Nine adolescents were found to have both cannabinoid hyperemesis syndrome and superior mesenteric artery syndrome, suggesting that CHS-related weight loss may trigger the vascular complication.
Pediatric gastroenterologists, emergency physicians, and parents of adolescents who use cannabis
Average 6 kg weight loss and nearly 20 weeks to diagnosis
What the researchers found
All nine patients presented with nausea, vomiting, and weight loss. They lost an average of 6.0 kg and had a mean BMI at the 15.61st percentile (BMI Z-score: -1.5). Six of nine were female. Symptoms were present for an average of 19.6 weeks before diagnosis. Only four patients received cannabis cessation support.
Why it matters
This is the first report describing CHS co-occurring with superior mesenteric artery syndrome in adolescents. SMAS occurs when weight loss reduces the fat pad between the aorta and superior mesenteric artery, compressing the duodenum. The vomiting cycle of CHS may drive the weight loss that triggers this potentially serious surgical condition.
The numbers in context
9 patients identified. 6 female. Mean weight loss: 6.0 kg. Mean BMI percentile: 15.61 (BMI 17.7 kg/m2). Mean BMI Z-score: -1.5. Mean symptom duration before diagnosis: 19.6 weeks. Only 4/9 received cannabis cessation support.
How the study worked
Retrospective case series identifying patients admitted to Children's Hospital of Colorado (2015-2023) who had both cannabis use and chronic vascular intestinal disorders on their problem lists via ICD-10 codes. Nine patients met criteria for both SMAS and chronic cannabis use.
What this study cannot tell us
Very small case series (n=9) from a single institution. Cannot establish that CHS caused the weight loss that led to SMAS. ICD code-based identification may miss cases or introduce misclassification. No comparison group.
How to read the evidence
Small case series from a single institution; useful for raising clinical awareness but cannot establish prevalence or causation.
When this study was published
2024 study using 2015-2023 data
The bigger picture
CHS is increasingly recognized as more than just cyclical vomiting. This case series suggests it can trigger downstream complications through weight loss, adding urgency to early recognition and cannabis cessation in affected adolescents.
Questions still open
- How often does CHS lead to clinically significant weight loss? Should adolescents with CHS be monitored for SMAS? Would earlier diagnosis and cannabis cessation prevent this complication?
Common questions
Can cannabinoid hyperemesis syndrome cause other health problems?
How long did it take to diagnose these patients?
Read the original research
Cannabinoid hyperemesis syndrome co-occurring with superior mesenteric artery syndrome in adolescents.
Journal of pediatric gastroenterology and nutrition, 79(3), 495-500
Citation
Shanker, A Isabella; Li, B U K; Kramer, Robert E. (2024). Cannabinoid hyperemesis syndrome co-occurring with superior mesenteric artery syndrome in adolescents.. Journal of pediatric gastroenterology and nutrition, 79(3), 495-500. https://doi.org/10.1002/jpn3.12317
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