CHS Diagnosis: Understanding Cannabis Hyperemesis Syndrome Detection

What is Cannabis Hyperemesis Syndrome?

Cannabis Hyperemesis Syndrome (CHS) is a condition characterized by severe and recurring episodes of nausea, vomiting, and abdominal pain. This syndrome affects individuals who are long-term, daily cannabis users. Typically, CHS symptoms manifest after a decade or more of consistent marijuana use.

Cannabis contains active compounds, notably THC and related chemicals. These substances interact with receptors in the brain, producing the characteristic “high” and other effects. However, these same compounds also interact with receptors in the digestive system. This interaction influences digestive processes such as stomach emptying rate and the function of the esophageal sphincter, the muscle controlling food passage to the stomach. Chronic cannabis use can disrupt the normal response of these receptors, leading to CHS symptoms.

Marijuana remains a prevalent illicit drug in the United States, particularly among young adults. While CHS affects a small percentage of users, it predominantly occurs in individuals with a history of prolonged and frequent cannabis consumption, often those who use it at least daily.

What are the Causes of CHS?

The precise mechanisms by which cannabis induces CHS are still under investigation due to marijuana’s complex effects on the body. Researchers are actively working to unravel the exact cause of CHS in susceptible individuals.

Paradoxically, in the brain, cannabis often exhibits antiemetic properties, effectively reducing nausea and vomiting. It’s even used to alleviate these symptoms in chemotherapy patients.

However, in the digestive tract, cannabis appears to have the opposite effect, potentially promoting nausea and vomiting. Initially, with cannabis use, the brain’s antiemetic signals might dominate. This could explain the initial anti-nausea effects some users experience. However, with chronic use, brain receptors may become desensitized to cannabis, leading to the cyclical vomiting associated with CHS.

The reasons why some heavy cannabis users develop CHS while others do not remain unclear and are an area of ongoing research.

What are the Symptoms of CHS?

CHS is marked by cyclical episodes of vomiting, interspersed with symptom-free periods. Clinicians often categorize CHS symptoms into three phases: prodromal, hyperemetic, and recovery.

Prodromal Phase: This phase is typically characterized by early morning nausea and abdominal discomfort. Some individuals may also develop anticipatory nausea, a fear of vomiting. Appetite usually remains normal during this stage, and surprisingly, some individuals may increase cannabis use, mistakenly believing it will alleviate their nausea. The prodromal phase can persist for months or even years.

Hyperemetic Phase: This is the most acute phase, featuring:

Persistent nausea.
Recurrent and severe vomiting episodes.
Abdominal pain.
Reduced appetite and subsequent weight loss.
Dehydration symptoms.

During the hyperemetic phase, vomiting can be intense and debilitating. A peculiar behavior often observed is the frequent use of hot showers for symptom relief. Hot water may modulate the hypothalamus, a brain region involved in temperature regulation and vomiting reflexes, providing temporary relief. Patients often seek medical attention during this distressing phase. The hyperemetic phase continues until cannabis use is completely discontinued, marking the onset of the recovery phase.

Recovery Phase: This phase is characterized by symptom resolution and the return of normal eating habits. Recovery can take days to months. However, symptom recurrence is highly probable if cannabis use is resumed.

How is CHS Diagnosed?

Diagnosing CHS requires a comprehensive approach, as many medical conditions can manifest with recurrent vomiting. To arrive at a Chs Diagnosis, healthcare providers rely on a detailed patient history, symptom evaluation, and physical examination, including a thorough abdominal assessment.

To exclude other potential causes of repeated vomiting, particularly those requiring urgent medical intervention, further investigations may be necessary. These tests are guided by the patient’s overall presentation and may include:

Blood tests: To assess for anemia, infection, and electrolyte imbalances.
Electrolyte levels: To evaluate for dehydration and electrolyte abnormalities.
Pancreatic and liver enzyme tests: To assess the function of these organs.
Pregnancy test: In women of childbearing age, to rule out pregnancy-related vomiting.
Urinalysis: To detect urinary tract infections or other urinary causes of vomiting.
Drug screening: To identify substance-induced vomiting, although paradoxical in CHS.
Abdominal X-rays: To visualize potential bowel obstructions or other structural abnormalities.
Upper endoscopy: A procedure to directly visualize the esophagus and stomach to identify potential sources of vomiting.
Head CT scan: If neurological causes of vomiting are suspected.
Abdominal ultrasound or CT scan: To evaluate for structural issues like inflammation or blockages contributing to vomiting.

Because CHS is a relatively recent medical discovery, awareness among healthcare providers may vary. Consequently, chs diagnosis can be delayed, sometimes for years, and it is often misdiagnosed as cyclical vomiting syndrome, a condition with overlapping symptoms. Gastroenterologists, specialists in digestive disorders, are often better equipped to recognize and diagnose CHS.

A chs diagnosis is considered likely when the following criteria are met:

History of long-term, frequent cannabis use (daily or weekly).
Presence of abdominal pain.
Severe, recurrent nausea and vomiting.
Relief of symptoms with hot showers or baths.

Currently, there is no definitive laboratory test for chs diagnosis. However, the characteristic relief experienced with hot showers is a strong indicator. Honest communication with healthcare providers regarding cannabis use history is crucial for accurate chs diagnosis and appropriate management. Ultimately, the confirmation of chs diagnosis often rests on symptom resolution following complete cessation of cannabis use.

How is CHS Treated?

Severe vomiting associated with CHS may necessitate hospitalization for supportive care. Treatment during the hyperemetic phase focuses on:

Intravenous (IV) fluid rehydration: To correct dehydration resulting from excessive vomiting.
Antiemetic medications: To reduce nausea and vomiting.
Pain management: To alleviate abdominal pain.
Proton pump inhibitors: To address potential stomach inflammation.
Hot showers or baths: Continued as a symptomatic relief measure.
Benzodiazepines: Prescribed to reduce anxiety and agitation.
Topical capsaicin cream: In some cases, applying capsaicin cream to the abdomen has shown promise in reducing pain and nausea, mimicking the effect of hot showers.

Symptoms typically subside within one to two days of ceasing cannabis use, provided there is no further cannabis consumption.

Complete recovery from CHS hinges on the permanent cessation of cannabis use. For individuals struggling to quit, drug rehabilitation programs, cognitive behavioral therapy, or family therapy can provide valuable support. Abstinence from cannabis should prevent symptom recurrence.

What are the Potential Complications of CHS?

Severe and prolonged vomiting can lead to significant dehydration and electrolyte imbalances. If left untreated, these complications can, in rare instances, progress to:

Muscle spasms or weakness.
Esophageal tears (Mallory-Weiss tears) from forceful vomiting.
Seizures.
Kidney failure.
Cardiac arrhythmias.
Shock.
In extremely rare cases, cerebral edema (brain swelling).

Medical professionals promptly address dehydration and electrolyte disturbances to mitigate the risk of these complications.

How Can CHS be Prevented?

The most effective way to prevent CHS is to abstain from cannabis use in all forms. Individuals may find it challenging to accept cannabis as the underlying cause, especially with a history of prolonged use without prior issues. However, CHS can develop over years, and the initial antiemetic effects of cannabis can mask its long-term pro-emetic potential in susceptible individuals. Complete cessation of cannabis is essential for preventing CHS recurrence.

Quitting cannabis offers additional health benefits, including:

Improved respiratory function.
Enhanced memory and cognitive abilities.
Better sleep quality.
Reduced risk of depression and anxiety.

When to Seek Medical Advice?

It is advisable to contact a healthcare provider if you experience severe vomiting lasting for more than 24 hours.

Key Takeaways About Cannabis Hyperemesis Syndrome

CHS is a condition characterized by recurrent, severe vomiting linked to chronic cannabis use.
Hot showers are commonly used by sufferers for self-treatment to alleviate symptoms.
Chs diagnosis may be delayed for years in some individuals. Open communication with healthcare providers about daily cannabis use can expedite chs diagnosis.
Hospitalization may be necessary to manage dehydration from CHS.
Symptoms typically resolve within a day or two after discontinuing cannabis use.
Symptoms almost invariably return with resumed cannabis use.

Next Steps

To maximize the benefits of your healthcare provider visit:

Understand the reason for your visit and desired outcomes.
Prepare a list of questions beforehand.
Consider bringing a companion for support and memory aid.
During the consultation, note down any new diagnoses, medications, treatments, or tests, and instructions.
Understand the purpose, benefits, and potential side effects of any prescribed medication or treatment.
Inquire about alternative treatment options.
Understand the rationale behind recommended tests or procedures and their potential implications.
Know the expected consequences of declining medication, tests, or procedures.
Schedule follow-up appointments, noting the date, time, and purpose.
Know how to contact your provider with any subsequent questions.

Medical Reviewer: Michelle Anderson DNP
Medical Reviewer: Daphne Pierce-Smith RN MSN