In this narrative review, we elaborate on the role of the ECS, its management, and the identification of gaps in our current knowledge of CHS to further enhance its understanding in the future. Cannabis, derived from Cannabis sativa plants, is a prevalent illicit substance in the United States, containing over 400 chemicals, including 100 cannabinoids, each affecting the body’s organs differently upon ingestion. Cannabis hyperemesis syndrome (CHS) is a gut–brain axis disorder characterized by recurring nausea and vomiting intensified by excessive cannabis consumption. CHS often goes undiagnosed due to inconsistent criteria, subjective symptoms, and similarity to cyclical vomiting syndrome (CVS). Understanding the endocannabinoid system (ECS) and its dual response (pro-emetic at higher doses and anti-emetic at lower doses) is crucial in the pathophysiology of CHS. Recent research noted that type 1 cannabinoid receptors in the intestinal nerve plexus exhibit an inhibitory effect on gastrointestinal motility.

Diagnosis of CHS

Despite negative workups, physicians must consider CHS when standard treatments fail and patients continue to present with persistent symptoms related to cannabis use. The difficulty in diagnosing CHS arises because its symptoms overlap with other gastrointestinal and metabolic disorders, such as gastroparesis, cyclic vomiting syndrome, or peptic ulcer disease. Overlapping symptoms such as abdominal pain and cyclic vomiting are especially difficult to pinpoint to a specific illness. Two treatment patterns were noted in Sifuentes et al.’s long-term follow-up study of CHS patients 105. Some patients require a gradual increase in their maintenance dose to maintain stability, as dose tolerance leads to ‘breakthrough’ vomiting episodes. Once patients achieve stability with TCA therapy, evidenced by no emergency department visits for at least one year, the amitriptyline dosage can often be tapered or discontinued entirely over the following year.

What are the symptoms of CHS?

A systematic review by Richards et al. 64 showed that these standard anti-emetics are often ineffective when used alone and demonstrated superior efficacy with intravenous benzodiazepines. During this phase, patients may experience morning nausea, abdominal discomfort, or anxiety about vomiting. Symptoms, patients often eat well, maintain weight, and remain functional at work.

• The only treatments available to people with CHS are those that restore hydration and help control nausea and vomiting.
• Only peer-reviewed articles, case reports, clinical trials, and review articles focusing on CHS or its comparison with similar disorders (e.g., CVS) were considered.
• Over time, the symptoms will go away completely unless you start to use again.
• The ECS includes ligands, receptors, signaling pathways, and enzymes acting as regulators and inhibitors.

Are there complications of cannabinoid hyperemesis syndrome?

Substances like THC (tetrahydrocannabinol) and other chemicals in cannabis bind to molecules in your brain to trigger the “high” that can occur when using cannabis products. It is important for people with CHS to stop using marijuana because this will resolve their nausea and vomiting. Preventing dehydration and stopping nausea and vomiting are the treatment goals during the hyperemesis stage of the condition. During this phase, the main symptoms are often early morning nausea and belly (abdominal) pain. Some people use more marijuana because they think it will help stop the nausea. Studies focused on individuals diagnosed with CHS, as well as those with comparable conditions like CVS, were selected.

What Are the Treatment Options for CHS?

• Warm stimulation is hypothesized to transiently activate transient receptor potential vanilloid-1 (TRPV1) in the hypothalamus which would otherwise be downregulated by chronic cannabis use 34.
• One 2018 study found that 32.9% of self-reported frequent marijuana users who’d gone to the emergency room (ER) had symptoms of CHS.
• The biggest risk factor for CHS is heavy cannabis use, as in almost daily or multiple times per day over several years.
• Opioids may exacerbate CHS symptoms due to their association with bowel dysfunction, and they could also potentially lead to opioid dependence in chronic users 47.

Many people with CHS go to their doctor or an emergency room (ER) for treatment. However, doctors may find it challenging to diagnose the syndrome because people tend not to report their use of marijuana. When people with CHS stop using marijuana, their symptoms of nausea and vomiting usually disappear. Nausea and vomiting tend to return if they start using marijuana again. Cannabinoid Hyperemesis Syndrome (CHS) is a condition that causes severe nausea, vomiting, and stomach pain. It’s a difficult experience linked to long-term, regular cannabis use.

Researchers have identified two receptors called CB1 and CB2 to which marijuana molecules attach. Receptors are specialized cells that respond to specific stimuli or changes in the environment. The recovery process might feel overwhelming but know that support is available.

Diagnosis

Many people experience temporary relief from their nausea and vomiting when bathing in hot water. Some people with CHS may compulsively bathe in hot water for hours a day to find relief. To make a diagnosis, your healthcare provider will conduct a thorough physical examination and ask you about your past health and current symptoms. It’s helpful to volunteer your history of cannabis use with your provider if Drug rehabilitation you are not asked about it.

TCA is used in caution with underlying cardiac arrhythmias, recent myocardial infarction, mania, or severe liver disease 97. Amitriptyline use is not advised during pregnancy, and it is classified as a Category C drug by the FDA. Pathological hot bathing can temporarily relieve CHS symptoms 64. TPRV1 receptors are activated https://ecosoberhouse.com/article/am-i-an-alcoholic-do-i-have-a-drinking-problem/ at temperatures above 43 °C attained during hot showers. Scopolamine patches are an antimuscarinic agent with an anti-emetic effect for up to three days, ensuring consistent absorption between oral and parenteral medications. Scopolamine is commonly used to alleviate nausea and motion sickness.