Cyclic vomiting syndrome shares features with cannabinoid hyperemesis but has deeper roots in migraine and mitochondrial disorders | Research

The takeaway

Cyclic vomiting syndrome (CVS) is associated with migraine, mitochondrial disorders, autonomic dysfunction, and psychiatric comorbidities, while cannabinoid hyperemesis syndrome is an increasingly recognized CVS-like illness linked to chronic cannabis use.

People with cyclic vomiting, those wondering whether their symptoms are CHS-related, and clinicians managing episodic vomiting.

Zero randomized trials for cyclic vomiting syndrome despite increasing recognition

What the researchers found

CVS is characterized by severe episodic emesis with no randomized controlled trials to guide treatment. CHS is an increasingly recognized CVS-like condition associated with chronic cannabis use. Associations with migraine, mitochondrial disorders, autonomic dysfunction, and psychiatric conditions provide pathophysiologic clues.

Why it matters

CVS and CHS are frequently confused, with different treatment implications. Understanding their shared and distinct features helps clinicians distinguish between them and choose appropriate management. CHS resolves with cannabis cessation; CVS requires different approaches.

The numbers in context

No placebo-controlled randomized trials for CVS exist. Associated conditions: migraine, mitochondrial disorders, autonomic dysfunction, psychiatric comorbidities. A multicenter registry is proposed as the foundation for future research.

How the study worked

Expert review of CVS pathophysiology, comorbidities, and future research directions, proposing a multicenter registry approach to advance understanding and treatment development.

What this study cannot tell us

Review article without systematic methodology. CVS lacks standardized diagnostic criteria and outcome measures. The overlap between CVS and CHS is not fully characterized. Treatment recommendations based on limited clinical data.

How to read the evidence

Moderate: expert review covering pathophysiology and comorbidities, though based on limited clinical trial data.

When this study was published

Published in 2019.

The bigger picture

As cannabis use increases, distinguishing CHS from CVS becomes more important. Both cause cyclic vomiting, but the treatments diverge completely. Building a registry and developing CVS-specific outcome measures would benefit patients with either condition.

Questions still open

What percentage of CVS cases are actually unrecognized CHS? Could mitochondrial dysfunction explain why some cannabis users develop CHS while others don't? Would biomarkers help distinguish CVS from CHS?

Common questions

What's the difference between CVS and CHS?

Both cause cyclic vomiting, but CHS is specifically associated with chronic cannabis use and resolves when cannabis stops. CVS occurs independently of cannabis use and is linked to migraine, mitochondrial disorders, and autonomic dysfunction.

How is cyclic vomiting syndrome treated?

No randomized controlled trials guide CVS treatment. Current recommendations are based on limited clinical data and are informed by associated conditions like migraine. A multicenter registry has been proposed to improve treatment development.

Read the original research

Cyclic vomiting syndrome: Pathophysiology, comorbidities, and future research directions.

Neurogastroenterology and motility, 31 Suppl 2(Suppl 2), e13607

View on PubMed ↗Publisher’s paper ↗

Citation

Hasler, William L; Levinthal, David J; Tarbell, Sally E; Adams, Kathleen A; Li, B U K; Issenman, Robert M; Sarosiek, Irene; Jaradeh, Safwan S; Sharaf, Ravi N; Sultan, Shahnaz; Venkatesan, Thangam. (2019). Cyclic vomiting syndrome: Pathophysiology, comorbidities, and future research directions.. Neurogastroenterology and motility, 31 Suppl 2(Suppl 2), e13607. https://doi.org/10.1111/nmo.13607