Untangling cyclic vomiting syndrome from cannabinoid hyperemesis syndrome | Research

The takeaway

The relationship between chronic cannabis use and cyclic vomiting remains unclear, with debate about whether cannabinoid hyperemesis syndrome is a distinct condition or simply cyclic vomiting syndrome triggered or unmasked by cannabis use.

Emergency physicians, gastroenterologists, and cannabis users experiencing recurrent vomiting episodes.

CHS first described in 2004, diagnosis still debated

What the researchers found

Cannabis is commonly used in cyclic vomiting syndrome (CVS) for its antiemetic properties, yet chronic use has also been linked to cannabinoid hyperemesis syndrome (CHS). "Compulsive hot water bathing" has been associated with CHS but is not diagnostic. Existing data are heterogeneous with limited follow-up, making it difficult to determine whether cannabis is causal, merely coincidental, or a trigger in people already predisposed to CVS. The authors propose revised diagnostic criteria for CHS.

Why it matters

Misdiagnosis in either direction has consequences: treating CVS patients as having CHS may deny them a helpful antiemetic, while missing CHS means the underlying cause persists.

The numbers in context

First CHS description in 2004. Review analyzed all published case series and case reports against Rome IV criteria. No specific counts of cases meeting criteria provided.

How the study worked

Narrative review analyzing published case series and case reports on CHS, evaluating how many meet Rome IV criteria, and proposing revised diagnostic criteria.

What this study cannot tell us

Based primarily on case reports and case series. No large prospective studies exist. Diagnostic criteria for CHS remain debated.

How to read the evidence

Review of case-level evidence with proposed but unvalidated diagnostic criteria.

When this study was published

2019 review.

The bigger picture

As cannabis use increases, distinguishing between these two conditions becomes more clinically relevant and has implications for emergency department management of cyclic vomiting.

Questions still open

Can genetic testing identify people predisposed to CVS who might develop CHS with cannabis use? Would standardized dosing reduce the risk of CHS?

Common questions

What is cannabinoid hyperemesis syndrome?

CHS is a condition linked to chronic cannabis use involving episodes of severe vomiting, often accompanied by compulsive hot water bathing. However, debate continues about whether it is truly a distinct condition or a form of cyclic vomiting syndrome triggered by cannabis.

How can you tell CHS from cyclic vomiting syndrome?

This review found that distinguishing the two is difficult with current evidence, and proposed revised diagnostic criteria to help clinicians differentiate them.

Read the original research

Role of chronic cannabis use: Cyclic vomiting syndrome vs cannabinoid hyperemesis syndrome.

Neurogastroenterology and motility, 31 Suppl 2(Suppl 2), e13606

View on PubMed ↗Publisher’s paper ↗

Citation

Venkatesan, Thangam; Levinthal, David J; Li, B U K; Tarbell, Sally E; Adams, Kathleen A; Issenman, Robert M; Sarosiek, Irene; Jaradeh, Safwan S; Sharaf, Ravi N; Sultan, Shahnaz; Stave, Christopher D; Monte, Andrew A; Hasler, William L. (2019). Role of chronic cannabis use: Cyclic vomiting syndrome vs cannabinoid hyperemesis syndrome.. Neurogastroenterology and motility, 31 Suppl 2(Suppl 2), e13606. https://doi.org/10.1111/nmo.13606