Approach to Cyclic Vomiting Syndrome and Cannabinoid Hyperemesis Syndrome

Cyclic vomiting syndrome (CVS) is a disorder of gut-brain interaction in which patients experience recurrent, stereotyped episodes of repetitive bouts of emesis, prototypically with near or complete symptom remission between episodes. Patients with a similar symptom pattern who have chronically and frequently used cannabis have been described as having Cannabinoid Hyperemesis Syndrome (CHS), and current CHS diagnostic criteria require sustained symptom improvement following cannabis cessation. This review summarizes the current treatment options for patients suffering from these poorly understood conditions.

CVS occurs de novo in adults and impacts approximately 1% of the adult population. There also has been increasing clinical recognition of CHS, particularly as cannabis use has become more widespread in the general population. Due to the increasing clinical recognition of these conditions and the need for guidance on management, clinical guidelines for the diagnosis and management of CVS and CHS were recently released that support preventive and abortive pharmacological therapies. There is guideline support for lifestyle modification, addressing psychological risk factors that may link to acute exacerbations, and treating frequent comorbid medical conditions seen in both CVS and CHS.

This article reviews current pharmacologic and non-pharmacologic treatment approaches for CVS and CHS. Future research will hopefully identify a clearer pathophysiologic basis of CVS/CHS that leads to the development of more targeted therapies and a basis for personalized medicine approaches.