humulene and Gastroparesis

BACKGROUND Patients with type 1 diabetes mellitus may experience gastrointestinal symptoms, including those suggestive of diabetic gastroparesis. Cannabinoid hyperemesis syndrome (CHS) includes nausea, vomiting, and abdominal pain in the setting of chronic cannabinoid use. This report presents a case of CHS in a 23-year-old woman with uncontrolled type 1 diabetes mellitus. CASE REPORT A 23-year-old woman with chronically uncontrolled type 1 diabetes mellitus had been presenting monthly at the emergency department for the last 2 years, for acute bouts of intractable nausea and vomiting, occasionally with abdominal pain. Given her history of uncontrolled diabetes, she had been managed for diabetic gastroparesis with prokinetics. A gastric emptying study 6 months prior to admission was normal, and the patient had had multiple unremarkable abdominal computed tomography imaging scans. On this admission, she benefitted from supportive management with only temporary improvement of symptoms. On further questioning, she reported consistent use of cannabis for the last few years, and regression of acute vomiting with hot baths at home. With counseling, she ceased cannabis for 2 months and was symptom-free during this period. CONCLUSIONS This report has shown the importance of taking a comprehensive drug history in all patients, including in patients with type 1 diabetes, and is a reminder that cannabinoid use can cause severe nausea, vomiting, and abdominal pain in this patient group.

Topics: Abdominal Pain; Adult; Cannabinoids; Cannabis; Diabetes Mellitus, Type 1; Female; Gastroparesis; Humans; Nausea; Vomiting; Young Adult

Although cannabis may worsen nausea and vomiting for patients with gastroparesis, it may also be an effective treatment for gastroparesis-related abdominal pain. Given conflicting data and a lack of current epidemiological evidence, we aimed to investigate the association of cannabis use on relevant clinical outcomes among hospitalized patients with gastroparesis.. Patients with a diagnosis of gastroparesis were reviewed from the National Inpatient Sample (NIS) database between 2008 and 2014. Gastroparesis was identified by International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes with patients classified based on a diagnosis of cannabis use disorder. Demographics, comorbidities, socioeconomic status, and outcomes were compared between cohorts using χ2 and analysis of variance. Logistic regression was then performed and annual trends also evaluated.. A total of 1,473,363 patients with gastroparesis were analyzed [n=33,085 (2.25%) of patients with concomitant cannabis use disorder]. Patients with gastroparesis and cannabis use disorder were more likely to be younger and male gender compared with nonusers (36.7±18.8 vs. 51.9±16.8; P<0.001 and 52.9% vs. 33.5%; P<0.001, respectively). Race/ethnicity was different between groups (P<0.001). Cannabis users had a lower median household income and were more likely to have Medicaid payor status (all P<0.001). Controlling for confounders, length of stay, and mortality were significantly decreased for patients with gastroparesis and cannabis use (all P<0.001).. While patients with gastroparesis and cannabis use disorder were younger, with a lower socioeconomic status, and disproportionately affected by psychiatric diagnoses, these patients had better hospitalization outcomes, including decreased length of stay and improved in-hospital mortality.

Topics: Analgesics; Cannabis; Gastroparesis; Humans; Income; Inpatients; Length of Stay; Male; Marijuana Abuse; Substance-Related Disorders; Treatment Outcome; United States

BACKGROUND Tetrahydrocannabinol has been implicated in gastroparesis development, a disorder characterized by delayed gastric emptying in the absence of mechanical obstruction. While most patients with gastroparesis present with upper gastrointestinal symptoms, patients with significantly delayed emptying can be asymptomatic, creating a dangerous aspiration risk. CASE REPORT A 24-year-old man with a body mass index of 22 presented for right lower extremity open reduction and internal fixation. He endorsed daily marijuana use. His last meal was at 10 PM the prior night. After induction of general anesthesia and laryngeal mask airway (LMA) placement, 150 cc of gastric contents filled the LMA. The LMA was immediately removed and 25 to 50 cc of gastric contents was suctioned from the oropharynx. The airway was immediately secured with an endotracheal tube, after which 500 cc of clear gastric contents was suctioned from the stomach. Bronchoscopy revealed no obvious gastric contents in the tracheobronchial tree. The patient maintained adequate ventilation and oxygenation. He was safely extubated and brought to the post-anesthesia care unit, where recovery was uneventful. CONCLUSIONS Our case raises important questions and considerations for management of THC- dependent patients with potential for impacting NPO guidelines. It is unclear whether the quantity and chronicity of THC use effects gastroparesis development. The patient endorsed no signs of hyperemesis syndrome or gastric fullness; therefore, we cannot reliably deem patients risk-free based on their lack of symptomology alone. Until the true incidence of THC-induced gastroparesis is elicited in further studies, it is prudent to take aspiration precautions in all patients who endorse THC use.

Topics: Anesthesia, General; Cannabis; Fasting; Gastroparesis; Humans; Intubation, Intratracheal; Male; Young Adult

Topics: Cannabinoids; Cannabis; Gastroparesis; Hope; Humans; Prevalence