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Cannabinoids Hyperemesis Syndrome – A dilemma, Under-diagnosis, and Future Directions? – A Review of the Current Literature

Jinal Choudhari
Larkin Community Hospital

Co-Authors: Nisha Panta1, Ellie Soheili2, Diana Limon2, Claudia Maria Cuevas Lou2, Tulram Yadav3, Sujan Poudel2
1Kathmandu Medical College 2Larkin Community Hospital 3Jinnah Postgraduate Medical Centre

Cannabinoid Hyperemesis Syndrome (CHS) is characterized by a cyclical pattern of hyperemesis every few weeks to months, obsessive thoughts, and the compulsive act of needing to take hot baths or shower in the background of chronic Marijuana use. It is the illicit drug most commonly used in the United States, with an estimated 42 to 46% lifetime use prevalence. Unfortunately, clinicians\’ lack of knowledge of CHS imposes a significant delay in the patient\’s diagnosis and redirects them to undergo intrusive examinations and intensive investigation for years. This article aims to bring the attention of CHS to enable clinicians and, more specifically, addiction medicine specialists and psychiatrists to diagnose it as early as possible and thus avoid needless invasive examinations and investigations.

A thorough bibliographic review was conducted using PubMed, Cochrane, Embase, and Medline. In addition, databases were used to search for articles on CHS published between January 2011 and February 2023, yielding relevant articles. Keywords used were \”hyperemesis,\” \” Cyclical Vomiting,\” \”cannabis,\” and \”cannabinoid.\”

CHS is found to be associated with long-term marijuana use and typically presents as diffuse acute abdominal pain and uncontrolled cyclical vomiting; and usually alleviates symptoms by taking hot baths. They have a typical history of frequent emergency department (ED) visits and undergo many needless supplementary examinations and lab tests. No organic cause has been mentioned in the literature to explain the pathophysiology and clinical symptomatology; these patients are commonly referred to the psychiatry department; and frequently consulted to addiction medicine, given their history of chronic marijuana use. The only available treatment option is the complete cessation of consumption of cannabis.

Although rare, CHS is an underdiagnosed condition that clinicians do not know as much about. This syndrome has a pathognomonic clinical presentation and clinically mimics an acute abdomen. Early CHS detection prevents unnecessary repeated ED visits, and needless follow-up examinations and investigations increase patients\’ overall quality of life.

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