Cannabinoid Hyperemesis Syndrome (CHS) - An emerging gastrointestinal disorder and clinical challenge

Nausea and vomiting are not uncommon symptoms resulting in emergency department (ED) or primary care visits. One of the emerging etiologies - Cannabinoid Hyperemesis Syndrome (CHS) remains significantly under-diagnosed, often resulting in unnecessary repeat ED visits and testing. This is in part due to lack of experience with and knowledge about CHS by health care professionals. Characterized by cyclic vomiting, often severe and intractable, it is frequently associated with a form of self-treatment; the compulsive need to take hot showers, and in the context of chronic cannabis use. With increased legalization and resultant accessibility to cannabis containing products, the risk of adverse events is significantly rising. Lack of clinical familiarity with the range of potential deleterious physical and mental health effects associated with cannabis leads to delays in appropriate diagnosis and effective treatment of CHS. Moreover, commonly utilized anti-emetics, such as ondansetron, and similar 5 HT drugs may not fully attenuate symptoms of CHS, and other interventions may be necessary; ultimately abstinence being the most effective long term clinical preventive approach. The objective of this review article is to assist the clinician in identifying the specific clinical characteristics of CHS, distinguishing it from other causes of CVS or nausea and vomiting, to facilitate more rapid, effective interventions. Collaboration with substance use professionals should also be considered during CHS treatment.