The condition termed cannabinoid hyperemesis syndrome (CHS) was characterized a decade ago by Allen et al. and includes cyclic episodes of nausea and vomiting and the learned behavior of hot bathing in individuals with chronic cannabis abuse. During pregnancy, the differential diagnosis of this syndrome is challenging, since it can be masked by typical symptoms of early pregnancy or by hyperemesis gravidarum, a complication of early pregnancy associated with excessive nausea and vomiting.
Case description
The authors herein describe the case of a 21-year-old primigravida patient diagnosed with hyperemesis gravidarum at 6 weeks of gestation and with preeclampsia at 35 weeks. At 30 weeks of gestation, a drug screen was performed that was positive for cannabis; therefore, a diagnosis of CHS was made. After labor induction, the patient delivered an infant who developed normally and had a negative drug test of the umbilical cord blood. Esophagogastroduodenoscopy was performed 9 days post delivery, with biopsies taken of the duodenal, gastric, and esophageal tissues. Moderate chronic gastritis with lymphoid aggregates and slight acute inflammation were noticed, whereas no malignancy, dysplasia, or goblet cell metaplasia was detected. A number of Helicobacter-like organisms were identified by H. pylori immunostaining.
Conclusion
Presented here is the first case reporting an association of chronic cannabis use with H. pylori colonization and preeclampsia in pregnancy, which brings to light the possible involvement of a cannabinoid-related pathway in the link between pregnancy-specific complications and bacterial colonization.
AllenJH, de MooreGM, HeddleR, TwartzJC.Cannabinoid hyperemesis: cyclical hyperemesis in association with chronic cannabis abuse. Gut.2004;53:1566–1570.
2.
DonninoMW, CocchiMN, MillerJ, FisherJ.Cannabinoid hyperemesis: a case series. J Emerg Med.2011;40:e63–e66.
3.
NicolsonSE, DenysenkoL, MulcareJL, VitoJP, ChabonB.Cannabinoid hyperemesis syndrome: a case series and review of previous reports. Psychosomatics.2012;53:212–219.
4.
SimonettoDA, OxentenkoAS, HermanML, SzostekJH.Cannabinoid hyperemesis: a case series of 98 patients. Mayo Clin Proc.2012;87:114–119.
SontineniSP, ChaudharyS, SontineniV, LanspaSJ.Cannabinoid hyperemesis syndrome: clinical diagnosis of an underrecognised manifestation of chronic cannabis abuse. World J Gastroenterol.2009;15:1264–1256.
7.
BlumentrathCG, DohrmannB, EwaldN.Cannabinoid hyperemesis and the cyclic vomiting syndrome in adults: recognition, diagnosis, acute and long-term treatment. Ger Med Sci.2017;15:Doc06.
8.
GrootenIJ, RoseboomTJ, PainterRC. Barriers and challenges in hyperemesis gravidarum research. Nutr Metab Insights. 2015;8(Suppl 1):33–39.
9.
Mitchell-JonesN, GallosI, FarrenJ, TobiasA, BottomleyC, BourneT.Psychological morbidity associated with hyperemesis gravidarum; a systematic review and meta-analysis. BJOG2016;124(1):20–30.
10.
Practice Bulletin No. 153: Nausea and vomiting of pregnancy. Obstet Gynecol.2015;126:e12–e24.
11.
ArgamanyJR, RevelesKR, DuhonB. Synthetic cannabinoid hyperemesis resulting in rhabdomyolysis and acute renal failure. Am J Emerg Med. 2016;34:765.e1–e2.
12.
Committee Opinion No. 637: Marijuana use during pregnancy and lactation. Obstet Gynecol.2015;126:234–238.
13.
ChabarriaKC, DianaA. Racusin, KathleenM. Antony, MaikeKahr, MelissaA Suter, JoanM. Mastrobattista, . Marijuana use and its effects in pregnancy. Am J Obstet Gynecol. 2016;215(4):506.e1–7.
14.
McPartlandJM, DuncanM, Di MarzoV, PertweeRG.Are cannabidiol and Delta(9) -tetrahydrocannabivarin negative modulators of the endocannabinoid system? A systematic review. Br J Pharmacol.2015;172:737–753.
15.
HowlettAC.Efficacy in CB1 receptor-mediated signal transduction. Br J Pharmacol. 2004;142:1209–1218.
16.
HowlettAC, BreivogelCS, ChildersSR, DeadwylerSA, HampsonRE, PorrinoLJ.Cannabinoid physiology and pharmacology: 30 years of progress. Neuropharmacology. 2004;47(Suppl 1):345–358.
17.
PacherP, BatkaiS, KunosG. Cardiovascular pharmacology of cannabinoids. Handb Exp Pharmacol.2005;(168):599–625.
18.
ParfieniukA, FlisiakR. Role of cannabinoids in chronic liver diseases. World J Gastroenterol.2008;14:6109–6114.
19.
PertweeRG.Cannabinoids and the gastrointestinal tract. Gut. 2001;48:859–867.
20.
HowlettAC, BarthF, BonnerTI, CabralG, CasellasP, DevaneWA, . International Union of Pharmacology. XXVII. Classification of cannabinoid receptors. Pharmacol Rev.2002;54:161–202.
21.
Van SickleMD, DuncanM, KingsleyPJ, MouihateA, UrbaniP, MackieK, . Identification and functional characterization of brainstem cannabinoid CB2 receptors. Science. 2005;310:329–332.
22.
Van SickleMD, OlandLD, HoW, HillardCJ, MackieK, DavisonJS, SharkeyKA.Cannabinoids inhibit emesis through CB1 receptors in the brainstem of the ferret. Gastroenterology. 2001;121:767–774.
23.
TafelskiS, HauserW, SchaferM. Efficacy, tolerability, and safety of cannabinoids for chemotherapy-induced nausea and vomiting—a systematic review of systematic reviews. Schmerz.2016;30:14–24.
24.
SmithLA, AzariahF, LavenderVT, StonerNS, BettiolS.Cannabinoids for nausea and vomiting in adults with cancer receiving chemotherapy. Cochrane Database Syst Rev. 2015;(11):CD009464.
25.
RockEM, ParkerLA. Cannabinoids as potential treatment for chemotherapy-induced nausea and vomiting. Front Pharmacol. 2016;7:221.
26.
PertweeRG.Pharmacological actions of cannabinoids. Handb Exp Pharmacol. 2005;(168):1–51.
27.
DiPatrizioNV.Endocannabinoids in the gut. Cannabis Cannabinoid Res. 2016;1:67–77.
28.
IzzoAA, SharkeyKA.Cannabinoids and the gut: new developments and emerging concepts. Pharmacol Ther.2010;126:21–38.
29.
RichardsJR.Cannabinoid hypermesis syndrome: a disorder of the HPA axis and sympathetic nervous system?Med Hypotheses. 2017;103:90–95.
30.
Buyukbese SarsuS.Unusual side effect of cannabis use: acute abdomen due to duodenal perforation. Int J Emerg Med.2016;9:18.
31.
SevincMM, KinaciE, BayrakS, YardimciAH, CakarE, BektasH.Extraordinary cause of acute gastric dilatation and hepatic portal venous gas: chronic use of synthetic cannabinoid. World J Gastroenterol.2015:21:10704–10708.
MohammedF, PanchooK, BartholemewM, MaharajD.Compulsive showering and marijuana use—the cannabis hyperemisis syndrome. Am J Case Rep.2013;14:326–328.
34.
SorensenCJ, DeSantoK, BorgeltL, PhillipsKT, MonteAA.Cannabinoid hyperemesis syndrome: diagnosis, pathophysiology, and treatment—a systematic review. J Med Toxicol.2017;13:71–87.
35.
McParlinC, DuncanM, Di MarzoV, PertweeRG.Treatments for hyperemesis gravidarum and nausea and vomiting in pregnancy: a systematic review. JAMA. 2016;316:1392–1401.
36.
RobersonEK, PatrickWK, HurwitzEL. Marijuana use and maternal experiences of severe nausea during pregnancy in Hawai'i. Hawaii J Med Public Health. 2014;73:283–287.
37.
WuCS, JewCP, LuHC.Lasting impacts of prenatal cannabis exposure and the role of endogenous cannabinoids in the developing brain. Future Neurol. 2011;6:459–480.
38.
AlparA, Di MarzoV, HarkanyT. At the tip of an iceberg: prenatal marijuana and its possible relation to neuropsychiatric outcome in the offspring. Biol Psychiatry.2016;79:e33–e45.
39.
AndrewsKH, BraceroLA.Cannabinoid hyperemesis syndrome during pregnancy: a case report. J Reprod Med.2015;60:430–432.
40.
AlanizVI, LissJ, MetzTD, StickrathE.Cannabinoid hyperemesis syndrome: a cause of refractory nausea and vomiting in pregnancy. Obstet Gynecol.2015;125:1484–1486.
41.
SchmidSM, LapaireO, HuangDJ, JürgensFE, GüthU.Cannabinoid hyperemesis syndrome: an underreported entity causing nausea and vomiting of pregnancy. Arch Gynecol Obstet.2011;284:1095–1097.
42.
GunnJK, RosalesCB, CenterKE, NuñezA, GibsonSJ, ChristC, . Prenatal exposure to cannabis and maternal and child health outcomes: a systematic review and meta-analysis. BMJ Open. 2016;6:e009986.
43.
BrownSJ, MensahFK, Ah KitJ, Stuart-ButlerD, GloverK, LeaneC, . Use of cannabis during pregnancy and birth outcomes in an Aboriginal birth cohort: a cross-sectional, population-based study. BMJ Open.2016;6:e010286.
44.
VolkowND, ComptonWM, WargoEM. The risks of marijuana use during pregnancy. JAMA. 2017;317:129–130.
45.
RomS, PersidskyY. Cannabinoid receptor 2: potential role in immunomodulation and neuroinflammation. J Neuroimmune Pharmacol.2013;8:608–620.
46.
YusifzadeK, . The protective role of anandamide in mesenteric ischemia reperfusion injury in guinea pig. Bratisl Lek Listy.2009;110:379–384.
47.
WangPF, JiangLS, BuJ, HuangXJ, SongW, DuYP, HeB.Cannabinoid-2 receptor activation protects against infarct and ischemia-reperfusion heart injury. J Cardiovasc Pharmacol. 2012;59:301–307.
48.
PacherP, MackieK. Interplay of cannabinoid 2 (CB2) receptors with nitric oxide synthases, oxidative and nitrative stress, and cell death during remote neurodegeneration. J Mol Med (Berl).2012;90:347–351.
49.
AbanC, LeguizamonGF, CellaM, DamianoA, FranchiAM, FarinaMG.Differential expression of endocannabinoid system in normal and preeclamptic placentas: effects on nitric oxide synthesis. Placenta.2013;34:67–74.
50.
CardaropoliS, RolfoA, TodrosT. Helicobacter pylori and pregnancy-related disorders. World J Gastroenterol.2014;20:654–664.
51.
Di SimoneN, TersigniC, CardaropoliS, FranceschiF, Di NicuoloF, CastellaniR, . Helicobacter pylori infection contributes to placental impairment in preeclampsia: basic and clinical evidences. Helicobacter.2016;22(2).
52.
TersigniC, FranceschiF, TodrosT, CardaropoliS, ScambiaG, Di SimoneN.Insights into the role of Helicobacter pylori infection in preeclampsia: from the bench to the bedside. Front Immunol.2014;5:484.
53.
PanayiotidesIM.What is the association of cannabis consumption and cardiovascular complications?Subst Abus. 2015;9:1–3.
54.
KhanS, OkamotoT, EnomotoK, SakashitaN, OyamaK, FujiiS, . Potential association of Helicobactercinaedi with atrial arrhythmias and atherosclerosis. Microbiol Immunol.2012;56:145–154.
55.
ZhouX, NiuJM, JiWJ, ZhangZ, WangPP, LingXF, LiYM.Precision test for precision medicine: opportunities, challenges and perspectives regarding pre-eclampsia as an intervention window for future cardiovascular disease. Am J Transl Res.2016;8:1920–1934.
56.
QuB, SuJ, WangZ, WangY, HanX, WangH, . Effect of H. pylori Infection on cytokine profiles and oxidative balance in subjects with chronic alcohol ingestion. PLoS ONE.2015;10:e0129352.
