marijuana and stomach problems

cannabinoid hyperemesis syndrome is this in fact true ???? I asked the chemical dependence and they have never treated any with this so called disorder? Bu this is what they have been telling my son for the past two years. He has been admitted to the hospital four time and about 10 trips to the ER countless medication for GI and many test upper lower Gi X rays,mri, gluten test, chrons , on and on …………everything come back Negative. If you have every experienced this pain you know how bad it get. Last week at the ER he ripped something in his throat from vomiting so much. He is seen in the ER three times in the past week and our last trip wasn’t much fun. They refused to help him anymore because he smokes pot and this is why this is happening to him they say. Now because his frequent trip to the ER they say he has an Opiate addiction!!!! They are the ones who gave him the pain killers, now he has to be humiliated and go to a chemically dependent program to remove the opiates from his system just to get care for what ever the hell is wrong with him.

Dude doctors keep telling me to stop smoking. but really its becouse i had stop smoking in the mornings and would smoke at night.....in the last 6 months ive missed about 24 day of work half of that i was in the er..........i noticed that.....so i figured my only optionsis to stop smoking or continue to smoke like i used to.......ive been ok so far smoking in the mornings and eating healthy......can anyone post their opinions on that

By Sarah A. Buckley & Nicholas M. Mark
Faculty Peer Reviewed
An 18-year-old male presents complaining of crampy abdominal pain, nausea, and intractable vomiting for the past year. The symptoms are episodic, lasting several weeks and remitting for weeks to months. The patient states that his abdominal pain is 10 out of 10 in severity, and that he has been vomiting up to 20 times each day. He has been evaluated at multiple hospitals, and he has had numerous upper endoscopies, colonoscopies, swallowing studies, and CT and MRI imaging studies, all of which were unrevealing. He underwent a cholecystectomy, but had no improvement in his symptoms after the surgery. His pain and nausea are unresponsive to antacids and antiemetics. The patient’s only relief is with hot water bathing: he spends hours each day in the shower with the temperature set as hot as he can bear. The patient’s history is otherwise unremarkable, except that he admits to daily marijuana use beginning at the age of 14.
This patient’s story is typical of cannabinoid hyperemesis, a clinical syndrome characterized by intractable vomiting and abdominal pain associated with the unusual learned behavior of compulsive hot water bathing, occurring in the setting of long-term heavy marijuana use. Treatment consists of medication for immediate symptomatic relief and marijuana cessation for long-term relief. Symptoms usually remit within weeks of becoming abstinent.
If this disorder is so easily diagnosed and treated, why were the patient’s past doctors confused to the point of performing what might have been an unnecessary surgery? Cannabinoid hyperemesis is a new diagnosis, first described in 2004, and currently sixteen papers on the subject have been published. Therefore, it is likely that the patient’s prior doctors had never considered this disorder. Second, the pathogenesis of cannabinoid hyperemesis is poorly understood. How can marijuana, which is used in cancer clinics as an anti-emetic, cause intractable vomiting? And why would symptoms abate in response to high temperature? The connection between marijuana, vomiting, and heat is non-intuitive, and a medical team unfamiliar with this syndrome would be hard-pressed to reach the diagnosis.
The largest study of cannabinoid hyperemesis to date was the landmark report by Allen et al in 2004 in an area of Southern Australia where marijuana use is largely decriminalized.[i] The report tracked 10 patients who presented with cyclic vomiting after 3 to 27 years of cannabis abuse and no other history of drug abuse. All but one displayed compulsive hot water bathing; the remaining patient had only experienced his symptoms for 6 months, and the authors theorize that he had not yet learned to associate hot water with symptom palliation. The 9 compulsive bathers reported that this bizarre behavior occupied hours of their days and said that their symptoms were ameliorated within minutes of bathing and returned when the water cooled. All 10 patients were counseled to cease cannabis use, and 7 did so. Within weeks of cessation, the symptoms resolved for these 7 patients; the remaining 3 patients did not cease cannabis use and continued to have cyclic vomiting and abdominal pain. After several years of abstinence, 3 patients resumed cannabis use and were hospitalized again with cyclic vomiting and abdominal pain. Once again, 2 of these patients successfully stopped using cannabis, and their symptoms resolved. The remaining patient continued to use cannabis and continued to experience symptoms at the time of publication.
Following the first case report, further cases have been described on three continents. All patients presented with the classic triad of symptoms described by Allen et al: cyclic vomiting and abdominal pain, an extensive history of cannabis abuse, and palliation with hot water bathing. The fact that this unique triad is preserved in diverse patient populations suggests that there is a pathogenic mechanism that underlies this syndrome.
Several authors have speculated about the pathophysiology of cannabinoid hyperemesis, and though the specifics remain unclear, there is consensus over some of the basic principals: It appears that the high lipophilicity of delta-9-tetrahydrocannabinol (Δ9-THC, the active compound in marijuana) causes cumulative increases in concentration with chronic use, which may lead to toxicity in susceptible patients. The abdominal pain and vomiting are explained by the effect of cannabinoids on CB-1 receptors in the intestinal nerve plexus, causing relaxation of the lower esophageal sphincter and inhibition of gastrointestinal motility.[ii] This finding is supported by gastric emptying studies performed on one of the patients presented by Allen et al, which revealed severely delayed emptying. While cannabis appears to have anti-emetic effects that are centrally mediated,[iii] it is possible that these effects predominate at low doses whereas the gastrointestinal effects predominate at the high concentrations that occur with long-term use.
The proposed explanation for compulsive hot water bathing is based on the fact that cannabis disrupts autonomic and thermoregulatory functions of the hippocampal-hypothalamic-pituitary system. There is a high concentration of CB1 receptors within the limbic system,[iv] and the hypothalamus in particular is known to be responsible for integrating central and peripheral thermosensory input.[v] Furthermore, Δ9-THC induces hypothermia in mice in a dose-dependent manner.[vi] While this evidence links cannabis to the hypothalamus and to thermoregulation, it does not provide a causal relationship. Two mechanisms proposed by Chang et al are that (1) cannabinoid-induced hypothermia causes the desire for hot water bathing, or (2) hot water bathing is the direct result of CB1 activation in the hypothalamus. The true mechanism underlying hot water bathing remains enigmatic, and further studies are needed to elucidate the relationship between this bizarre learned behavior and the other features of cannabinoid hyperemesis.
A timely diagnosis of cannabinoid hyperemesis is essential not only to effect proper treatment but also to prevent iatrogenic morbidity and mortality from unnecessary diagnostic procedures and surgical interventions. There are, however, several obstacles to effective diagnosis:
First, the legal status of marijuana makes eliciting an accurate drug history challenging. Second, the bizarre hot water bathing is likely often attributed to psychological conditions such as obsessive-compulsive behavior. Third, the knowledge of the anti-emetic effects of cannabis likely disguises cases of cannabinoid hyperemesis, leading to the erroneous belief that cannabis is treating cyclic vomiting rather than causing it. Finally, the fact that this syndrome is so recently described and relatively unknown outside an esoteric subset of the GI literature means that most clinicians are unaware of its existence. The following diagnostic criteria adapted from Sontineni et al[vii] can be used to facilitate a diagnosis of cannabinoid hyperemesis syndrome:
ESSENTIAL FEATURES
History of chronic cannabis use
Nausea and cyclic vomiting over months
Relief with cessation of cannabis use
SUPPORTING FEATURES
Compulsive hot water bathing with transient relief of symptoms
Colicky abdominal pain
Exclusion of other etiologies (especially gall-bladder and pancreas)

Cannabinoid Hyperemesis Syndrome: Case Report of a Reaction with Heavy Marijuana Use
Abstract
Cannabinoid hyperemesis syndrome (CHS) is a rare constellation of clinical findings that includes a history of chronic heavy marijuana use, severe abdominal pain, unrelenting nausea, and intractable vomiting. A striking component of this history includes the use of hot showers or long baths that help to alleviate these symptoms. This is an underrecognized syndrome that can lead to expensive and unrevealing workups and can leave patients self-medicating their nausea and vomiting with the very substance that is causing their symptoms. Long-term treatment of CHS is abstinence from marijuana use—but the acute symptomatic treatment of CHS has been a struggle for many clinicians. Many standard medications used for the symptomatic treatment of CHS (including ondansetron, promethazine, and morphine) have repeatedly been shown to be ineffective. Here we present the use of lorazepam as an agent that successfully and safely treats the tenacious symptoms of CHS. Additionally, we build upon existing hypotheses for the pathogenesis of CHS to try to explain why a substance that has been used for thousands of years is only now beginning to cause this paradoxical hyperemesis syndrome.
1. Introduction
Marijuana is a popular recreational drug that comes from the Cannabis genus of flowering plants. It also has several medical applications—two of the most recognized being its use as an antiemetic and an appetite stimulant [1, 2]. However, heavy prolonged use of this drug has been shown to cause the poorly-understood, paradoxical cannabinoid hyperemesis syndrome (CHS). Cannabinoid hyperemesis syndrome was first described by Allen et al. in 2004 [3]. Sontineni et al. described diagnostic criteria that include: essential feature of chronic cannabis use; major features of recurrent severe nausea and vomiting that resolves after stopping cannabis use; supportive features of compulsive hot baths with symptom relief, colicky abdominal pain, and no evidence of gall bladder or pancreatic inflammation [4].
2. Case Presentation
A 28-year-old man with no past medical history presented to the emergency department with a two-week history of severe “10-out-of-10” colicky epigastric pain with profound nausea, 15–20 episodes of vomiting daily, and decreased oral intake for fear of triggering these symptoms. He denied alcohol and tobacco use, but reported he had smoked two marijuana cigars (each containing approximately 1.5 grams marijuana bud) every day for the last ten years. As his symptoms of nausea, vomiting, and abdominal pain intensified, he self-medicated himself with increasing amounts of marijuana and his symptoms became increasingly intense. The patient reported that he initially got symptomatic relief with a hot shower, though as his symptoms intensified, he required increasingly longer bathing times that eventually progressed to the patient soaking himself in hot baths for hours each day. He stated that he had never experienced any of these symptoms in the past. In the emergency department, the patient’s vital signs were within normal limits and his physical exam was significant only for minor tenderness to palpation in the epigastric region. The patient had no focal neurological deficits. The patient was admitted for intravenous fluid support, antiemetic therapy, and further evaluation.
The patient’s medical evaluation revealed a complete blood count, basic metabolic profile, and hepatic profile that were within normal limits. An abdominal computerized tomography (CT) scan was negative for pathology, an EGD with biopsies showed only mild gastritis, and a gastric emptying study showed mildly delayed gastric emptying.
In this patient, initial symptomatic treatment with ondansetron and morphine was unable to keep the patient from having breakthrough episodes of nausea, vomiting, and epigastric pain. The patient was unable to tolerate even a clear liquid diet, and was extremely anxious about trying to increase or advance his oral intake given the painful episodes that food had triggered in the past. After administering 1 mg IV lorazepam, the patient improved at a remarkable pace; within 10 minutes of administration he no longer experienced nausea, abdominal, or food aversion. Over the next 12 hours, he transitioned to a regular diet, oral lorazepam (1 mg tablets), and was able to discontinue all other analgesic and antiemetic medications. The time from marijuana cessation to complete resolution of symptoms was approximately three weeks. The patient was discharged with a seven-day prescription for lorazepam (1 mg PO, twice daily). The patient was contacted at 3 and 6 months after discharge and he reported that, with sustained abstinence from marijuana, he had no return of his symptoms.
3. Discussion and Conclusions
It has been hypothesized that the principal psychoactive constituent of the cannabis plant, Delta-9-tetrahydrocannabinol (THC) is the causative agent in CHS [3]. THC has been shown to cause delayed gastric emptying and thermoregulatory disturbances via action on the cannabinoid receptor type 1 (CB1) in the enteric plexus and central nervous system, respectively [5]. Chronic stimulation of the CB1 receptors may result in the development of the gastrointestinal and thermodysregulation symptoms in sensitive patients [6], though more research needs to be conducted to further elucidate what factors may predispose certain patients.
The earliest recorded uses of marijuana date from the 3rd millennium BC [7], so why are we only now beginning to see patients with CHS? We hypothesize that the emergence of this syndrome is related to changes in patterns of plant component utilization, and technological advances in the production of marijuana that have dramatically increased THC concentrations. In past decades, the stalks, leaves, and buds of both male and female plants were consumed. Modern analysis of the cannabis plant shows that the buds (flowers) of the female cannabis plant contain the highest concentrations of THC and that the leaves can contain ten times less THC than the buds, and the stalks one hundred times less THC [8]. This new understanding has led to the virtual elimination of stalks and leaves from consumption; now modern users almost exclusively buy and consume the highly-potent female buds and thus consume significantly higher amounts of THC. Furthermore, advances in breeding and cultivation techniques, including the use of hydroponics, cloning, high-intensity artificial lighting, and optimization of growing conditions (e.g., ambient temperature and air gas concentrations) have increased the potency of modern cannabis. Recent research undertaken at the University of Mississippi’s Potency Monitoring Project has found that the mean THC content in confiscated cannabis samples increased from 3.4% in 1993 to 8.8% in 2008 [9]. We believe that the modern consumption of higher-potency preparations of higher-potency marijuana is causing profoundly higher exposure to patients to THC and may be contributing to the emergence of the cannabinoid hyperemesis syndrome.
Anticipatory nausea and vomiting is seen in patients undergoing chemotherapy and lorazepam’s antiemetic, amnestic, and anxiolytic properties have made it helpful for treatment of this condition [10]. Lorazepam has also been suggested in the treatment of cyclic vomiting syndrome (CVS) [11]. One case report notes that benzodiazepines were given for one week to a patient with CHS, but the patient continued cannabis use, possibly limiting their efficacy [12]. We found that lorazepam was extremely effective in treating our patient’s CHS. It helped the patient overcome his conditioning to see food as a painful emetic trigger and also helped to ameliorate the physical symptoms of CHS. The addition of lorazepam to the patient’s regimen allowed for rapid transition from a clear liquid to a regular diet, and the ability to tolerate oral medications. We recommend that lorazepam be considered in the treatment of CHS, especially in patients with strongly conditioned food aversion.
It is unclear how this substance used by many to treat nausea and stimulate appetite causes a condition with severe nausea, vomiting, and anorexia with food anxiety. This lack of understanding and delayed diagnosis can lead patients to self-medicate with the very substance that is causing their suffering. As such, patient education is critical. For providers, increased awareness of this syndrome and its inclusion in the differential diagnosis of patients with intractable nausea and vomiting may help prevent expensive and unrevealing workups and decrease patient morbidity. Because many patients with CHS have been chronic, heavy marijuana users, it is important to assess if/how they may have incorporated their substance use into their social lives and daily routines. A thoughtful discussion about abstinence strategies, and referral for mental health support and chemical dependence treatment may also benefit patients with cannabinoid hyperemesis syndrome.

I've been sick for six years and only began smoking pot 8 months ago for sanity so my problems began long before my use. I will say that over the course of the six year and 15 "legal" prescriptions later that the drugs prescribed to me were worse in regard to side effects by far.

I now am down to 3 scripts and the marijuana at night as needed. I do not abuse it. I have a full time career and a amazing family. I use it to control pain because I don't want to go to the hospital for morphine or other drugs that to me will cause more harm than good not to mention more hospital bills. All I know is if you or your child or someone you know us sick with something if a mystery, change docs, change towns, research, do whatever it takes and tell everyone else to stick the "crazy" diagnosis up their ass.

YOU are your only advocate and only YOU live in your body everyday. Travel if you need to but don't settle for some BS diagnosis like IBS or reflux if you are suffering.
I have been diagnosed with the following:
IBS, reflux, gastritis, gluten intolerance, depression , anxiety, stress, fibromyalgia blah blah blah blah blah. Gall bladder and appendix surgery, hysterectomy and thousands of dollars down the drain for what? Because no one ever sat down to listen for more than 10 minutes as to what could be wrong with me.

Luckily I just found out that its been my pancreas this entire time. I have chronic pancreatitis and biliary stenosis. All symptoms are gone except back pain and I hope it will eventually go away as well.

Do what you need to do to stay sane. Every person knows their individual limits.

I forgot to mention I experienced episodes of severe abdominal pain and would vomit bile for hours at a time periodically throughout the past 6 years. The pain is so bad that you cannot find comfort. Mine wkuld cone and go and sometimes last fir hours. I went to the hospital a couple of times fir fluids and pain meds. It helped me get through it but It was assumed I had a virus when now I realize it was episodes of acute pancreatitis.

its called Cannabinoid hyperemesis syndrome. google it. just found out i have it after a year of thinking i had cyclic vomiting syndrome, which has the same symptoms. nothing will help but slowing down smoking. it only happens with regular very heavy smoking, so cutting down some should do it.

I was a very heavy smoker for about 5 years but I also dabbled in various other substances. I never did anything on a daily basis like I did with weed. I also have Mitrovalve prolapse and Neuro-cardiovascular syncope. I became very sick when trying to quit pot or if I ran out for a day to the point of it being almost detox symptoms. I think some of my issue had to do with the way I was metabolizing my medicine since I was constantly smoking. I never became physically ill from smoking only when quiting but after a week of feeling like sh*t I eventually got better and now only smoke on rare occasions and never experience these issues.

 

I have seen a lot of people trying to pacify themselves by adhering to the theory of glass being half filled. Smoking hash/weed is NOT good for you, else it would've been legal and be traded as a commodity worldwide. There maybe a few positive aspects to it, but the negative ones far outweigh the positive ones. This you would get to know in the longer run. Just wanted to share a few of my experiences related to hash (not weed). I'm a resident of Pakistan (one of the largest producers of the best hash in the world) and have been a smoker for about 10 years. I've always smoked grade "A" stuff. Until last May, everything was smooth. I was smoking about 2-3 J's a day after a period of heavy (5-6 J's a day, sometimes 9 -10 ) smoking for about 8 years. With hash, your system gradually tends to lose the tendency to resist and start feeling more down than high. After about 9 years, I couldn't smoke much cuz I couldn't take it. I didnt have very healthy eating habits since I was doing afternoon shifts and had to eat at work most of the times. Anyway, last May I was pretty smoked up after a meal at KFC and watching TV while lying down in my room. Suddenly I experienced that the back side of my head started going numb (neck upwards). In about 2-3 secs I couldn't feel my head or my face. I got a feeling as if my head was going to explode and I started to black out. My heart beat shot up to about 150-200 bpm. I had a mini panic attack cuz of what I felt in the head and thought I was going to die. Had to run out of the house to get fresh air and walk to calm myself down (the head numbing feeling coming and going meanwhile). After about an hour, I had finally calmed down and the doctor gave me a laxative to help me relax and sleep. For the next 5 days, I had a feeling where my heart was sinking, I couldn't eat, sleep, or even breathe properly. Obviously I was off the hash all this time. The doctors couldn't find whats wrong with me even though I had told them that I smoke. Eventually, I have been able to link this to my digestive system, where the hash had aggravated indigestion, and caused my serious mental and physical discomfort. I've quit since May, and I'm still off it gradually on the road to recovery. But that experience was near death for me. That day I knew what I had been doing to myself all this time. The head numbing is wearing off and I've had problems concentrating on work, sex or anything for that matter. I've been depressed, although married recently. Bottom line is smoking won't get you anywhere. What you can be as a normal person, you can never be when you're smoked up. Trust me. This is 10 years of experience talking. It might make you feel good momentarily but like I said, you dont know what you're doing to yourself and what the long term effects are. Thanks. Your well wisher.

Hi,

      I had stomach problems before I smoked weed a lot ,2 times each day now.Gas and bloating .

I changed to a high fibre diet ,no fatty foods lost weight and no bloating,gas remains.

I cannot eat in Mc Donalds or similar I get indigestion with any fatty foods.

In Ireland the cold damp weather in winter causes me stomach problems especially in the morning.

I got bad stomach aches after returning from 4 months abroad.I put it down to chemicals in the food on my return.

I went to the doctor had 2 scans and a camera inside .The only result was gastro inflammation.

The problem went away after time .I continue to smoke .An x ray of my lungs show a small trace .

I smoke using just  rolled up aluminium foil made like a small pipe it requires very little weed to get high.

A post earlier suggests the munchies could be the problem .

I agree, I smoke in the evening and do eat late at night picking a lot.

I do find weed helpful when I have the flu it relaxes the muscles.

The debate continues as to health problems using it .

Well its better than cigarettes or alcohol abuse in my opinion.

 

You mention eating at night eg the munchies !! .What kind of food ?Try a high fibre diet no fatty foods and eat early. This causes problems with me gas,bloating and indigestion..

I know the stomach problems all too well. I smoked weed for a about 15 years. On average i would smoke about an eighth a week, sometime a quarter.  it was not until my 15th year that i was starting to throw up in the mornings and retching throughout the day. I took x-rays, prescribed prilosec, and pills for nausea. Nothing seemed to work. After losing about 10 pounds and thinking something serious is going on, i quit smoking weed. Within 2 weeks, my symtoms went away and felt so much better.

as soon as i felt better, i was back to smoking. That's when my symtoms would immediately come back. I'm certain that long term marijuana smoking was the cause of my stomach issues. I'm now mary jane free and feeling good. I do miss toking it up but i don't miss puking on a daily basis.

I dont think I really need to post much on here. If you are also researching the non proven, poorly researched and poorly documented Cannabis Hyperemesis you will probably have seen me before looking for answers.

For equality purposes and anyone else reading who doesnt suffer these symptoms and are unsure...........there are other adult sufferers of this terrible vomiting syndrome that do not smoke cannabis aswell!! Make that of what you will! Infact a doctor who specialises in the field of the known syndrome of Cyclic Vomiting state that only 40% of her adult CVS sufferers smoke cannabis. So what exactly are the causes of vomiting for the others? Even the published studies say that abstaining cannabis doesnt work in every case!!!!

Here is a paper which was written by a CVSA specialist in which cannabis, although not condoned, it is quoted "The possible role of cannabis in causing CVS has been examined, although it remains controversial"  

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That means a specialist who specialises in the area of cyclic vomiting has examined the possible role and even she doesnt believe it!!!!! It doesnt take a genuis to see that various doctors are not doing their research thoroughly enough and I invite anyone who believes they have cannabis hyperemesis to come over to the CVSA forum for a friendly discussion about it. I think doctors check that forum and would be very interested to hear from you. You will see the thread I have started, it would be great to hear your stories, more particularly your recovery. As I said, there are either 2 completely different illnesses or 60% of adult sufferers are liars.

Thats enough from me. It is actually making me ill tracking these threads down for real answers now! Please it is important for fellow CVS sufferers and the label the could potentially get. Remember, only 40% of a specialists patients smoke cannabis. That isnt even half. If cannabis does stop symptoms....it cant be that of CVS so there surely must be some difference. From what I have found out the symptoms get progressively worse and vomiting more frequent until it is abstained but again that is only from 2 random people. I have the email addresses of 4 people who have abstained cannabis and it made no difference so again, I am only looking for answers. Please no trolling or abuse :)

Its ot galstones. Could be a problem for some but other people have an actual problem from smoking too much marajuana. I have been checked and i dont have galstones. Smoking too much weed caused build up of tar and resin in your upper stomach causing vomiting spasim attacks. Lets not get people confused with this coz smoking a lot of weed causes problems in your stomach! People need to be aware of this. Ive been looking for answers for years and ive only just found out!

Ive never heard that weed causes a build up of tar and resin in the upper stomach causing vomiting spasm attacks. This is a new one to me, no offence meant at all. What proof do you have of this? Did your GI tell you? Do you suffer from this? Thanks