DeVuono Marieka V, Venkatesan Thangam, Hillard Cecilia J
Department of Anatomy and Cell Biology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.
Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA.
Neurogastroenterol Motil. 2025 Mar;37(3):e14911. doi: 10.1111/nmo.14911. Epub 2024 Sep 2.
Classical antiemetics that target the serotonin system may not be effective in treating certain nausea and vomiting conditions like cyclic vomiting syndrome (CVS) and cannabinoid hyperemesis syndrome (CHS). As a result, there is a need for better therapies to manage the symptoms of these disorders, including nausea, vomiting, and anxiety. Cannabis is often used for its purported antiemetic and anxiolytic effects, given regulation of these processes by the endocannabinoid system (ECS). However, there is considerable evidence that cannabinoids can also produce nausea and vomiting and increase anxiety in certain instances, especially at higher doses. This paradoxical effect of cannabinoids on nausea, vomiting, and anxiety may be due to the dysregulation of the ECS, altering how it maintains these processes and contributing to the pathophysiology of CVS or CHS.
The purpose of this review is to highlight the involvement of the ECS in the regulation of stress, nausea, and vomiting. We discuss how prolonged cannabis use, such as in the case of CHS or heightened stress, can dysregulate the ECS and affect its modulation of these functions. The review also examines the evidence for the roles of ECS and stress systems' dysfunction in CVS and CHS to better understand the underlying mechanisms of these conditions.
针对5-羟色胺系统的传统止吐药可能对治疗某些恶心和呕吐病症无效，如周期性呕吐综合征（CVS）和大麻素类呕吐综合征（CHS）。因此，需要更好的疗法来控制这些病症的症状，包括恶心、呕吐和焦虑。鉴于内源性大麻素系统（ECS）对这些过程的调节作用，大麻常因其所谓的止吐和抗焦虑作用而被使用。然而，有大量证据表明，大麻素在某些情况下也会引起恶心和呕吐，并增加焦虑，尤其是在高剂量时。大麻素对恶心、呕吐和焦虑的这种矛盾作用可能是由于ECS失调，改变了其维持这些过程的方式，并导致了CVS或CHS的病理生理学变化。
本综述的目的是强调ECS在应激、恶心和呕吐调节中的作用。我们讨论了长期使用大麻，如在CHS或压力增加的情况下，如何使ECS失调并影响其对这些功能的调节。该综述还研究了ECS和应激系统功能障碍在CVS和CHS中的作用证据，以更好地理解这些病症的潜在机制。
