Cannabinoid Hyperemesis Takes Nearly 20 Months to Diagnose on Average | Research

The takeaway

Ten patients with cannabinoid hyperemesis syndrome had symptoms for an average of 19 months before diagnosis, were frequently misdiagnosed, and all relapsed when they resumed cannabis use.

Read this if you experience chronic nausea and vomiting and use cannabis regularly.

19.3 months average delay before CHS diagnosis

What the researchers found

Researchers identified 10 cases of cannabinoid hyperemesis syndrome (CHS) at gastroenterology clinics over two years. All had been previously misdiagnosed with various conditions.

Patients experienced symptoms for a mean of 19.3 months before correct diagnosis. The median duration of cannabis use before symptoms began was 42 months. Eight of 10 patients (80%) had the classic compulsive hot water bathing behavior.

During follow-up, three patients who returned to regular cannabis use experienced symptom recurrence, while those who maintained abstinence remained symptom-free. The authors emphasized that CHS is frequently missed because clinicians do not routinely ask about cannabis use in vomiting patients.

Why it matters

Nearly 20 months of unnecessary suffering and likely expensive diagnostic testing could be avoided by simply asking vomiting patients about cannabis use. CHS remains widely underdiagnosed despite increasing cannabis use.

The numbers in context

10 cases; 5 men; mean age 27; symptom duration before diagnosis: 19.3 months; median cannabis use: 42 months; 80% had compulsive hot bathing; 3 relapsed with resumed cannabis use

How the study worked

Retrospective cohort study of patients attending tertiary neurogastroenterology and secondary gastroenterology clinics from 2013-2015. Chart review of 10 identified CHS cases.

What this study cannot tell us

Small retrospective case series from two clinics. Cannot establish prevalence. Patients seen at gastroenterology referral centers may represent more severe or diagnostic cases.

How to read the evidence

Small retrospective case series. Provides important clinical data on diagnostic delay but limited generalizability.

When this study was published

Published in 2015. Awareness of CHS among clinicians has improved considerably.

The bigger picture

CHS is a diagnosis of exclusion that becomes straightforward once considered. The long diagnostic delay suggests a systematic failure to include cannabis use in the differential diagnosis for chronic vomiting.

Questions still open

What proportion of chronic vomiting patients have undiagnosed CHS? Would routine cannabis screening in GI clinics reduce diagnostic delay? Are some individuals genetically predisposed to developing CHS?

Common questions

Why does CHS take so long to diagnose?

Clinicians often do not ask about cannabis use, and patients may not volunteer the information. CHS symptoms mimic other conditions like cyclic vomiting syndrome. The average 19-month delay in this study reflects a systematic gap in clinical assessment.

Does CHS come back if you start using cannabis again?

In this study, all three patients who resumed cannabis use had symptom recurrence. Those who maintained abstinence remained symptom-free. Cannabis cessation appears to be the only reliable treatment.

Read the original research

Cannabinoid hyperemesis syndrome: an important differential diagnosis of persistent unexplained vomiting.

European journal of gastroenterology & hepatology, 27(12), 1403-8

View on PubMed ↗Publisher’s paper ↗

Citation

Ruffle, James K; Bajgoric, Sanjin; Samra, Kiran; Chandrapalan, Subashini; Aziz, Qasim; Farmer, Adam D. (2015). Cannabinoid hyperemesis syndrome: an important differential diagnosis of persistent unexplained vomiting.. European journal of gastroenterology & hepatology, 27(12), 1403-8. https://doi.org/10.1097/MEG.0000000000000489