In patients suffering from cvs there is consensus

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In patients suffering from CVS, there is consensus that application of preventive medication and medication capable of aborting an episode reduces the intensity and frequency of cycles [1], [3], [4]. Amitriptyline, propranolol, sumatriptane are recommended preventive medications [1], [3], [4]. Metoclopramide, ondansetron, lorazepam or oxycodone, ideally with application at the onset of pro- dromal symptoms, can abort an episode [1], [3], [4]. Psychosocial care is of additional benefit [1], [3], [4]. In patients who refuse cessation of cannabis use and especially in patients who do not sufficiently respond to cannabis use cessation alone, adopting the therapeutic regime of CVS might be beneficial. But there is no data supporting a potential benefit of applying the therapeutic strategy of CVS to CHS in these patients. Follow-up of CVS and CHS Reliable long-term follow up data (minimum follow up time: 12 months) of patients suffering from CVS or CHS is sparse [1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [13], [14], [15]. Differentiation between CVS and CHS is simple in patients who do not practise chronic marijuana abuse [1], [2]. Distinguishing between CVS from CHS in patients who practise chronic marijuana abuse can be extremely difficult [1], [3], [5], [9], [11]. 4/8 GMS German Medical Science 2017, Vol. 15, ISSN 1612-3174 Blumentrath et al.: Cannabinoid hyperemesis and the cyclic vomiting syndrome ...
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Table 1: Criteria for the diagnosis of CVS and CHS Table 2: Differential diagnoses of CVS and CHS 5/8 GMS German Medical Science 2017, Vol. 15, ISSN 1612-3174 Blumentrath et al.: Cannabinoid hyperemesis and the cyclic vomiting syndrome ...
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Table 3: Treatment Follow-up involving these patients pursues five main ob- jectives: 1. Evaluation of complete and permanent resolution of symptoms due to cannabis cessation alone. 2. Evaluation of the effectiveness of therapeutic strategies for CVS when applied to CHS patients who refuse cannabis cessation. 3. Evaluation of the efficacy of therapeutic strategies for CVS patients in patients who do not fully respond to cannabis cessation. 4. Providing access to physicians familiar with CVS and CHS to patients suffering from either syndrome. 5. Collection of data helpful to evaluate therapeutic strategies in CVS and CHS patients [1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [13], [14], [15]. Patients who fully respond to cannabis cessation alone for a minimum period of 12 months after complete resol- ution of symptoms are likely to suffer from CHS [2], [5], [6], [8]. Diagnosis in patients who cease cannabis abuse and continue to have symptoms is probably CVS. Patients who continue cannabis abuse but benefit from therapeut- ic regimes available for CVS patients may be diagnosed CVS [1], [2]. The occurence of patients who do not cease cannabis abuse and continue to have symptoms despite treatment alike CVS patients support the hypothesis that cannabis cessation is the only available treatment for CHS [2]. Discussion From a practitioner’s point of view, the major issue of CVS and/or CHS is the limited awareness among physi- cians which consequently results in diagnostic failure and inadequate treatment [1], [2]. Displaying educational material in poster format in departments of emergency
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  • Fall '19
  • Cannabis, Cyclic vomiting syndrome

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