What is the cannabis-induced gastrointestinal disorder called?

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Cannabinoid Hyperemesis Syndrome (CHS)

The cannabis-induced gastrointestinal problem is called Cannabinoid Hyperemesis Syndrome (CHS). 1

What is CHS?

CHS is a disorder of gut-brain interaction that has been included in the Rome IV classification of functional gastrointestinal disorders since 2016. 1 It is characterized by:

  • Cyclic vomiting (stereotypical episodes occurring 3+ times annually)
  • Nausea and abdominal pain
  • Compulsive hot water bathing behavior (long hot baths or showers for symptom relief)

This condition occurs paradoxically in chronic, heavy cannabis users despite cannabis being traditionally used as an antiemetic. 1

Key Clinical Features

The typical CHS patient profile from a systematic review of 271 cases shows: 1

  • Mean age: 30 years
  • 69% male
  • Mean duration of cannabis use before symptom onset: 6.6 years
  • Daily cannabis use in 68%
  • Hot water bathing reported in 71%

Diagnostic Criteria

CHS should be suspected in any patient with chronic nausea and vomiting who uses cannabis. 1 The clinical diagnostic criteria include:

  1. Clinical features: Stereotypical episodic vomiting resembling cyclic vomiting syndrome with frequency ≥3 times annually

  2. Cannabis use patterns:

    • Duration >1 year before symptom onset
    • Frequency >4 times per week on average

  3. Cannabis cessation: Resolution of symptoms after ≥6 months of abstinence from cannabis, or at least equal to the total duration of 3 typical vomiting cycles

Important Clinical Distinction

A critical caveat: CHS can only be definitively distinguished from cyclic vomiting syndrome (CVS) by establishing complete remission during 6-12 months of cannabis abstinence. 2 One-third of CVS patients also regularly use cannabis, making initial differentiation challenging in emergency settings. 2

The hot water bathing pattern, while commonly considered an indicator of CHS, is not pathognomonic as it also occurs in CVS. 1

References

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.