Abstract

Cyclic Vomiting Syndrome (CVS) is a common disorder which is characterized by the occurrence of nausea and vomiting that typically lasts for 1 - 5 days followed by asymptomatic periods [1]. The etiology of CVS is unknown, however it has been related to various other associations such as menses (catamenial CVS), migraine headaches, diabetes mellitus, pregnancy, chronic cannabis use and many more (See table 1) [2,3]. CVS tends to affect all age groups. Many reports link cannabis, also called cannabinoid or marijuana, use to CVS as high as 40 - 50% in male population [1]. Adults are often associated with cannabinoid- induced CVS, meanwhile there are limited reports linking cannabinoid-induced CVS to the pediatric population. We came across a very young case of a 13-year old male who visited the Emergency Room 9 times over a 24-month period with severe cognitive impairment and symptoms of CVS. Each time this patient was admitted for hospitalization, diagnostic imaging, laboratory tests and toxicology screening were performed. The toxicology reported positive for cannabinoids. This is just one of many cases on the rise in United States that involves increasing use of cannabis among adolescents. Through our observation, all physicians should start considering the role of cannabis in diagnosis of CVS, particularly in adults and pediatric males.

Keywords: Cyclic Vomiting Syndrome (CVS); Nausea; Vomiting; Cannabinoid

References

1. Pattathan MB., et al. “Association of Marijuana Use and Cyclic Vomiting Syndrome”. Pharmaceuticals 5.7 (2012): 719-726. 
2. Hayes WJ., et al. “Cyclic vomiting syndrome: diagnostic approach and current management strategies”. Clinical and Experimental Gastroenterology 11 (2018): 77-84. 
3. George Katsaras., et al. “Cyclic Vomiting Syndrome in an Adolescent Girl. A Case Report and Review of the Literature”. EC Paediatrics 8.3 (2019): 179-185.
4. Lucia-Casadonte CJ., et al. “Yield and Costs of Evaluating Children With Cyclic Vomiting Syndrome”. Journal of Pediatric Gastroenterology and Nutrition 67.1 (2018): 13-17. 
5. Foley JD. “Adolescent use and misuse of marijuana”. Adolescent Medicine Clinics 17 (2006): 319-334.
6. Substance Abuse Center for Behavioral Health Statistics and Quality. Results from the 2018 National Survey on Drug Use and Health: Detailed Tables, SAMHSA (2020). 
7. Blumentrath CG., et al. “Cannabinoid hyperemesis and the cyclic vomiting syndrome in adults: recognition, diagnosis, acute and long-term treatment”. German Medical Science: GMS e-journal 15 (2017): Doc06. 
8. Gremida A and Gammack J. “Marijuana-Induced Cyclic Vomiting: What Clinicians Need to Know”. American Journal of Gastroenterology 109 (2014): S544.
9. Allen JH., et al. “Cannabinoid hyperemesis: cyclical hyperemesis in association with chronic cannabis use”. Gut 53 (2004): 1566-1570.
10. Simonetto DA., et al. “Cannabinoid hyperemesis: a case series of 98 patients”. Mayo Clinic Proceedings 87 (2012): 114-119.
11. Sontineni SP., et al. “Cannabinoid hyperemesis syndrome: clinical diagnosis of an under recognised manifestation of chronic cannabis abuse”. World Journal of Gastroenterology 15 (2009): 1264-1266.
12. Sallan SE., et al. “Antiemetic effect of delta-9- tetrahydrocannabinol in patients receiving cancer chemotherapy”. New England Journal of Medicine 293 (1975): 795-797.
13. Pertwee RG. “Pharmacology of cannabinoid CB1 and CB2 receptors”. Pharmacology and Therapeutics 74 (1997): 129-180.
14. Pertwee RG. “Pharmacological Actions of Cannabinoids”. Handbook of Experimental Pharmacology Cannabinoids (2005): 1-51. 
15. McCallum RW., et al. “Delta-9-tetrahydrocannabinol delays the gastric emptying of solid food in humans: a double-blind, randomized study”. Alimentary Pharmacology and Therapeutics 13 (1999): 77-80.
16. Abell TL., et al. “Cyclic vomiting syndrome in adults”. Neurogastroenterology and Motility 20 (2008): 269-284.
17. Map of Marijuana Legality by State (2020). 
18. Pertwee RG. “Cannabinoids and the gastrointestinal tract”. Gut 48.6 (2001): 859-867. 
19. Venkatesan T., et al. “An Internet survey of marijuana and hot shower use in adults with cyclic vomiting syndrome (CVS)”. Experimental Brain Research 232.8 (2014): 2563-2570.