Ruffle James K, Bajgoric Sanjin, Samra Kiran, Chandrapalan Subashini, Aziz Qasim, Farmer Adam D
aCentre for Digestive Diseases, Blizard Institute, Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, London bDepartment of Gastroenterology, University Hospitals of North Midlands NHS Trust, Royal Stoke University Hospital, Stoke on Trent, UK.
Eur J Gastroenterol Hepatol. 2015 Dec;27(12):1403-8. doi: 10.1097/MEG.0000000000000489.
Chronic nausea and vomiting have a detrimental impact on quality of life. When standard diagnostic investigations fail to provide a definitive diagnosis, patients are often attributed as having a functional gastrointestinal disorder such as cyclic vomiting syndrome. Cannabinoid hyperemesis syndrome (CHS) is a relatively recently described entity presenting with symptoms similar to cyclic vomiting syndrome.
We carried out a retrospective cohort study of all patients attending a tertiary neurogastroenterology and secondary care gastroenterology clinic from 2013 to 2015. Data were obtained by review of clinical notes, letters and electronic patient records.
We identified 10 cases of CHS (five men, mean age 27 years, range 19-51), who hitherto had been labelled with a variety of alternative diagnoses. All patients had symptoms that were episodic and refractory to medical therapy. Patients had experienced symptoms for a mean of 19.3±11.09 months before diagnosis. The median length of cannabinoid use was 42 months (interquartile range: 15-81.8). Eight patients (80%) had a history of compulsive hot water bathing (hydrophilia). The patients had a median follow-up of 9.5 months (range 1-20), during which symptoms recurred in three patients who returned to regular cannabis use.
CHS is an underappreciated cause of recurrent nausea and vomiting and is frequently misdiagnosed. Healthcare providers should have a low index of suspicion for diagnosing CHS and the clinical history in such patients should routinely include direct questioning on cannabis use. The prognosis is very good upon cessation of cannabis intake.
慢性恶心和呕吐会对生活质量产生不利影响。当标准诊断检查未能提供明确诊断时，患者常被归因于患有功能性胃肠疾病，如周期性呕吐综合征。大麻素呕吐综合征（CHS）是一种相对较新描述的疾病，其症状与周期性呕吐综合征相似。
我们对2013年至2015年在三级神经胃肠病学和二级护理胃肠病学诊所就诊的所有患者进行了一项回顾性队列研究。通过查阅临床记录、信件和电子病历获取数据。
我们确定了10例CHS患者（5名男性，平均年龄27岁，范围19 - 51岁），这些患者此前被贴上了各种不同的诊断标签。所有患者的症状都是发作性的，且药物治疗无效。患者在诊断前平均经历症状19.3±11.09个月。大麻素使用的中位数时长为42个月（四分位间距：15 - 81.8）。8名患者（80%）有强迫性热水浴（嗜水）史。患者的中位随访时间为9.5个月（范围1 - 20个月），在此期间，3名恢复常规大麻使用的患者症状复发。
CHS是复发性恶心和呕吐的一个未得到充分认识的病因，且经常被误诊。医疗服务提供者对CHS的诊断应保持较低的怀疑指数，此类患者的临床病史应常规包括直接询问大麻使用情况。停止摄入大麻后预后非常好。
