The goal of the guideline is to raise awareness of how to recognize and treat CHS, which will allow providers to avoid opioids, radiation, and invasive procedures for CHS patients. Expert panel members engaged in an iterative process to provide evidence-based input into the draft guideline until complete consensus was achieved. Having IBS can be a very frustrating experience as its symptoms can be quite difficult to get under control. And although there are some prescription medications for the disorder and its symptoms, the relief from these treatments is often incomplete and unsatisfying. This unfortunate state of affairs has led people who have IBS to seek alternative remedies, one of which is the use of marijuana.
Links to NCBI Databases
One study found that 32.9% of self-reported frequent marijuana users who came to an emergency department for care met the criteria for CHS. With the widespread use, increased potency and legalization of marijuana in multiple states in the U.S., CHS may be becoming increasingly common. In older patients, especially those with hypertension, cardiovascular illnesses such as aortic pathology and atypical coronary artery syndromes may present as vague abdominal pain, nausea, and vomiting. Although there was some limited evidence that the medication reduces large intestine contractions, results on pain relief have been mixed. As of chs syndrome now, there do not seem to be many research studies on the use of smoked marijuana for IBS. From the few randomized controlled trials that do exist, one theory is that cannabinoids in marijuana affect acetylcholine and opioid receptors in addition to cannabis receptors, in this way providing IBS symptom improvement.
What are the symptoms?
The bottom line is that more research is needed which will clarify the role of cannabis as a treatment for IBS, and what dosages could help with digestive issues. In the meantime, your best course of action is to work with your healthcare provider on a symptom management plan that is right for you. CHS is also underdiagnosed because people sometimes use marijuana to suppress nausea and vomiting. Doctors currently lack knowledge of the condition, and there are no clinical guidelines for its treatment and management.
Read the full Clinical Practice Update
The use of marijuana as a viable treatment for IBS has not yet been supported by research. The uses of prescription forms of medical marijuana have neither been shown to have clear benefits for IBS nor have they been approved by the FDA for use as a treatment for IBS. As support for his theory, he pointed to the fact that IBS is frequently seen alongside fibromyalgia and migraine headaches, two health conditions that Russo also theorized might involve the endocannabinoid system of the body. The first researcher to make a connection between marijuana and IBS was Ethan B. Russo who, in 2003, theorized that IBS and other health conditions were the results of a deficiency in the amount of the body’s own cannabinoid chemicals. The term “medical marijuana” was coined to describe the use of the Cannabis plant, either in whole or extract form, to treat symptoms or diseases. This means, yes, it’s better to quit cannabis entirely than to continue dealing with the symptoms.
- We identified four case reports of patients initially diagnosed as hyperemesis gravidarium but were ultimately diagnosed as CHS, with a history of chronic cannabis use, compulsive hot baths/showers, and a history of cyclic vomiting predating the pregnancy 18, 64, 180, 181.
- Since the 1990s, there has been a progressive change in the composition of the plant, with increases in the tetrahydrocannabinol (THC) and a reduction of cannabidiol (CBD).6 This trend correlates with increased cannabis use.
- Symptoms of CHS typically come on several years after the start of chronic marijuana use.
Within 10 minutes, nausea and vomiting stopped, and the person no longer felt abdominal pain. Certain therapies, such as taking hot showers or using prescription medications, may help relieve symptoms. Severe nausea, vomiting, and stomach pain are the hallmark symptoms of cannabinoid hyperemesis syndrome (CHS). The word “cannabinoid” refers to compounds uniquely found in cannabis, and “hyperemesis” means severe vomiting.
- If you need help quitting, speak to a healthcare provider or connect with your local addiction treatment services.
- Other researchers theorize that the effects of marijuana can change with chronic use.
- It’s a condition that can lead to serious health complications if you don’t get treatment for it.
- Cannabinoid hyperemesis syndrome (CHS) is a condition in which a patient experiences cyclical nausea, vomiting, and abdominal pain after using cannabis.
- Articles eligible for inclusion under the category of “treatment” were those that (1) presented results of treatment outcomes using specific interventions, both behavioral and pharmacologic, to manage CHS or (2) used animal studies to evaluate treatments for CHS or cyclic vomiting.
- As of this writing, the federal government considers marijuana use in any form to be illegal.
- Haloperidol and topical capsaicin have pathophysiologic bases and evidence for use in CHS.
Some people with CHS require pain relievers if abdominal pain is present. Substance abuse As people with CHS often only consult their doctors during the hyperemesis stage, there is a lack of knowledge regarding the treatment of people during the prodromal stage. Doctors have also noticed that people in the hyperemesis stage take frequent showers and baths, which seem to relieve nausea.
What is cannabis hyperemesis syndrome?
Patients may deny cannabis use as a cause of their symptoms and fail to follow-up or seek medical care at other facilities resulting in repeated testing and resource utilization 8. Therefore, substance abuse experts should be involved when the diagnosis is made. It’s important to be honest about your marijuana use if you have symptoms of CHS. Without knowing this background, providers often misdiagnose CHS as other conditions, like cyclic vomiting syndrome (CVS).
Clinical diagnostic criteria for cannabinoid hyperemesis syndrome
The endocannabinoid system is thought to play a role in gastrointestinal motility 123, 124 appetite 125, nausea/vomiting 126, inflammation 127, mood 128, sleep 129, pain 130, and more. We found very limited evidence to support the theory that a genetic variation in metabolic enzymes accounts for the appearance of CHS symptomatology; however, this theory is attractive in that it may explain why some, but not all, chronic cannabis users develop CHS 131. There is also some evidence to suggest that cannabinoids interact directly with CB-1 receptors in the gastrointestinal tract and alter gastrointestinal motility 16, 92, 95, 132–134. Animal studies lend some credibility to this theory; however, results are not consistently reproducible in human studies. Additionally, many inferential hypotheses were identified that attribute different aspects of CHS to a myriad of dysregulatory issues at CB-1 receptors throughout the body (brain, gastrointestinal tract, and vasculature) 97, 98, 102, 105, 133, 135–137. The experimental evidence behind these inferences illustrates the complexity of the pathophysiology of CHS and raises many additional questions.