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Recurrent Cyclic Vomiting in Adolescents

Sudden recurrent vomiting, nausea, and abdominal pain lasting for several days is not an uncommon presentation in adolescents, also known as cyclic vomiting syndrome (CVS). This cyclic vomiting can lead to multiple emergency room (ER) visits as well as hospitalizations due to dehydration and pain. The differential diagnosis of cyclic vomiting is broad and includes; cyclical psychogenic vomiting, abdominal migraine, eating disorders with vomiting, psychological factors, physical stressors, severe anxiety, or possible “drug-seeking” behavior. Such patients may undergo extensive medical evaluations, which often reveal few anatomical or pathological abnormalities. In the adult literature, similar presentations of recurrent cyclical vomiting, nausea, and abdominal pain have been seen in chronic cannabis users in whom symptoms are often temporarily relieved by compulsive hot showers and resolved by cannabis use cessation. This link between CVS and chronic cannabis use, termed cannabinoid hyperemesis syndrome (CHS) was first described in Australia by Allen et al in 2004. Subsequently, there have been more than 100 reported cases of CHS as a cause of cyclic vomiting in adults. However, descriptions of CHS in the pediatric literature is limited. To date there have been only 3 reported cases. This brief report describes 2 cases of CHS in adolescents with recurrent cyclic vomiting, nausea, and abdominal pain.