Most patients with cyclic vomiting syndrome who used cannabis said it helped, and few met criteria for cannabinoid hyperemesis | Research

The takeaway

Among 140 patients with cyclic vomiting syndrome, 41% used cannabis and most reported symptom relief, but only one patient met formal criteria for cannabinoid hyperemesis syndrome.

Gastroenterologists treating CVS or CHS, patients with cyclic vomiting considering cannabis use, and emergency physicians evaluating recurrent vomiting.

Only 1 of 57 cannabis-using CVS patients met CHS criteria

What the researchers found

41% of CVS patients used cannabis, with 21% using regularly (4+ times/week). Most users reported cannabis helped control symptoms. Among all cannabis users, 88% had abstained for over a month at some point, but only 1 reported resolution of vomiting episodes during abstinence, meeting Rome IV criteria for CHS.

Why it matters

Distinguishing CVS from cannabinoid hyperemesis syndrome is a clinical challenge. This study suggests the overlap may be smaller than assumed, with most cannabis-using CVS patients genuinely benefiting from cannabis rather than being misdiagnosed CHS cases.

The numbers in context

140 CVS patients (72% female, mean age 37). 41% current cannabis users. 21% regular users. 88% of users had abstained >1 month. Only 1 of 57 users (1.8%) met Rome IV CHS criteria.

How the study worked

Cross-sectional study of 140 patients with cyclic vomiting syndrome at a specialized clinic. Cannabis use screened with the Cannabis Use Disorder Identification Test. Users classified as regular (4+ times/week) or occasional.

What this study cannot tell us

Cross-sectional design at a single specialized clinic. Self-reported cannabis use and symptom relief. The specialized clinic population may not represent all CVS patients. Small number of regular users limits subgroup analysis.

How to read the evidence

Well-characterized clinical cohort from a specialized center, but cross-sectional and self-reported outcomes limit causal conclusions.

When this study was published

2020 study from a specialized CVS clinic. Highlights the challenge of distinguishing CVS from CHS.

The bigger picture

The assumption that cannabis use in vomiting patients automatically means CHS may lead to misdiagnosis and inappropriate treatment. Better diagnostic criteria and longitudinal data are needed to distinguish these conditions.

Questions still open

What biological factors determine whether cannabis helps or worsens cyclic vomiting? Could some patients diagnosed with CHS actually have CVS? Would controlled cannabis cessation trials in CVS patients clarify the relationship?

Common questions

What is the difference between CVS and CHS?

Cyclic vomiting syndrome (CVS) causes recurrent episodes of nausea and vomiting with various triggers. Cannabinoid hyperemesis syndrome (CHS) has similar symptoms but is specifically caused by chronic cannabis use and resolves with cessation.

Did cannabis help CVS patients?

Most cannabis-using CVS patients in this study reported that cannabis helped control their symptoms, and only 1 of 57 users experienced symptom resolution during a period of cannabis abstinence.

Read the original research

Patterns of Cannabis Use in Patients With Cyclic Vomiting Syndrome.

Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 18(5), 1082-1090.e2

View on PubMed ↗Publisher’s paper ↗

Citation

Venkatesan, Thangam; Hillard, Cecilia J; Rein, Lisa; Banerjee, Anjishnu; Lisdahl, Krista. (2020). Patterns of Cannabis Use in Patients With Cyclic Vomiting Syndrome.. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 18(5), 1082-1090.e2. https://doi.org/10.1016/j.cgh.2019.07.039