A rare syndrome associated with long-term chronic cannabis use that is characterised by recurrent nausea and vomiting associated with abdominal pain has been reported. These symptoms have been reported to be alleviated temporarily by taking a hot shower or bath or more permanently by abstaining from cannabis use. Several case reports have been published across the world in the last five years and are listed in Table 1.
The first published cases of cannabinoid hyperemesis were reported by Allen and colleagues in 2004. This article spurred some interest in clinicians and several other case reports were published (see Table 1). However, the article also spurred some debate. Byrne and colleagues (2006) posited that “alternative explanations (of symptoms) need to be sought” and that the syndrome “should not be accepted as being caused by cannabis without additional reports and other evidence”. Although several case reports have been published, there remains to be any accepted explanation of symptoms.
Sontineni and colleagues (2009) have offered guidelines for the clinical diagnosis of cannabinoid hyperemesis. They suggest the essential features of: 1) history of regular cannabis use for years; 2) major clinical features of syndrome; 3) severe nausea and vomiting; 4) vomiting that recurs in a cyclic pattern over months; and 5) resolution of symptoms after stopping cannabis use. In addition diagnosis has supportive features of:
1) compulsive hot baths with symptom relief; 2) colicky abdominal pain; and 3) no evidence of gall bladder or pancreatic inflammation.
Various theories attempting to explain symptoms have been published. These theories fall into two themes; 1) dose dependent build up of cannabinoids and related effects of cannabinoid toxicity, and 2) the functionality of cannabinoid receptors in the brain and particularly in the hypothalamus (which regulates body temperature and the digestive system). Chang and Windish (2009) offer a summary of corroborating evidence for these theories; however, the authors note that the mechanisms by which cannabis causes or controls nausea and the adverse consequences of long-term cannabis toxicity remain unknown. The authors also conclude that organic disease should not be ruled out as a possible cause. Thus, Byrne and colleagues’ (2006) call for further evidence and research is still pertinent.
Table 1: Cannabinoid hyperemesis case reports
References
- Alfonso, M.V., Ojesa, F. & Moreno-Osset, E. (2006). Cannabinoid hyperemesis. Gastroenterología y hepatología 29, 434-435.
- Allen, J.H., De Moore, G.M., Heddle, R., & Twartz, J.C. (2004). Cannabinoid hyperemesis: Cyclical hyperemesis in association with chronic cannabis abuse. Gut 53, 1566-1570.
- Boeckxstaens, G.E. (2005). Cannabinoid hyperemesis with the unusual symptom of compulsive bathing. Nederlands Tijdschrift Voor Geneeskunde 149, 1468.
- Budhraja, V., Narang, T. & Azeez, S. (2008). Cannabinoid hyperemesis syndrome: Cyclic vomiting, chronic cannabis use, and compulsive bathing. Practical Gastroenterology September, 79-80.
- Byrne, A., Hallinan, R. & Wodak, A. (2006). “Cannabis hyperemesis” causation questioned. Gut 55, 132.
- Chang, Y.H. & Windish, D.M. (2009). Cannabinoid hyperemesis relieved by compulsive bathing. Mayo Clinic Proceedings 84, 76-78.
- Chepyala, P. & Olden, K.W. (2008). Cyclic vomiting and compulsive bathing with chronic cannabis abuse. Clinical Gastroenterology and Hepatology 6, 710-712.
- de Moore, G.M., Baker, J. & Bui, T. (1996) Psychogenic vomiting complicated by marijuana abuse and spontaneous pneumomediastinum. Australia and New Zealand Journal of Psychiatry 30, 290–294.
- Martineau-Beaulieu, D. & Baillargeon, J.D. (2009). A lipase induced in error... Canadian Journal of General Internal Medicine 4, 7-9.
- Ochoa-Mangado, E.M., Jiménez G.M., Salvador V.E., & Madoz-Gúrpide, A. (2009). Cyclical hyperemesis secondary to cannabis abuse. GastroenterologIa y Hepatologia 32, 406-409.
- Roche, E. & Foster, P.N. (2005). Cannabinoid hyperemesis: Not just a problem in Adelaide Hills. Unpublished manuscript.
