New Treatment Approaches for Cyclic Vomiting Syndrome and Its Link to Cannabis | Research

The takeaway

A review explored novel treatments for cyclic vomiting syndrome and discussed the overlapping relationship with cannabinoid hyperemesis syndrome, noting that the endocannabinoid system itself may be a therapeutic target rather than simply a cause of symptoms.

People experiencing cyclic vomiting and clinicians trying to distinguish between CVS and cannabinoid hyperemesis.

"Scant evidence" that marijuana use is causative in cannabinoid hyperemesis

What the researchers found

This review examined treatment options for cyclic vomiting syndrome (CVS), a disorder of episodic severe nausea and vomiting, and addressed the complicated relationship between CVS and cannabis.

The recognition that chronic cannabis use is associated with cyclic vomiting led to the proposed diagnosis of "cannabinoid hyperemesis syndrome" (CHS), which presents identically to CVS. The standard recommendation is cannabis abstinence, though the review noted there is "scant evidence" that marijuana use is actually causative.

The review explored the possibility that the endocannabinoid system may be involved in CVS pathophysiology regardless of cannabis use, and that therapeutic agents targeting this system could transform patient care. It also discussed prophylactic and abortive treatments and general management strategies.

Why it matters

CVS is often misdiagnosed, leading to years of unnecessary testing and treatment delays. The overlap with cannabinoid hyperemesis syndrome creates diagnostic confusion, and the review suggests the relationship may be more nuanced than simply "cannabis causes vomiting."

The numbers in context

No specific trial results were presented. The review noted CVS was initially thought to only affect children but is increasingly recognized in adults, and that there is an absence of randomized controlled trials for CVS treatment.

How the study worked

This was a clinical review examining published literature and expert consensus on CVS treatment. Due to the absence of randomized controlled trials for CVS, recommendations were based on available evidence and clinical experience.

What this study cannot tell us

No randomized controlled trials exist for CVS treatment, so all recommendations are based on lower-quality evidence. The distinction between CVS and CHS remains debated. The review presented one perspective on the cannabis-vomiting relationship that is not universally accepted.

How to read the evidence

This is a clinical review based on available literature and expert consensus in the absence of randomized controlled trials.

When this study was published

Published in 2016. Understanding of both CVS and cannabinoid hyperemesis has continued to develop, though the diagnostic overlap remains debated.

The bigger picture

The relationship between cannabis and cyclic vomiting remains controversial. This review challenged the assumption that cannabis straightforwardly causes CHS, suggesting instead that endocannabinoid system dysfunction may underlie both CVS and the vomiting seen in some cannabis users.

Questions still open

Is cannabinoid hyperemesis syndrome truly a distinct condition from cyclic vomiting syndrome? Could endocannabinoid-targeting medications treat both CVS and CHS?

Common questions

Are CVS and cannabinoid hyperemesis the same thing?

They present identically with cyclical severe nausea and vomiting, and the distinction is based on cannabis use history. This review suggested the relationship may be more complex than currently understood, with the endocannabinoid system potentially involved in both conditions.

Should people with cyclic vomiting stop using cannabis?

Cannabis cessation is the standard recommendation for suspected cannabinoid hyperemesis and can help clarify the diagnosis. However, this review noted limited evidence that cannabis is causative, and suggested the endocannabinoid system may be a therapeutic target rather than simply a cause of symptoms.

Read the original research

Novel Treatments for Cyclic Vomiting Syndrome: Beyond Ondansetron and Amitriptyline.

Current treatment options in gastroenterology, 14(4), 495-506

View on PubMed ↗

Citation

Bhandari, Sanjay; Venkatesan, Thangam. (2016). Novel Treatments for Cyclic Vomiting Syndrome: Beyond Ondansetron and Amitriptyline.. Current treatment options in gastroenterology, 14(4), 495-506.