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Cannabinoid Hyperemesis: A Case Series of 98 Patients
test, ultrasound, radiological tests, extensive laboratory work (including HBA1c) and careful clinical assessment were performed before patients received a final diagnosis. Results: Among the 125 patients presenting with N/V, 94(76.4%) were F and the mean age was 51. Sixty three (51%) were Hispanic, 58 (47%) were Caucasians and 4 (3.3%) were African Americans. The etiologies of N/V among all subjects were determined as follows: 25 (20%) had diabetic gastroparesis (GP), 15 (12%) idiopathic GP, 21 (17%) dumping syndrome, 17 (14%) cyclic vomiting, 6 (5%) conditioned vomiting, and 2 (1.6%) rumination. The comparison between Hispanics and Caucasians are summarized in Table 1. Conclusions: In a predominantly Hispanic population with N/V: 1) Hispanics had a higher frequency of diabetic GP when compared to Caucasians (29% vs 12%), while Caucasians dominated the idiopathic GP group (17% vs 8%); 2) Other than GP causes for N/V were more common in Caucasian (50% vs 20%). 3) Since the proportion of Hispanics throughout the USA is growing it's important to recognize the specific etiologies of nausea and vomiting in this population. Demographics and Etiologies
AGA Abstracts
role in management of acute episodes, ongoing opioid therapy is a poor prognostic marker and may lead to iatrogenic dependence and withdrawal. As even mild withdrawal symptoms may function as stressors and trigger CVS exacerbations, slow tapers should be considered to decrease the likelihood of repeat exacerbation.
Opioid use expressed in morphine equivalents per month Tu1361 Proton Pump Inhibitor Therapy Use Does Not Predispose to Small Intestinal Bacterial Overgrowth Shiva K. Ratuapli, Taylor G. Ellington, Mary O'Neill, Lucinda A. Harris, Amy E. FoxxOrenstein, George E. Burdick, John K. DiBaise, Michael D. Crowell Background: Small intestinal bacterial overgrowth (SIBO) occurs due to an increase or an alteration of the microbiota within the upper gastrointestinal tract. Hypochlorhydria from use of proton pump inhibitor therapy (PPI) has been suggested as a risk factor for developing SIBO. Studies have yielded conflicting results on the association between PPI therapy and risk of developing SIBO. Aim: To compare the prevalence of SIBO as measured by glucose hydrogen breath testing (GHBT) in patients on PPI therapy vs. those not on PPI therapy. Methods: A retrospective chart review was completed for all the patients who underwent GHBT testing from 2004 to 2010. Breath samples for hydrogen (H2) and methane (CH4) were collected prior to and every 20 mins for 120 mins following ingestion of a 50g oral glucose load. Gastrointestinal symptoms were assessed at baseline and over the 2 hour test period. Due to lack of universally accepted cut-off values for hydrogen and methane, we used following criteria for positive GHBT (a) H2 > 20 ppm b) H2 > 10 ppm c) CH4 > 15 ppm d) either H2 > 20 ppm or CH4 > 15 ppm. Patients with prior gastrointestinal surgeries were excluded. Demographic, clinical and PPI data were compared between the two groups using SPSS v18.0 (Chicago, IL). Results: The study included 1191 patients (70% female), of which 566 (48%) were on PPI therapy. A clinical diagnosis of IBS was found in 230 (19%) pts that were evenly distributed between PPI (44%) and non-PPI (56%) groups (P = 0.24). GHBT positivity did not differ significantly between PPI users and non-users by any of the diagnostic criteria used (Table). GHBT positivity was associated with older age (OR 1.02, 95% CI 1.01-1.04) and antidiarrheal use (OR 2.31. 95% CI 1.39-3.83) using H2 > 20, older age (OR 1.01, 95% CI 1.00 - 1.02) and diarrhea (OR 1.48, 95% CI 1.12-1.95) using H2 > 10, and older age (OR 1.01, 95% CI 1.00 - 1.02) and lower BMI (OR 1.03, 95% CI 1.01-1.06) using either H2 > 20 or CH4 > 15. PPI use was not significantly associated with GHBT positivity using any of these criteria. Conclusion: In this large patient sample, PPI use did not predispose to development of SIBO. Differences in sample size, patient characteristics and dietary intake might explain the observed variation in results from other studies. Prospective studies are needed to confirm these findings.
Tu1363 Cannabinoid Hyperemesis: A Case Series of 98 Patients Douglas A. Simonetto, Amy S. Oxentenko, Margot L. Herman, Jason Szostek Introduction: Cannabis is the most widely used illicit drug in the world. In 2004, chronic cannabis use was identified as a cause of cyclic vomiting, and the term Cannabinoid Hyperemesis (CH) was coined. Since then, several case reports have identified important clinical features of CH. Given the prevalence of cannabis use, the recent recognition of CH and the paucity of literature on CH, it is likely that this disease is significantly under-recognized. In order to promote wider recognition and further understanding of this condition, we conducted a case series, the largest to-date, of patients diagnosed with CH at our institution. Methods: Using institutional software, the electronic medical record was searched from January 1, 2005 through June 15, 2010. Patients were included if they had 1) chronic marijuana use prior to the start of symptoms, 2) a history of recurrent vomiting and 3) the absence of a major illness that could explain the symptoms. As a result, 1571 patients were identified, of which 98 met inclusion criteria. Results: The majority of patients were males (67%) with the average age of symptom onset at 25.3 ± 8.9 years. The majority (68%) consumed cannabis products for more than 2 years prior to symptoms, and 98% used it more than once per week. All patients had symptoms of cyclic nausea and vomiting. Eightyfour patients (86%) had associated abdominal pain; 61% described the pain as epigastric while 23% reported a periumbilical location. Fifty-seven patients had documentation of the effects of hot water bathing on their symptoms; of these, 91% reported relief of their symptoms with hot showers or baths. Diagnostic studies were obtained in most patients and were negative for alternative diagnoses. Follow-up was reported in only 10 patients (10%). Six patients stopped using cannabis and noted complete resolution of their symptoms. The time to improvement varied from 1 to 3 months. Discussion: Based on our patient data, we propose clinical criteria, divided into major and supportive features, for diagnosing CH. Chronic cannabis use is essential for the diagnosis. The major features include 1) severe cyclic nausea and vomiting, 2) resolution with cannabis cessation, 3) relief of symptoms with hot showers or baths, 4) abdominal pain and 5) weekly use of cannabis. The supportive features are 1) age less than 50, 2) weight loss of greater than 5 kg, 3) morning predominance of symptoms, 4) normal bowel habits and 5) negative diagnostic evaluation. CH should be considered in younger patients with chronic cannabis use and recurrent nausea, vomiting and abdominal pain. The timing, location and characteristic of symptoms can be helpful diagnostically, and patients should be asked about the relief of symptoms with hot water bathing. Cessation of cannabis use should result in improvement of symptoms.
Tu1362 Tu1364
What Are the Most Common Etiologies of Nausea and Vomiting in a Predominantly Hispanic Population? Ana C. Zamora, Mithun Pattathan, Alicia Alvarez, Ricardo Badillo, Suhair Aldewairey, Richard McCallum, Irene Sarosiek
Factors Affecting Patient Outcome, Following Surgical Insertion of Gastric Electrical Stimulator for Gastroparesis - 10 Year Experience in a Single UK Centre Adriana Rotundo, Alan Askari, Francesco Pata, Cheuk Bong Tang, Mark AlexanderWilliams, Michael Harvey, Sritharan Kadirkamanathan
Introduction: There are a paucity of comprehensive studies highlighting the different etiologies of nausea/vomiting (N/V) among various racial/ethnic backgrounds and specifically in an Hispanic population. One of the gastrointestinal causes of N/V is gastroparesis (GP), a complication of longstanding diabetes mellitus which is highly prevalent among Hispanics. The objective of our study is to identify the most common etiologies of N/V in a predominantly Hispanic population in West Texas. Methods: Retrospective chart review of a 125 referred to a gastrointestinal (GI) motility clinic with a chief complaint of N/V. All patients were evaluated by one physician from October 2009 to October 2010. All relevant GI tests including upper endoscopy, colonoscopy, gastric emptying test (GET), four hour scintigraphy
AGA Abstracts
Background: Drug refractory gastroparesis is a debilitating disorder associated with severe nausea and vomiting, resulting in a negative impact on quality of life. High frequency gastric electrical stimulation (GES) is a viable, alternative treatment with a reported success rate of between 50 and 70%. This study looks at the factors affecting outcome that may help in improved patient selection. Patients and Methods: Clinical data from 48 patients with severe, intractable gastroparesis, (12 diabetic and 36 idiopathic) were studied. The median age of
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AGA Abstracts
role in management of acute episodes, ongoing opioid therapy is a poor prognostic marker and may lead to iatrogenic dependence and withdrawal. As even mild withdrawal symptoms may function as stressors and trigger CVS exacerbations, slow tapers should be considered to decrease the likelihood of repeat exacerbation.
Opioid use expressed in morphine equivalents per month Tu1361 Proton Pump Inhibitor Therapy Use Does Not Predispose to Small Intestinal Bacterial Overgrowth Shiva K. Ratuapli, Taylor G. Ellington, Mary O'Neill, Lucinda A. Harris, Amy E. FoxxOrenstein, George E. Burdick, John K. DiBaise, Michael D. Crowell Background: Small intestinal bacterial overgrowth (SIBO) occurs due to an increase or an alteration of the microbiota within the upper gastrointestinal tract. Hypochlorhydria from use of proton pump inhibitor therapy (PPI) has been suggested as a risk factor for developing SIBO. Studies have yielded conflicting results on the association between PPI therapy and risk of developing SIBO. Aim: To compare the prevalence of SIBO as measured by glucose hydrogen breath testing (GHBT) in patients on PPI therapy vs. those not on PPI therapy. Methods: A retrospective chart review was completed for all the patients who underwent GHBT testing from 2004 to 2010. Breath samples for hydrogen (H2) and methane (CH4) were collected prior to and every 20 mins for 120 mins following ingestion of a 50g oral glucose load. Gastrointestinal symptoms were assessed at baseline and over the 2 hour test period. Due to lack of universally accepted cut-off values for hydrogen and methane, we used following criteria for positive GHBT (a) H2 > 20 ppm b) H2 > 10 ppm c) CH4 > 15 ppm d) either H2 > 20 ppm or CH4 > 15 ppm. Patients with prior gastrointestinal surgeries were excluded. Demographic, clinical and PPI data were compared between the two groups using SPSS v18.0 (Chicago, IL). Results: The study included 1191 patients (70% female), of which 566 (48%) were on PPI therapy. A clinical diagnosis of IBS was found in 230 (19%) pts that were evenly distributed between PPI (44%) and non-PPI (56%) groups (P = 0.24). GHBT positivity did not differ significantly between PPI users and non-users by any of the diagnostic criteria used (Table). GHBT positivity was associated with older age (OR 1.02, 95% CI 1.01-1.04) and antidiarrheal use (OR 2.31. 95% CI 1.39-3.83) using H2 > 20, older age (OR 1.01, 95% CI 1.00 - 1.02) and diarrhea (OR 1.48, 95% CI 1.12-1.95) using H2 > 10, and older age (OR 1.01, 95% CI 1.00 - 1.02) and lower BMI (OR 1.03, 95% CI 1.01-1.06) using either H2 > 20 or CH4 > 15. PPI use was not significantly associated with GHBT positivity using any of these criteria. Conclusion: In this large patient sample, PPI use did not predispose to development of SIBO. Differences in sample size, patient characteristics and dietary intake might explain the observed variation in results from other studies. Prospective studies are needed to confirm these findings.
Tu1363 Cannabinoid Hyperemesis: A Case Series of 98 Patients Douglas A. Simonetto, Amy S. Oxentenko, Margot L. Herman, Jason Szostek Introduction: Cannabis is the most widely used illicit drug in the world. In 2004, chronic cannabis use was identified as a cause of cyclic vomiting, and the term Cannabinoid Hyperemesis (CH) was coined. Since then, several case reports have identified important clinical features of CH. Given the prevalence of cannabis use, the recent recognition of CH and the paucity of literature on CH, it is likely that this disease is significantly under-recognized. In order to promote wider recognition and further understanding of this condition, we conducted a case series, the largest to-date, of patients diagnosed with CH at our institution. Methods: Using institutional software, the electronic medical record was searched from January 1, 2005 through June 15, 2010. Patients were included if they had 1) chronic marijuana use prior to the start of symptoms, 2) a history of recurrent vomiting and 3) the absence of a major illness that could explain the symptoms. As a result, 1571 patients were identified, of which 98 met inclusion criteria. Results: The majority of patients were males (67%) with the average age of symptom onset at 25.3 ± 8.9 years. The majority (68%) consumed cannabis products for more than 2 years prior to symptoms, and 98% used it more than once per week. All patients had symptoms of cyclic nausea and vomiting. Eightyfour patients (86%) had associated abdominal pain; 61% described the pain as epigastric while 23% reported a periumbilical location. Fifty-seven patients had documentation of the effects of hot water bathing on their symptoms; of these, 91% reported relief of their symptoms with hot showers or baths. Diagnostic studies were obtained in most patients and were negative for alternative diagnoses. Follow-up was reported in only 10 patients (10%). Six patients stopped using cannabis and noted complete resolution of their symptoms. The time to improvement varied from 1 to 3 months. Discussion: Based on our patient data, we propose clinical criteria, divided into major and supportive features, for diagnosing CH. Chronic cannabis use is essential for the diagnosis. The major features include 1) severe cyclic nausea and vomiting, 2) resolution with cannabis cessation, 3) relief of symptoms with hot showers or baths, 4) abdominal pain and 5) weekly use of cannabis. The supportive features are 1) age less than 50, 2) weight loss of greater than 5 kg, 3) morning predominance of symptoms, 4) normal bowel habits and 5) negative diagnostic evaluation. CH should be considered in younger patients with chronic cannabis use and recurrent nausea, vomiting and abdominal pain. The timing, location and characteristic of symptoms can be helpful diagnostically, and patients should be asked about the relief of symptoms with hot water bathing. Cessation of cannabis use should result in improvement of symptoms.
Tu1362 Tu1364
What Are the Most Common Etiologies of Nausea and Vomiting in a Predominantly Hispanic Population? Ana C. Zamora, Mithun Pattathan, Alicia Alvarez, Ricardo Badillo, Suhair Aldewairey, Richard McCallum, Irene Sarosiek
Factors Affecting Patient Outcome, Following Surgical Insertion of Gastric Electrical Stimulator for Gastroparesis - 10 Year Experience in a Single UK Centre Adriana Rotundo, Alan Askari, Francesco Pata, Cheuk Bong Tang, Mark AlexanderWilliams, Michael Harvey, Sritharan Kadirkamanathan
Introduction: There are a paucity of comprehensive studies highlighting the different etiologies of nausea/vomiting (N/V) among various racial/ethnic backgrounds and specifically in an Hispanic population. One of the gastrointestinal causes of N/V is gastroparesis (GP), a complication of longstanding diabetes mellitus which is highly prevalent among Hispanics. The objective of our study is to identify the most common etiologies of N/V in a predominantly Hispanic population in West Texas. Methods: Retrospective chart review of a 125 referred to a gastrointestinal (GI) motility clinic with a chief complaint of N/V. All patients were evaluated by one physician from October 2009 to October 2010. All relevant GI tests including upper endoscopy, colonoscopy, gastric emptying test (GET), four hour scintigraphy
AGA Abstracts
Background: Drug refractory gastroparesis is a debilitating disorder associated with severe nausea and vomiting, resulting in a negative impact on quality of life. High frequency gastric electrical stimulation (GES) is a viable, alternative treatment with a reported success rate of between 50 and 70%. This study looks at the factors affecting outcome that may help in improved patient selection. Patients and Methods: Clinical data from 48 patients with severe, intractable gastroparesis, (12 diabetic and 36 idiopathic) were studied. The median age of
S-806