What is CHS? Symptoms and Signs of “Stoner Stomach”

What Is CHS?

Similar to cyclic vomiting syndrome, which occurs in children, CHS is a rare condition that leads to repeated and severe bouts of vomiting, as well as other gastrointestinal symptoms like nausea and abdominal discomfort. It occurs in cannabis users as a result of long-term marijuana use.

CHS Symptoms and Signs

CHS is a fairly new condition that only began to appear in heavy users over the past few decades, though it’s becoming more common as more people use marijuana.

Some of the symptoms of CHS include:[2]

• Morning nausea
• Intense abdominal discomfort or pain
• Persistent nausea
• Repeated severe vomiting and retching, often without warning
• Loss of appetite
• Weight loss
• Anxiety about vomiting

People with CHS may feel an overwhelming urge to take a hot shower or bath, which may provide temporary relief from nausea. With CHS, people may take excessive baths or showers, sometimes spending hours in the water.

The Three Phases of CHS Symptoms

The symptoms of CHS are spread across three phases:[3]

CHS Prodromal Phase

The prodromal phase often occurs in adults who have used marijuana for an extended period. It may include stomach pain or morning sickness, but not necessarily vomiting. Some people in the prodromal phase feel a fear of vomiting, even if they haven’t.

CHS Hyperemetic Phase

The hyperemetic phase is the most intense and lasts 24 hours to days. It may include repeated vomiting and nausea, possibly leading to dehydration from fluid loss. People tend to avoid eating or become extremely selective about what foods they eat.

CHS Recovery Phase

When you stop using marijuana, the symptoms of CHS typically subside over days or months. This is the CHS recovery phase. Once people quit for good, the symptoms of CHS often go away completely unless they use marijuana again.

What Causes CHS?

People who use marijuana regularly may get CHS, but others may not. The medical community is not yet sure why CHS only affects certain people, but experts believe genetics may be one of the factors.

Marijuana contains cannabinoids that bind to the cannabinoid receptors in the endocannabinoid system in the brain and gut. The primary cannabinoids in marijuana are tetrahydrocannabinol (THC) and cannabidiol (CBD), which give marijuana its psychoactive and therapeutic effects.

Ironically, this includes the cannabinoids in the brain that control nausea and vomiting, which is why cannabis is sometimes helpful for managing the symptoms of cancer treatments.

But over time, using marijuana can change how the cannabinoid receptors in the body respond to cannabinoids.[4] For example, marijuana cannabinoids can affect the cannabinoid receptors in the esophageal sphincter, which is responsible for opening and closing to allow food to pass from the throat to the stomach. If that sphincter no longer works properly, it may cause stomach acids to return to your esophagus, leading to nausea and vomiting.

Complications of CHS

The primary symptom of CHS is extreme vomiting, which can cause dehydration and electrolyte imbalances in marijuana users. The risks of complications increase with severe dehydration and may include:[5]

• Seizures
• Kidney failure
• Muscle spasms and weakness
• Shock
• Heart rhythm problems
• Though rare, brain swelling

Other complications may arise with CHS, including:

• Inflammation in the esophagus (esophagitis)
• Tears in the esophagus (Mallory-Weiss Syndrome)
• Malnutrition from appetite issues
• Tooth decay
• Low potassium (hypokalemia)
• Low phosphorus (hypophosphatemia)
• Air trapped in the chest cavity (pneumomediastinum)
• Aspiration pneumonia

CHS Diagnosis and Treatment

CHS is a relatively recently recognized condition, so it’s still being researched. Some doctors aren’t familiar with the condition or its symptoms, so you may need a gastroenterologist or another specialist to diagnose it.

Typically, a lot of questions about your cannabis use and the types of products you use are valuable to the diagnostic process. Be sure to be honest with your doctor about your use and symptoms.

Your healthcare provider may want to rule out other causes of vomiting with diagnostic tests like:

• Blood tests
• Urine tests
• Radiographs
• MRI
• Head or stomach CT
• Pregnancy test
• Electrolyte test
• Liver and pancreatic enzyme tests
• Endoscopy

During the hyperemetic phase, it may be necessary to stay in the hospital for supportive care to avoid complications. This may include intravenous fluids to stay hydrated, antiemetic medications to reduce vomiting and pain medications.

CHS is connected with marijuana use, so the only true “cure” is to stop using marijuana products. Though CHS’s side effects and symptoms may last for weeks, they typically subside with cessation of marijuana use.

Can I Treat CHS at Home?

Though supportive care and medical supervision are recommended for severe cases of CHS in the hyperemetic phase, some home remedies, like hot baths, can provide temporary relief for symptoms. However, be cautious about excessive sweating, leading to further dehydration.

Some over-the-counter medications may help with the symptoms until the CHS subsides, including:[6]

• Antihistamines
• NSAIDs like ibuprofen or pain relievers like acetaminophen
• Topical capsaicin cream, which can relieve nausea and vomiting when rubbed on the abdomen

CHS Prevention

The only way to prevent CHS or reduce your risk of getting it is to avoid marijuana completely. Even if you’ve used marijuana for months or years without any symptoms, CHS can happen at any time.

If you already have CHS, the only option is to quit, as your symptoms may persist as long as you’re using marijuana.

If you or a loved one is struggling to quit marijuana, treatment options are available for marijuana use disorder. Treatment for marijuana addiction often includes similar treatment modalities as other substance use disorders, such as individual therapy, group therapy, and behavioral therapies like cognitive behavioral therapy (CBT) on an inpatient or outpatient basis.