PHILADELPHIA – When evaluating potential causes of gastroparesis, cannabis use is a “do not miss” diagnosis that is easy to overlook and likely on the rise, according to Anthony J. Lembo, MD.

“This is not an infrequent problem, and I’ve even missed it a couple of times,” said Dr. Lembo, director of the GI Motility Laboratory at Beth Israel Deaconess Medical Center, Boston.

The rate of U.S. emergency department visits for vomiting with cannabis use disorder rose from 2.3 to 13.3 per 100,000 visits from 2006 to 2013, according to an analysis recently published by Dr. Lembo and colleagues (J Clin Gastroenterol. 2017 Oct 31. doi: 10.1097/MCG.0000000000000944).

The study showed that men between 20 and 29 years were the most common group presenting for vomiting with cannabis use disorder.

“Remember, 90% of people with chronic gastroparesis are women, so a young male is a red flag for cannabinoid use, whether or not you’ve got the right history,” Dr. Lembo told attendees at the meeting, jointly provided by Rutgers and Global Academy for Medical Education.

Dr. Lembo recounted an example from his own practice where a young male patient with recurrent nausea and vomiting denied cannabis use in the presence of family members.

“It was only after we managed to hospitalize him because he was losing so much weight that he came out and talked to one of the residents that he was an actually a daily pot smoker,” Dr. Lembo said. “Once we stopped it, the symptoms went away.”

Clinicians in states where cannabis use is increasing might need to be particularly alert for cannabis-related issues. According to the study by Dr. Lembo, the Midwest and West regions registered higher rates of vomiting with cannabis use disorder, compared with the Northeast and South.

Whether cannabinoids also can be a treatment for nausea or vomiting is a frequently asked question, Dr. Lembo said.

While there are no data for smoked marijuana, Dr. Lembo said, some data suggest that dronabinol, a synthetic cannabinoid, is effective in some patients with nausea, particularly post-chemotherapy nausea patients.

Dronabinol is indicated for adults for the treatment of chemotherapy-associated nausea and vomiting in patients who don’t respond adequately to conventional antiemetics, according to the agent’s prescribing information.

The cannabinoid medication is an isomer of tetrahydrocannabinol (THC), one of the active compounds in marijuana, according to Dr. Lembo.

“If you smoke marijuana, the levels go up high very quickly,” Dr. Lembo said. “If you take dronabinol, it takes 45 minutes to an hour. It’s a slower rise of it, so people are less likely to abuse dronabinol.”

In his talk, Dr. Lembo reported disclosures related to Allergan, Ironwood Pharmaceuticals, Salix Pharmaceuticals, and Takeda Pharmaceuticals.

Global Academy for Medical Education and this news organization are owned by the same company.

Do not miss cannabis use in gastroparesis patients