Cannabinoid Hyperemesis Takes Nearly 20 Months to Diagnose on Average
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.
Quick Facts
What This Study 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.
Key Numbers
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 They Did This
Retrospective cohort study of patients attending tertiary neurogastroenterology and secondary gastroenterology clinics from 2013-2015. Chart review of 10 identified CHS cases.
Why This Research 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 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.
What This Study Doesn't 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.
Questions This Raises
- ?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?
Trust & Context
- Key Stat:
- 19.3 months average delay before CHS diagnosis
- Evidence Grade:
- Small retrospective case series. Provides important clinical data on diagnostic delay but limited generalizability.
- Study Age:
- Published in 2015. Awareness of CHS among clinicians has improved considerably.
- Original Title:
- Cannabinoid hyperemesis syndrome: an important differential diagnosis of persistent unexplained vomiting.
- Published In:
- European journal of gastroenterology & hepatology, 27(12), 1403-8 (2015)
- Authors:
- Ruffle, James K(2), Bajgoric, Sanjin(2), Samra, Kiran(2), Chandrapalan, Subashini, Aziz, Qasim, Farmer, Adam D
- Database ID:
- RTHC-01054
Evidence Hierarchy
Looks back at existing records to find patterns.
What do these levels mean? →Frequently Asked 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.
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Cite This Study
https://rethinkthc.com/research/RTHC-01054APA
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
MLA
Ruffle, James K, et al. "Cannabinoid hyperemesis syndrome: an important differential diagnosis of persistent unexplained vomiting.." European journal of gastroenterology & hepatology, 2015. https://doi.org/10.1097/MEG.0000000000000489
RethinkTHC
RethinkTHC Research Database. "Cannabinoid hyperemesis syndrome: an important differential ..." RTHC-01054. Retrieved from https://rethinkthc.com/research/ruffle-2015-cannabinoid-hyperemesis-syndrome-an
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.