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Rome IV Diagnostic Criteria for Cannabinoid Hyperemesis Syndrome (CHS)
Diagnoses cannabinoid hyperemesis syndrome in chronic cannabis users.
Rome IV Diagnostic Criteria for Cannabinoid Hyperemesis Syndrome (CHS)
Stereotypical episodic vomiting resembling cyclic vomiting syndrome in onset, duration, and frequency
Presentation occurs after prolonged, excessive cannabis use
Vomiting episodes are relieved by sustained cessation of cannabis use
ResultCriteria not met
Symptom pattern does not fulfil all required Rome diagnostic criteria for cannabinoid hyperemesis syndrome; consider alternative diagnoses or further evaluation.
When to use
- Distinguishing cannabinoid hyperemesis syndrome from cyclic vomiting syndrome in a patient with heavy chronic cannabis use.
Formula
All required (no separate duration/frequency requirement in the Rome IV criteria): stereotypical episodic vomiting resembling cyclic vomiting syndrome in onset, duration, and frequency; presentation after prolonged, excessive cannabis use; relief of vomiting episodes with sustained cannabis cessation.
Pearls and pitfalls
- Compulsive hot-water bathing or showering for symptom relief is a classic supportive feature but is not required for diagnosis.
- Diagnosis is confirmed retrospectively by symptom resolution after cannabis cessation.
- Unlike most other Rome IV disorders of gut-brain interaction, CHS has no separate "last 3 months / onset >=6 months" duration requirement — chronicity is captured instead by the "prolonged, excessive cannabis use" criterion.