Cholette-Tétrault Samuel, Grad Roland
Faculty of Medicine and Health Sciences, McGill University, 3605 Rue de la Montagne, Montreal H3G 2M1, Canada.
Department of Family Medicine, McGill University, 5858 Chem. de la Côte-des-Neiges, Montréal, QC H3S 1Z1, Canada.
Fam Pract. 2025 Feb 7;42(2). doi: 10.1093/fampra/cmae067.
Cannabinoid hyperemesis syndrome (CHS) is an increasingly recognized condition linked to chronic cannabis use, yet it remains frequently overlooked in clinical practice. The syndrome is characterized by cyclic episodes of severe nausea, vomiting, and abdominal pain, often relieved temporarily by hot showers or baths. With the rising prevalence of cannabis use following its legalization, the incidence of CHS has surged, presenting a significant challenge in both diagnosis and management within primary healthcare settings. Understanding the epidemiology, risk factors, and potential long-term sequelae of CHS is crucial for timely identification and intervention. This case report highlights the challenge of diagnosis and management of CHS in primary healthcare.
OBJECTIVE(S): To emphasize the importance of proper counseling and the use of Rome IV criteria in diagnosing CHS. To illustrate how this may reduce patient suffering and unnecessary investigation.
A 22-year-old female with chronic, daily cannabis use presented with recurrent episodes of intense nausea, vomiting, and abdominal pain over a 2-year period. Extensive diagnostic evaluations were inconclusive. A tentative diagnosis of CHS was made by a medical student and family doctor based on published criteria. The Rome IV criteria were then applied for confirmation of diagnosis and management. In so doing, the patient was advised to cease cannabis use for a minimum of 3 months. Initially, symptom improvement was reported with cannabis cessation. However, symptoms recurred following a relapse in cannabis use.
To confirm the diagnosis of CHS, counseling should specify the need for a minimum of 3 months of cannabis cessation to achieve symptom relief. Increased physician and patient awareness of this minimal time period for drug cessation can help to avoid unnecessary investigations, and prolonged patient suffering. This case emphasizes the need for vigilance in recognizing CHS and consideration of cannabis as a potential cause of cyclic vomiting.
大麻素呕吐综合征（CHS）是一种与长期使用大麻相关且日益被认识到的疾病，但在临床实践中仍经常被忽视。该综合征的特征是严重恶心、呕吐和腹痛的周期性发作，常通过热水淋浴或泡澡暂时缓解。随着大麻合法化后其使用的日益普遍，CHS的发病率激增，在初级医疗保健环境中的诊断和管理方面都带来了重大挑战。了解CHS的流行病学、危险因素和潜在的长期后遗症对于及时识别和干预至关重要。本病例报告强调了初级医疗保健中CHS诊断和管理的挑战。
强调正确咨询和使用罗马IV标准在诊断CHS中的重要性。说明这如何能减轻患者痛苦并避免不必要的检查。
一名22岁的女性，长期每日使用大麻，在2年期间反复出现强烈恶心、呕吐和腹痛发作。广泛的诊断评估未得出明确结论。一名医学生和家庭医生根据已发表的标准初步诊断为CHS。随后应用罗马IV标准进行诊断确认和管理。在此过程中，建议患者至少停止使用大麻3个月。最初，报告称停止使用大麻后症状有所改善。然而，在再次使用大麻后症状复发。
为确诊CHS，咨询应明确指出至少需要停止使用大麻3个月以缓解症状。提高医生和患者对这一最短停药时间的认识有助于避免不必要的检查和患者的长期痛苦。本病例强调了在识别CHS以及将大麻视为周期性呕吐潜在病因时保持警惕的必要性。
