The question of whether cannabis use causes gastroparesis, a condition involving delayed stomach emptying, is common. While cannabis is not typically cited as a direct cause of long-term gastroparesis, it is strongly linked to a severe condition called Cannabis Hyperemesis Syndrome (CHS). Both conditions share delayed gastric emptying, which often leads to misdiagnosis. Understanding the distinction between their underlying causes and treatments is essential for accurate management.
Understanding Gastroparesis
Gastroparesis (GP) is a chronic disorder where the stomach muscles fail to move food into the small intestine efficiently, resulting in delayed gastric emptying. This lack of proper muscle contraction is often caused by damage or dysfunction of the vagus nerve, which regulates digestive movements. When this nerve is compromised, the stomach’s natural contractions, or motility, slow down or stop completely.
The most frequent cause of gastroparesis is long-standing, poorly controlled diabetes, as high blood sugar levels can damage the vagus nerve. Other causes include complications following stomach surgery, neurological conditions like Parkinson’s disease, or viral infections. When the cause remains unknown, it is referred to as idiopathic gastroparesis. This condition is defined by muscle and nerve damage that impairs stomach function, independent of cannabinoid exposure.
Cannabis Hyperemesis Syndrome
Cannabis Hyperemesis Syndrome (CHS) is a cyclical vomiting illness developing in individuals with a history of long-term, frequent cannabis use, typically daily for months or years. This syndrome is characterized by recurrent, severe bouts of nausea, abdominal pain, and intense vomiting (hyperemesis) that can persist for hours or days. Symptoms frequently lead to emergency room visits and dehydration, often mimicking standard gastroparesis, including delayed gastric emptying.
The syndrome is divided into three phases: prodromal, hyperemetic, and recovery. The prodromal phase involves early morning nausea and discomfort, during which a person may increase cannabis use believing it will help relieve symptoms. The hyperemetic phase is marked by relentless vomiting that often temporarily improves with compulsive hot showering or bathing, a distinctive feature of CHS. CHS is frequently misdiagnosed as cyclic vomiting syndrome or idiopathic gastroparesis due to overlapping symptoms.
How Cannabis Affects Gut Motility
The mechanism behind CHS involves the overstimulation and dysregulation of the body’s endocannabinoid system (ECS) within the gastrointestinal tract and brain. The primary psychoactive component of cannabis, delta-9-tetrahydrocannabinol (THC), interacts with cannabinoid receptors, specifically CB1 and CB2, which are abundant in the gut and central nervous system. CB1 receptors are primarily located on the nerves of the enteric nervous system, where they modulate neurotransmitter release.
Activation of CB1 receptors normally slows gastrointestinal motility and reduces nausea, explaining why acute cannabis use often relieves these symptoms. However, chronic, high-dose exposure to THC causes a paradoxical effect by disrupting the normal signaling of the ECS. Over time, the constant presence of THC leads to receptor desensitization and changes in regulatory pathways. This ultimately results in the delayed gastric emptying and severe, cyclical vomiting characteristic of CHS, which is distinct from the nerve damage seen in typical gastroparesis.
Management and Long-Term Recovery
The only definitive treatment for Cannabis Hyperemesis Syndrome is the complete and permanent cessation of all cannabis products. Symptoms usually begin to resolve within days to two weeks of sustained abstinence. If cannabis use is resumed, the cyclical vomiting episodes are highly likely to return.
During the hyperemetic phase, supportive care is necessary to manage severe symptoms and prevent dehydration. This often includes intravenous fluids for hydration and anti-nausea medications, though standard antiemetics are often ineffective against CHS-related vomiting. Temporary relief is often found through frequent hot showers or baths, and topical capsaicin cream applied to the abdomen may also help alleviate pain and nausea. Avoiding all forms of cannabis is the most important step for long-term recovery and preventing relapse.