User:Rsomepalli/Cannabinoid hyperemesis syndrome

A syndrome associated with long-term chronic cannabis use that is characterised by recurrent nausea, vomiting and colicky abdominal pain has been reported. These symptoms have been reported to be alleviated temporarily by taking a hot shower or bath or more permanently by abstaining from cannabis use. The cannabinoid hyperemesis syndrome is recognized by Allen and colleagues (2004), and simplified clinical diagnostic criteria were offered by Sontineni and colleagues (2009)[1,5]. The contributions made by these leading world experts on the subject were pivotal in establishing the existence of cannabinoid hyperemesis syndrome at a time when cannabis use is on the rise.

Epidemiology
Cannabinoid hyperemesis was first reported from Adelaide hills of South Australia [1]. Since the first recognition, several cases were recognized worldwide [2]. Cannabis is by far the most widely cultivated, trafficked and abused illicit drug. Half of all drug seizures worldwide are cannabis seizures. The geographical spread of those seizures is also global, covering practically every country of the world. About 147 million people, 2.5% of the world population, consume cannabis (annual prevalence) compared with 0.2% consuming cocaine and 0.2% consuming opiates. In the present decade, cannabis abuse has grown more rapidly than cocaine and opiate abuse. The most rapid growth in cannabis abuse since the 1960s has been in developed countries in North America, Western Europe and Australia. Cannabis has become more closely linked to youth culture and the age of initiation is usually lower than for other drugs[3]. Given such a widespread use of cannabis, the cannabinoid hyperemesis syndrome is afflicting large number of people and is in steady rise in its incidence[4].

Clinical presentation
Cannabis has been used recreationally for millennia and yet the adverse effects are just becoming unfolded. The long-term and short-term toxicity of cannabis abuse is associated with pathological and behavioural effects leading to a wide variety of effects on the body systems and physiologic states[5]. The phenomenon of cannabinoid hyperemesis and clinical diagnosis remained obscure until recently even though its features were beginning to be understood by leading physicians worldwide. Inspite of these early reports, an uncertainity remained among the doctors and scientists regarding the existence of the cannabinoid hyperemesis syndrome[6]. Sontineni and colleagues (2009) discuss the cannabinoid hyperemesis syndrome in their seminal paper to offer guidelines for the clinical diagnosis. The suggested criteria for the diagnosis are - Essential: 1) history of regular cannabis use for years; Major clinical features of syndrome: 2) severe nausea and vomiting, 3) vomiting that recurs in a cyclic pattern over months and 4) resolution of symptoms after stopping cannabis use. In addition diagnosis has supportive features of - 1) compulsive hot baths with symptom relief; 2) colicky abdominal pain; and 3) no evidence of gall bladder or pancreatic inflammation. Since the publication of these guidelines, the syndrome is more easily recognized and treated.

Pathogenesis
Various pathogenic mechanistic theories attempting to explain symptoms have been put forward. These theories fall into two themes; 1) dose dependent build up of cannabinoids and related effects of cannabinoid toxicity, and 2) the functionality of cannabinoid receptors in the brain and particularly in the hypothalamus (which regulates body temperature and the digestive system). But the mechanisms by which cannabis causes or controls nausea and the adverse consequences of long-term cannabis toxicity remain unknown and organic disease should not be ruled out as a possible cause.

The neurobiology of the compound has led to the discovery of an endogenous cannabinoid system. The therapeutic potential of cannabinoids has been recognized and these compounds are utilized as anti-emetics[3–5]. Recently, a distinct syndrome in chronic cannabis abusers characterized by recurrent vomiting associated with abdominal pain and a tendency to take hot showers has been increasingly recognised. This clinical manifestation is paradoxical to the previously identified therapeutic role of cannabinoids as anti-emetics. We describe the case of a young male seeking repeated emergency room care with recurrent nausea and vomiting

REFERENCES

1.Allen JH, de Moore GM, Heddle R, Twartz JC. Cannabinoid hyperemesis: cyclical hyperemesis in association with chronic cannabis abuse. Gut. 2004 Nov;53(11):1566-70. 2.Roche, E. & Foster, P.N. (2005). Cannabinoid hyperemesis: Not just a problem in Adelaide Hills. 3.World health Organization.Cannabis - epidemiology. 4.New 'Severe Vomiting' Syndrome Linked to Chronic Pot Use. 5.Sontineni SP, Chaudhary S, Sontineni V, Lanspa SJ. Cannabinoid hyperemesis syndrome: Clinical diagnosis of an underrecognised manifestation of chronic cannabis abuse. World J Gastroenterol. 2009 March 14; 15(10): 1264–1266. 6.Byrne A, Hallinan R, Wodak A."Cannabis hyperemesis" causation questioned.Gut. 2006 Jan;55(1):132. 7.Chronic marijuana abuse linked to severe vomiting. 8. NCPIC.Cannabinoid hyperemesis syndrome.