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We read the article by Allen and colleagues (Gut 2004;53:1566–70) with interest and would like to report a case of probable cannabinoid hyperemesis seen in a district general hospital in the UK.
A 21 year old chef was admitted to our hospital on seven occasions over a two year period (April 2001 to December 2002) with profuse vomiting. Apart from a history of migraine as a child, he was fit and well. He smoked cannabis. Physical examination was unremarkable. The observation that the patient wanted to take regular baths because he had found that bathing eased the sickness was documented in the nursing notes but its significance was not appreciated. Investigations during attacks disclosed neutrophilia but blood urea, electrolytes, liver biochemistry, and serum amylase were normal. Abdominal x ray was also normal. Upper gastrointestinal endoscopy showed grade I oesophagitis and gastritis. Gastric biopsies were histologically normal. An abdominal ultrasound scan and small bowel barium follow through examination were normal. Additional normal or negative investigations included: autoantibodies and immunoglobulins, C reactive protein, and urinary porphyrin screen. Computed tomography scan of the brain was also normal.
During his last admission, the patient’s girlfriend showed us an article published in an Australian newsletter which she had obtained via the internet, in which Dr JH Allen had raised the possibility of a link between recurrent vomiting and cannabis abuse. With the aid of the internet we traced and contacted Dr Allen who shared his experience of this condition with us.
Reviewing the patient’s history, he freely admitted to smoking cannabis and experiencing the compulsive desire to bathe during bouts of vomiting. Following his last admission in December 2002, our patient stopped smoking cannabis and has remained free of symptoms. The clinical presentation which is almost identical to the cases described by Allen et al, together with the response to cessation of smoking cannabis, supports the view that our patient was suffering from cannabinoid hyperemesis and that this condition is international.
Conflict of interest: None declared.
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