Chronic Cannabis Use with Hyperemesis, Epigastric Pain and Conditioned Showering Behavior

This report promotes awareness to an emerging cannabisinducedsyndrome that is beguiling to primary care doctors andgastroenterologist specialists and a major expense on the healthcaresystem. It is also a diagnosis of exclusion. Four different youngadults presented with recurrent admissions complaining of intractablenausea, vomiting, and epigastric pain with an incidental findingof excessive showering. They were all chronic heavy marijuanasmokers. After extensive negative work up and observation ofsymptomatic cessation upon the discontinuation of marijuana, adiagnosis of exclusion was determined. Under the extrapolationof different animal model studies and basic science research, ahypothetical mechanism may explain why these patients present withthese characteristic symptoms. The manifestation of chronic Δ9-tetrahydrocannabinol (Δ9-THC) may not show until after a long timeand is reproducible when exposure to Δ9-THC supersaturates thecannabinoid receptor-1 (CB-1). Chronic Δ9-THC exposure appearsto desensitize the gabanergic effects of CB-1 which is known tocause intestinal hypomotility, analgesia, and hypothermia. Extensivegastrointestinal workup is usually non-yielding and may imposefinancial burden on the healthcare system.