Summary about Disease
Cannabinoid Hyperemesis Syndrome (CHS) is a condition characterized by severe, persistent nausea, vomiting, and abdominal pain in chronic, heavy cannabis users. Paradoxically, hot showers or baths often provide temporary relief from the symptoms.
Symptoms
Intense nausea
Recurrent and severe vomiting (often projectile)
Diffuse abdominal pain
Compulsive hot bathing or showering (to relieve symptoms)
Dehydration
Weight loss (due to prolonged vomiting)
Loss of appetite
Causes
The exact cause is not fully understood, but it is believed to be related to the effects of chronic cannabis use on the endocannabinoid system, particularly in the gut and brain. Overstimulation of cannabinoid receptors followed by dysregulation is a leading hypothesis.
Medicine Used
Anti-emetics: Medications to reduce nausea and vomiting (e.g., ondansetron, prochlorperazine).
Proton pump inhibitors (PPIs): To reduce stomach acid production (e.g., omeprazole).
Intravenous fluids: To treat dehydration.
Topical capsaicin cream: Applied to the abdomen, may help relieve pain.
Benzodiazepines: For anxiety and severe nausea in some cases.
Haloperidol: Used in some cases to treat nausea and vomiting.
Is Communicable
No, Cannabinoid Hyperemesis Syndrome is not a communicable disease. It is not infectious and cannot be spread from person to person.
Precautions
Cessation of Cannabis Use: The most important precaution is to completely stop using cannabis.
Hydration: Maintaining adequate hydration by drinking plenty of fluids is essential.
Avoid Triggers: Identify and avoid any specific triggers that exacerbate symptoms.
Stress Management: Implementing stress-reduction techniques may be beneficial.
Hot Showers/Baths (with caution): While they provide temporary relief, excessive hot water exposure can cause burns or electrolyte imbalances.
How long does an outbreak last?
An outbreak, or episode, can last for hours to days. Without cessation of cannabis use, episodes are likely to recur. Symptoms typically resolve within days to weeks after stopping cannabis use completely.
How is it diagnosed?
Diagnosis is primarily based on clinical presentation and a history of chronic cannabis use. There is no specific diagnostic test. Doctors typically rely on:
History and Physical Exam: Detailed assessment of symptoms and cannabis use history.
Exclusion of Other Conditions: Ruling out other potential causes of nausea and vomiting (e.g., cyclic vomiting syndrome, bowel obstruction, gallbladder disease).
Symptom Relief with Hot Baths/Showers: A positive response to hot baths or showers is a key diagnostic feature.
Improvement with Cannabis Cessation: Resolution of symptoms after stopping cannabis use is strong evidence of CHS.
Timeline of Symptoms
CHS typically progresses through three phases:
Prodromal Phase: Early morning nausea, abdominal discomfort, and fear of vomiting. Cannabis use may even temporarily alleviate these symptoms, reinforcing the habit. This phase can last for months or years.
Hyperemetic Phase: Intense nausea, severe vomiting, and abdominal pain. Compulsive hot bathing or showering becomes prominent. Dehydration and weight loss are common. This phase is characterized by acute episodes.
Recovery Phase: Symptoms gradually subside after cessation of cannabis use. This phase can take days to weeks, and full recovery depends on complete abstinence.
Important Considerations
Cessation is Key: Stopping cannabis use is the only definitive treatment for CHS. Continued use will lead to recurrent episodes.
Misdiagnosis: CHS can be misdiagnosed as other gastrointestinal disorders, leading to unnecessary treatments.
Education: Patients need to be educated about the link between their symptoms and cannabis use.
Support: Support groups or counseling may be helpful for individuals struggling to stop cannabis use.
Long-Term Effects: Chronic vomiting can lead to complications such as Mallory-Weiss tears (esophageal tears), electrolyte imbalances, and dental problems.