Unlike anorexia nervosa or bulimia, these patients maintain normal eating patterns in this stage. They may increase their use of cannabis due to their belief in its beneficial effects in nausea relief. The ECS is actively involved in motility, secretions, emesis, satiety and inflammation 32. The underlying mechanism of the cannabis-induced biphasic effect related to emesis is not clearly understood, but the literature supports the role of the brainstem and hypothalamic–pituitary–adrenal (HPA) axis.
Diagnosis
Patients with CHS usually remain misdiagnosed for a considerable time period. In one case series the average number of emergency room visits (7.1 ± 4.3) prior to diagnosis and the delay in diagnosis (for up to 9 years) was substantial 62. Not surprisingly, the early identification of patients with CHS leads to a reduction in morbidity and costs 6. The differential diagnosis of nausea and vomiting is extensive and includes a broad range of pathologic conditions affecting the gastrointestinal tract, the peritoneal cavity, CNS, as well as endocrine and metabolic functions 63. The initial approach to evaluate a patient with cyclical vomiting should start by cannabinoid hyperemesis syndrome excluding these vast disorders. In this context a comprehensive history along with initial screening tests should be performed to exclude acute conditions and emergencies (e.g pancreatobiliary disease, intestinal obstruction, pregnancy, etc).
About Our Atlanta Drug Rehab
These studies exemplify the diagnostic difficulty in the identification of CHS and suggest that CHS may be more common than is reported. Cannabis (or more affectionately referred to on the street as marijuana or ganja) is one of the most frequently used illicit drugs both internationally 1 and in the Caribbean islands 2,3. Cannabis has several well known effects on the gastrointestinal system.
Acute cannabinoid-induced nausea and vomiting
- And primary care providers, are vital in diagnosing and treating CHS as its prevalence rises.
- In one case series the average number of emergency room visits (7.1 ± 4.3) prior to diagnosis and the delay in diagnosis (for up to 9 years) was substantial 62.
- Not everyone with the condition seeks medical help or tells their provider that they use marijuana.
- Liquid nutrition can be delivered this way, letting your system rest while still getting the calories you need.
- Parenteral narcotics are contraindicated for abdominal pain from CHS, as these drugs may exacerbate hyperemesis and lead to addictive behavior.
- A study evaluating the TCA effect on CVS with CHS indicated that both conditions showed significant pain relief 5.
- Anandamide and 2-AG are released locally on demand by neurons, are present in small quantities, and undergo rapid inactivation 8.
Visits and extensive recurring serum testing and imaging evaluations with increased healthcare-related costs. It is crucial to exclude other entities such as Addison’s disease, migraines, hyperemesis gravidarum, bulimia, and psychogenic vomiting, which can mimic CHS symptoms and may also occur alongside it. A thorough medical history, complete physical examination, and focused diagnostic testing help differentiate from these other differential conditions.
Benzodiazepines, with their gamma-aminobutyric acid (GABA) agonistic actions, inhibit the medullary and vestibular nuclei, causing anti-emetic action. Additionally, anxiolytic and sedative properties aid in counteracting the abnormal sympathetic nervous system response, helping in the reduction in vomiting and decreasing pain perception 67. A small dataset study showed five mutations with plausible etiological roles in the phenomenology of CHS symptoms and signs. These genes are COMT, transient receptor potential vanilloid receptor 1 (TRPV1), CYP2C9, the gene coding for the dopamine-2 receptor (DRD2), and the ATP-binding cassette transporter gene (ABCA1). This constellation of genetic susceptibilities may represent a valid diagnostic tool for identifying at-risk individuals.
In addition to frequent and severe vomiting, patients may have difficulty eating and drinking, and only find (temporary) relief in hot showers and baths. First, doctors treating people with CHS advise them to stop using marijuana. During the hyperemesis stage, doctors focus on preventing dehydration and stopping the symptoms of nausea and vomiting. The orthosteric ligands of the CB1R were considered to be potential pharmaceuticals in the treatment of disorders such as drug addiction, obesity, and https://ecosoberhouse.com/ pain 33. However, cannabinoid receptor activation results in adverse psychoactive effects (including depression and suicidal thoughts), which is concerning for them in clinical use 104. With more research, the complexity of allostery can be elucidated, which will be beneficial in the development of safe and efficacious drugs with no neuropsychiatric side effects.
- The metabolism of anandamide is principally carried out via fatty acid amide hydrolase (FAAH), whereas the major enzyme metabolizing 2-AG is monoacylglycerol lipase (MAGL) 18.
- This will help to rule out life-threatening causes or diagnoses that confer significant potential morbidity to the patient or to establish the presumptive diagnosis of CHS.
- Martinez et al. suggest that a minimum workup should include basic laboratories, abdominal ultrasound (US) and/or computerized tomography (CT) scan, and esophagogastroduodenoscopy (EGD) with initial admission.
- Δ9-tetrahydrocannabinol (THC) has several well-established effects in the central nervous system, such as alteration of psychomotor behavior, impairment in short-term memory, stimulation of appetite, and analgesia 8.
- After about years of chronic marijuana use, patients begin to have a strong feeling of sickness, throwing up, and belly pain.
- Most people who quit using cannabis experience no more CHS symptoms within 10 days, but sometimes it may take weeks or months for symptoms to stop.
- The internal validity of our findings is limited by the possibility of missing articles from our search strategy.
- Over time, these tools can help you live without marijuana and remove the ongoing threat of CHS from your life.
- If you need help quitting, speak to a healthcare provider or connect with your local addiction treatment services.
- Future studies following patients longitudinally for extended periods of time are needed.
- Conventional anti-emetics, such as ondansetron and promethazine, are routinely utilized in the acute symptomatic phase 42.
The only surefire way to avoid developing CHS is to not use marijuana. This doesn’t mean everyone who tries cannabis occasionally will wind up with this condition. In serious cases, doctors might insert a nasogastric tube, which goes through your nose into your stomach. Liquid nutrition can be delivered this way, letting your system rest while still getting the calories you need.
History
But once you and your provider identify CHS, you can start working on an effective plan to stop the cycle of vomiting. Doctors rely mostly on a person’s symptoms, medical history, and history of marijuana use to identify CHS. You’ll likely undergo a physical exam, and your doctor might ask questions like how often you use cannabis, how long you’ve been using, and what patterns you notice about your nausea. If you’re not upfront about your marijuana use, your provider may diagnose you with a completely different issue. The recovery phase can last as long as you remain free from cannabis. If you start using again, there’s a good chance you’ll cycle back into the prodromal and hyperemetic phases.
Can You Treat CHS Symptoms at Home?
Doctors also noticed that individuals with CHS would take frequent hot showers and baths. The first reports came from doctors treating regular users of marijuana for nausea and vomiting in South Australia. It blocks NK1 and inhibits the binding of substance P, thereby preventing receptor activation and reducing nausea sensation in the brainstem 85. Sober living house Aprepitant can be considered as third-line management when Lorazepam or Haloperidol fails, owing to its efficacy in treating moderate to severe CVS.