Untangling cyclic vomiting syndrome from cannabinoid hyperemesis syndrome

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.

Venkatesan, Thangam et al.·Neurogastroenterology and motility·2019·Moderate EvidenceReview
RTHC-02331ReviewModerate Evidence2019RETHINKTHC RESEARCH DATABASErethinkthc.com/research

Quick Facts

Study Type
Review
Evidence
Moderate Evidence
Sample
Not reported

What This Study 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.

Key Numbers

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 They Did This

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

Why This Research 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 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.

What This Study Doesn't Tell Us

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

Questions This Raises

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

Trust & Context

Key Stat:
CHS first described in 2004, diagnosis still debated
Evidence Grade:
Review of case-level evidence with proposed but unvalidated diagnostic criteria.
Study Age:
2019 review.
Original Title:
Role of chronic cannabis use: Cyclic vomiting syndrome vs cannabinoid hyperemesis syndrome.
Published In:
Neurogastroenterology and motility, 31 Suppl 2(Suppl 2), e13606 (2019)
Database ID:
RTHC-02331

Evidence Hierarchy

Meta-Analysis / Systematic Review
Randomized Controlled Trial
Cohort / Case-Control
Cross-Sectional / ObservationalSnapshot without intervening
This study
Case Report / Animal Study

Summarizes existing research on a topic.

What do these levels mean? →

Frequently Asked 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 More on RethinkTHC

Cite This Study

RTHC-02331·https://rethinkthc.com/research/RTHC-02331

APA

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

MLA

Venkatesan, Thangam, et al. "Role of chronic cannabis use: Cyclic vomiting syndrome vs cannabinoid hyperemesis syndrome.." Neurogastroenterology and motility, 2019. https://doi.org/10.1111/nmo.13606

RethinkTHC

RethinkTHC Research Database. "Role of chronic cannabis use: Cyclic vomiting syndrome vs ca..." RTHC-02331. Retrieved from https://rethinkthc.com/research/venkatesan-2019-role-of-chronic-cannabis

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.