MDCalc

Rome IV Diagnostic Criteria for Cannabinoid Hyperemesis Syndrome (CHS)

Official Rome IV criteria for the diagnosis of cannabinoid hyperemesis syndrome.

Use in patients with symptoms suggestive of cannabinoid hyperemesis syndrome (CHS) such as stereotypical episodes of vomiting, resembling cyclic vomiting syndrome (CVS), for at least the past 6 months, in the setting of prolonged cannabis use.

Patients with any of the following features must be evaluated clinically for other diagnoses even though CHS may be present:

  • Signs or symptoms of GI bleeding.

  • Unexplained iron deficiency anemia.

  • Unintentional weight loss.

  • Palpable abdominal mass or lymphadenopathy on exam.

  • Family history of GI cancer and no recent upper endoscopy.

  • Dysphagia.

  • Persistent vomiting.

  • Neurologic symptoms.

Must have the following:

For 3 months prior with symptom onset ≥6 months ago

Diagnostic Result

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Advice

If diagnostic criteria are not met (negative):

Symptoms are unlikely to be caused by cannabinoid hyperemesis syndrome. Consider further assessment for other diseases, or a different functional GI disorder, e.g. CVS, chronic nausea, and vomiting syndrome.

If meets diagnosis (positive):

Likely diagnosis of cannabinoid hyperemesis syndrome.

Management

Management of cannabinoid hyperemesis syndrome centers primarily on sustained cessation of cannabis use. Neuromodulators can be used in an attempt to abort attacks.

Critical Actions

This calculator should only be used in patients after appropriate organic, systemic, and metabolic causes have been ruled out after careful investigation, which may include drug screening.