[The cannabinoid hyperemesis syndrome-A narrative review]

Until 25 years ago cyclic vomiting attacks under the chronic influence of cannabis were virtually unknown. Following the legalization of non-medical cannabis in North America and the associated increase in cannabis use, including high-potency strains, the number of patients there with cannabis-related cyclic vomiting is increasing. The ROME-IV criteria now define cannabis-induced cyclic vomiting as cannabinoid hyperemesis syndrome (CHS). This review aims to provide information about CHS, as an increase in cases is also to be expected in Germany following legalization.

Selective review article.

The CHS is most frequently registered in emergency departments. A clear differentiation between CHS and cyclic vomiting syndrome (CVS), in which one third of those affected also regularly use cannabis, is only possible by establishing full remission during a 6-12 month cannabis abstinence. Therefore, mixed forms of CVS and CHS are initially seen in emergency departments (suspected CHS), also with hidden life-threatening abdominal comorbidities. Severe vomiting can also lead to serious complications. The commonly used antiemetics often do not help. Hot showers and baths as well as i.m. haloperidol (5 mg) can provide acute relief from severe vomiting. Rubbing the abdomen with 0.075-0.1% capsaicin cream also has an antiemetic effect but less quickly.

In ROME-IV the CHS is nosologically considered a special variant of CVS. In particular, it is a specific cannabis-related, often severe physical disorder. As healing can only be achieved through sustained cannabis abstinence, suspected CHS in emergency departments is an interdisciplinary challenge for gastroenterology, neuropsychiatry and the addiction support system.