Cannabis Hyperemesis or Cyclic Vomiting- A Comparative Literature Review

IntroductionGastrointestinal functional disorders are based on gut-brain axis dysfunction and have overlapping symptoms. This review demonstrates a diagnostic dilemma in the patients presenting with chronic cannabis use and hot bathing behavior, prompting a diagnosis of Cannabis hyperemesis syndrome (CHS). It highlights the lack of guidelines generally used for diagnosis and even the drawback of the Rome criterion with a requirement of improvement with cessation, which does not allow a diagnosis at the initial visit. Some patients get ultimately diagnosed with Cyclic vomiting syndrome (CVS) which is overlapping disorder often ignored in cannabis smokers.MethodsThe authors reviewed databases including PubMed and Cochrane to look at reviews published in the last 5 years proposing guidelines for diagnosis, postulating shared pathophysiology based on animal/human studies and consolidated the treatment protocols.DiscussionThe signs and symptoms of the diseases highly overlap. This occurs due to the internal endocannabinoid system with CB1 receptor stimulation leading to improvement in nausea but persistent use leading to possible contrary effects or receptor downregulation. Rome criterion, used for diagnosis and CVS includes acute stereotypical vomiting episodes with 3 episodes in a year and 2 in 6 months preceding diagnosis and relative symptom-free interval, supported by personal or family history of migraines whereas CHS has CVS-like episodes, cannabis use and improvement on cessation in criterion with hot showers as support. Thangam et al proposed a better criterion with at least one year of >4 times/week cannabis use and 6 months of cessation to allow washout. Lastly, treatment includes cannabis cessation, anti-emetics including ondansetron, and even aprepitant. Sumatriptan has been used as a good abortive agent as well. For maintenance of remission, coenzyme Q, tricyclic antidepressants and topiramate has shown promise. Lifestyle modifications and therapy are adjuvantsConclusionGut brain axis is complex and leads to overlap in presentation and delayed diagnosis. Using defined criterion is the key for diagnosis and treatments though less studied have been postulated and can be used as per limited data available.The underlying case and review show the similarities and differences between cyclic vomiting and cannabis hyperemesis while touching upon pathogenesis and treatments. It also focuses on the prevalence of cannabis use in patients with cyclic vomiting and the role of the endocannabinoid system in the pathogenesis of both diseases.