in subjects with IBS. Conclusions CVS (vs. FV) was not associated with clinical factors, but was associated with younger age, male gender and cannabinoid use. A larger proportion of CVS (vs. IBS) patients had used cannabinoids.

Challenges With Acute Care and Response to Treatment Among Adult Patients With Cyclic Vomiting Syndrome

“…Marijuana consumption was common (38%) and consistent with reports in the literature citing 26%-53% of adult CVS patients use marijuana ( Choung et al, 2012 ;Fleisher et al, 2005 ;Kumar et al, 2012 ;Namin et al, 2007;Pattathan, Hejazi, & McCallum, 2012 ). Those who consumed marijuana described using it to obtain relief from nausea, vomiting, stress, and anxiety associated with their illness.…”

Cyclic vomiting syndrome in 28 patients

“…We found no associations with functional dyspepsia, childhood travel sickness or previous cannabis abuse, which have been suggested in other papers [20,21]. Furthermore, it has been suggested that when patients are in the 'emesis phase' of the syndrome, they indulge in 'guzzle and vomiting behaviour', that is ingesting large amounts of water to induce emesis to reduce the nausea [18].…”

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

“…A diagnostic dilemma arises when CVS patients concurrently use cannabis, as it can be difficult to discern if the true underlying disorder is CHS or CVS that is being symptomatically managed with cannabis. Several studies were identified in our search that attempted to isolate and diagnose CHS patients among cohorts of CVS patients and deserve special mention [171][172][173]. The Rome criteria were developed by an international committee of experts in order to delineate and standardize the diagnosis of functional gastrointestinal disorders [174].…”