Cyclic Vomiting Syndrome and Cannabinoid Hyperemesis

Cyclic Vomiting Syndrome and Cannabinoid Hyperemesis

1st Edition - July 14, 2022

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  • Editors: William Hasler, David Levinthal, Thangam Venkatesan
  • eBook ISBN: 9780128217405

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Cyclic Vomiting Syndrome and Cannabinoid Hyperemesis comprehensively reviews the clinical features and pathophysiology of cyclic vomiting syndrome (CVS) and cannabinoid hyperemesis syndrome (CHS). This book differentiates the clinical presentation of CVS and CHS from other vomiting syndromes and provides the information necessary to diagnose and effectively treat these disorders. Compiled by expert CVS/CHS clinicians and written by physicians and researchers from several disciplines, this reference provides the most updated, evidence-based approaches, and summarizes the latest research on CVS/CHS. Important topics such as the neural systems that drive nausea and vomiting, clinical features of CVS/CHS including its subtypes, insights into pathogenesis, as well as the curious association of hot-water bathing associated with both of these disorders are all explored. This is a must-have reference for residents and fellows in training, as well as busy clinicians who care for patients with CVS and CHS across multiple care settings including ambulatory clinics, the emergency department, hospitals, and substance use/abuse treatment centers. It is also a useful reference for investigators with an interest in these vomiting disorders.

Key Features

• Provides a comprehensive review of the diagnosis and management of CVS and CHS and the impact of these disorders on patients

• Outlines the pathophysiology and known factors that contribute to CVS and guides further investigation and treatment.

• Explores the role of cannabis in CVS and CHS, reviews the current literature, and identifies knowledge gaps that need to be addressed.


Gastroenterologists, gastroenterology researchers, physicians; Residents in training, and graduate and medical students in gastroenterology, general medical care, emergency care, and substance use/abuse

Table of Contents

  • Cover image
  • Title page
  • Table of Contents
  • Copyright
  • List of contributors
  • Foreword
  • 1. Cyclic vomiting syndrome health experiences among patients and their caregivers
  • Abstract
  • 1.1 A mother’s story
  • 1.2 Patient perceptions about causes of cyclic vomiting syndrome
  • 1.3 Cyclic vomiting syndrome onset and symptoms
  • 1.4 Receiving a diagnosis
  • 1.5 Triggers for episodes
  • 1.6 Impact of cyclic vomiting syndrome on the day-to-day life of patients
  • 1.7 Impact on caregivers of children with cyclic vomiting syndrome
  • 1.8 Perception about treatment in acute/urgent care
  • 1.9 Importance of health-care knowledge
  • 1.10 Hope and support
  • 1.11 A revelation—February 2021
  • References
  • 2. Central nervous system pathways of nausea and vomiting
  • Abstract
  • 2.1 Introduction
  • 2.2 Dynamic threshold
  • 2.3 Central mediation of nausea and the role of the nucleus tractus solitarii
  • 2.4 Afferent input into the nucleus tractus solitarii
  • 2.5 Efferent output from the nucleus tractus solitarii
  • 2.6 Cyclic vomiting syndrome
  • 2.7 Conclusion
  • References
  • 3. Clinical features of cyclic vomiting syndrome
  • Abstract
  • 3.1 History of cyclic vomiting syndrome
  • 3.2 Epidemiology
  • 3.3 Cyclic vomiting syndrome symptom presentation
  • 3.4 Associated symptoms
  • 3.5 Temporal patterns of vomiting
  • 3.6 Triggers of cyclic vomiting syndrome attacks
  • 3.7 Comorbid conditions
  • 3.8 Cyclic vomiting syndrome diagnostic criteria
  • 3.9 Conclusion
  • References
  • 4. Cyclic vomiting syndrome subtypes—do they provide insight into cyclic vomiting syndrome pathogenesis?
  • Abstract
  • 4.1 Introduction
  • 4.2 Cyclic vomiting syndrome subtypes
  • 4.3 Cyclic vomiting syndrome subtypes: different roads leading toward a common destination
  • References
  • 5. Clinical and pathophysiological relationship between migraines and cyclic vomiting syndrome
  • Abstract
  • 5.1 Overview of relationship between cyclic vomiting syndrome and migraines
  • 5.2 Clinical features of migraine headaches
  • 5.3 Epidemiology of migraine headaches and cyclic vomiting syndrome
  • 5.4 Pathophysiology of migraine headaches
  • 5.5 Treatment of migraine headaches
  • 5.6 Conclusion
  • References
  • 6. Psychosocial contributors to cyclic vomiting syndrome
  • Abstract
  • 6.1 Introduction
  • 6.2 Psychological and social aspects of cyclic vomiting syndrome
  • 6.3 Stress and cyclic vomiting syndrome
  • 6.4 Quality of life
  • 6.5 School and work accommodations
  • 6.6 Psychiatric comorbidity
  • 6.7 Cannabis use and cyclic vomiting syndrome
  • 6.8 Psychological and psychiatric treatment
  • 6.9 Symptom assessment
  • 6.10 Summary
  • References
  • 7. Treatment of acute cyclic vomiting syndrome attacks
  • Abstract
  • 7.1 Introduction
  • 7.2 The four phases of CVS
  • 7.3 Approach to treatment of an acute CVS episode
  • 7.4 Medications commonly used as abortive treatments for CVS
  • 7.5 Treatment modifications for selected patient populations
  • 7.6 Supportive treatment of CVS in the hospital setting
  • 7.7 Conclusions
  • 7.8 Future directions
  • References
  • 8. Prevention of recurrent cyclic vomiting syndrome episodes
  • Abstract
  • 8.1 Introduction
  • 8.2 How might cyclic vomiting syndrome prophylactic therapies work?
  • 8.3 Adult cyclic vomiting syndrome prophylaxis in the current era
  • 8.4 Prevention of cyclic vomiting syndrome episodes in pediatric patients
  • 8.5 Treating women with cyclic vomiting syndrome who are of childbearing age or are pregnant
  • 8.6 Nonpharmacologic approaches to preventing cyclic vomiting syndrome attacks
  • 8.7 Major questions and future directions
  • References
  • 9. Clinical features of cannabinoid hyperemesis syndrome
  • Abstract
  • 9.1 History of cannabinoid hyperemesis syndrome
  • 9.2 Cannabinoid hyperemesis syndrome symptom presentation
  • 9.3 Associated behaviors and symptoms
  • 9.4 Diagnosis of cannabinoid hyperemesis syndrome
  • 9.5 Cannabis use profiles in cannabinoid hyperemesis syndrome
  • 9.6 Epidemiology
  • 9.7 Working toward a more clinically useful definition of cannabinoid hyperemesis syndrome
  • 9.8 Conclusion
  • References
  • 10. How common is cannabinoid hyperemesis syndrome and why is it so hard to diagnose?
  • Abstract
  • 10.1 Cannabinoid hyperemesis syndrome diagnostic criteria
  • 10.2 Epidemiology
  • 10.3 Cannabinoid hyperemesis syndrome as a substance-induced functional GI disorder
  • 10.4 Why is cannabinoid hyperemesis syndrome hard to diagnose?
  • 10.5 How will future diagnostic criteria evolve to more reliably diagnose cannabinoid hyperemesis syndrome?
  • 10.6 Summary
  • References
  • 11. Proposed mechanisms of cannabinoid hyperemesis syndrome—how can cannabinoid pathways both relieve and cause vomiting?
  • Abstract
  • 11.1 Introduction
  • 11.2 Gut-brain axis pathways involved in CHS
  • 11.3 Cannabinoid receptor biology
  • 11.4 Potential mechanisms for development of CHS
  • 11.5 Conclusions and future directions
  • References
  • 12. The curious association of hot-water bathing with cyclic vomiting and cannabinoid hyperemesis syndromes
  • Abstract
  • 12.1 Introduction
  • 12.2 History and epidemiology
  • 12.3 Effects of hot-bathing behavior
  • 12.4 Thermoregulation in humans
  • 12.5 Nausea and thermoregulation
  • 12.6 Cannabis, endocannabinoids, and thermoregulation
  • 12.7 Postulated mechanisms for hot-water bathing responses in CVS and CHS
  • 12.8 Conclusions
  • References
  • 13. Management of cannabinoid hyperemesis syndrome—is it more than just avoiding cannabis use?
  • Abstract
  • 13.1 Introduction
  • 13.2 Pathophysiology
  • 13.3 Diagnostic criteria
  • 13.4 Epidemiology
  • 13.5 Treatment modalities
  • 13.6 Special considerations
  • 13.7 Conclusion
  • References
  • Further reading
  • 14. Role of the emergency department in cyclic vomiting syndrome and cannabinoid hyperemesis syndrome care
  • Abstract
  • 14.1 Introduction
  • 14.2 Cyclic vomiting syndrome symptoms and other factors that mandate emergency department care
  • 14.3 Devising a personalized care plan
  • 14.4 Negotiating the patient relationship with the hospital
  • 14.5 Patient empowerment
  • 14.6 Conclusion
  • References
  • 15. What can be accomplished to advance the field?
  • 15.1 Spotlight on cyclic vomiting syndrome and cannabinoid hyperemesis
  • 15.2 Areas of need for investigation
  • 15.3 Epidemiology
  • 15.4 Pathophysiology and associated comorbid conditions
  • 15.5 Clinical features and diagnostic evaluation
  • 15.6 Treatment
  • 15.7 Moving forward
  • References
  • Index

Product details

  • No. of pages: 308
  • Language: English
  • Copyright: © Academic Press 2022
  • Published: July 14, 2022
  • Imprint: Academic Press
  • eBook ISBN: 9780128217405

About the Editors

William Hasler

William L. Hasler, MD is a Professor of Medicine in the Division of Gastroenterology and Hepatology, at the Mayo Clinic in Scottsdale, Arizona. Dr. Hasler’s research focuses on nausea and vomiting and the pathophysiology of gastric motility disorders, and he is an internationally recognized expert in clinical and translational research in CVS and gastroparesis. He serves as a lead advisor to the Rome Foundation and has helped craft the clinical descriptions of CVS and CHS in adults. He also provided pivotal input to develop the first clinical guidelines on the management of CVS in adults

Affiliations and Expertise

Professor, Division of Gastroenterology and Hepatology, Mayo Clinic Scottsdale, AZ, United States

David Levinthal

David J. Levinthal, MD, PhD is an Assistant Professor of Medicine in the Division of Gastroenterology, Hepatology and Nutrition at the University of Pittsburgh School of Medicine in Pittsburgh, Pennsylvania. Dr. Levinthal’s research focuses on the neural mechanisms of brain-gut interactions and autonomic function, and he is involved in clinical and translational research in CVS. He serves as a Counselor of the American Neurogastroenterology and Motility Society, a Medical Advisor of the Cyclic Vomiting Syndrome Association, and helped to develop the first clinical guidelines on the management of CVS in adults.

Affiliations and Expertise

Assistant Professor, Division of Gastroenterology, Hepatology, and Nutrition Director, Neurogastroenterology and Motility Center, University of Pittsburgh Medical Center, PA, United States

Thangam Venkatesan

Thangam Venkatesan, MD is Professor of Clinical Medicine in the Division of Gastroenterology, Hepatology and Nutrition at the Ohio State University in Columbus, Ohio. Patients with CVS travel across the US and beyond to access her well-established CVS center. As a leading CVS expert, she serves as the Chief Medical Advisor of the Cyclic Vomiting Syndrome Association and spearheaded the first clinical guidelines on the management of CVS in adults. She conducts clinical and translational research to develop better therapies for patients with CVS around the world.

Affiliations and Expertise

Professor of Medicine, Division of Gastroenterology, Hepatology and Nutrition Director – Section of Neurogastroenterology and Motility

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