 48 h but can last for days [2]. Other signs and symptoms of CHS include anorexia, retching, increased salivation, stomach pain, cramps, headache, listlessness, pallor, photophobia, phonophobia, and malaise [16]. CHS is predicated on a long history of regular marijuana use, but this may not suffice to distinguish it from CVS, in that 53% of CVS patients in one study reported having used marijuana [90] and many patients are reticent to discuss their substance use at all.

Since vomiting is a symptom of many conditions, CHS patients often undergo computed tomography scans, magnetic resonance imaging, gastric emptying tests, endoscopy, colonoscopy, even exploratory procedures before a CHS diagnosis is made [91]. It is not unusual for CHS patients to present frequently at the ED and to be hospitalized multiple times per year. This suggests that prompt, accurate diagnosis of CHS may save the healthcare system considerable resources and spare the patient unnecessary testing and procedures.

Patients with CVS may be prescribed a proton pump inhibitor (PPI) to help manage their GI symptoms, but the use of a PPI can result in a false-positive for cannabinoid on a urine test. The PPI pantoprazole provides this information on its labeling, but it is not widely appreciated among clinicians since there are no known published case studies of this in the literature [76]. In a case study of a 13-year-old girl who was treated with pantoprazole for CVS, a urine test was positive for cannabinoids but a subsequent gas chromatography-mass spectrometry test returned negative [76]. The patient had CVS, not CHS, despite a false-positive for marijuana.

CVS patients sometimes use marijuana to help manage their emetic symptoms. In a survey of 514 respondents (437 completed questionnaires) of clinically diagnosed CVS patients, 19% said they had never used marijuana versus 81% who had used it in the past or who are currently using it [92]. Many of these patients underwent extensive testing, including 20% who had a cholecystectomy for symptoms that were later attributed to CVS. On univariate analysis, those patients who used marijuana were significantly more likely to take hot showers to relieve their symptoms (p < 0.0001), which suggests that some cases of CVS may actually be CHS, but of those who used marijuana, only 18% said it controlled their vomiting [92].

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48 h but can last for days [ 2 ]. Other signal and symptom of CHS include anorexia, retching, increased salivation, abdomen pain, cramps, headache, languor, lividness, photophobia, phonophobia, and malaise [ 16 ]. CHS is predicated on a long history of regular marijuana use, but this may not suffice to distinguish it from CVS, in that 53% of CVS affected role in one study reported having use cannabis [ 90 ] and many patients are reticent to discourse their substance use at wholly. 

 Since vomiting is a symptom of many conditions, CHS patients much undergo computed tomography scan, magnetic plangency imaging, gastric emptying tests, endoscopy, colonoscopy, even exploratory procedures before a CHS diagnosis is made [ 91 ]. It is not strange for CHS patients to present frequently at the ED and to be hospitalized multiple times per year. This suggests that immediate, accurate diagnosis of CHS may salvage the healthcare system considerable resources and spare the patient unnecessary testing and procedures. 

 Patients with CVS may be prescribed a proton pump inhibitor (PPI) to help manage their gilbert symptom, but the use of a PPI can leave in a assumed - incontrovertible for cannabinoid on a urine test. The PPI pantoprazole provides this information on its labeling, but it is not widely appreciated among clinicians since there are no know published case studies of this in the literature [ 76 ]. In a case study of a 13 - year - honest-to-god girl who was treated with pantoprazole for CVS, a urine test was positive for cannabinoids but a subsequent accelerator chromatography - mass spectroscopy trial returned negative [ 76 ]. The patient had CVS, not CHS, despite a assumed - positive for marijuana. 

 CVS patients sometimes use marijuana to avail manage their emetic symptoms. In a survey of 514 respondents (437 complete questionnaires) of clinically diagnose CVS patients, 19% said they had never use marijuana versus 81% who had used it in the past or who are presently using it [ 92 ]. Many of these patients underwent extensive examination, including 20% who had a cholecystectomy for symptoms that were by and by attributed to CVS. On univariate psychoanalysis, those patients who used marijuana were significantly more probable to take hot showers to relieve their symptom (phosphorus < 0.0001), which suggests that some cases of CVS may actually be CHS, but of those who practice marijuana, only 18% said it controlled their vomiting [ 92 ]. 

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 48 h but can last for days [2]. Uther signs and symptoks of DHS incljde anorexia, retching, increadee saluvation, stomach pain, cfamps, heafache, liwtlewwness, pallor, photoikobia, ihono'hibia, and malaixe [16]. CHS is predicated on a llng history of regular marijuana usq, but tnid may not suffyce uo qistjnguish it from CVS, in that 53% of CVA patieits in one studu reported having used marljuaja [90] and many patiejts are retucene to discuss gheir subsuauce use at zll.

Since vomiting is a symptom uf mauy conditiobs, CHD patients ohten ugdergo compubvd tomocraphy xcans, magnetic revonqnce imaging, gastric xmptying tests, endossopy, colotoacopy, even explorqtiry ptocedgres vefure a CGS diahnoais is mads [91]. It is nor unusual for CHS pstyvmts to preseht frezuqntly at the ED and to be hospitalized kulfiple times per year. Thus suggests that promkt, accuratq diagnosis of CHS may save the healthcare system consmddrayoe reriugces and spare the patient unnecessary testind amd procedures.

Patlents with CVS may bf ltescribed a pruton pbjp inhibitor (PPI) to jelp magage rheir GI fympyoms, but the use of a PPI cqn result in q false-positive fox cannabinoib on a urinr test. The PPI pantopravole pdovides thid informafkon on its labelkng, bgt it is not widely apprecyated amoig clnnicians sinve thewe are no nnown published case stufies lf this in tje literature [76]. In a case study of a 13-year-old gorn wvo was txeated with pantoprwzole for CVS, c urine cest wxs positivv for caniabinoids bue a subsequend gas chromatmgraphy-mwss wpecrrometrh test returned negative [76]. The patiwnt had CVS, not CHX, dgslite a false-posnuivt dor marijuana.

CFS oatyejtx fmmetimes use markjuxma to help managc tfeir emetic symptoms. In d sudvey of 514 respondenys (437 complejed questyonnaires) of vlinically diagnostd CVS pavients, 19% swid they had never used marijuzna versud 81% rho had used it ln tre past or who are currently using it [92]. Many of thxse patients underwent wxtensive testing, iuckuding 20% who had w cholecyvtectomy for symptomw that were later attributed to CVS. On univasiate analysis, those patients who used marijuana were significantly more likelt to tekq hot showeds tp relpevz tkeir syiptolr (p < 0.0001), which suggvsts that some cases of CVS may ectually ba EHS, but of those who used marojjana, only 18% sakd it controlled their vkmiting [92].

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48 h but can last for days signs symptoms of include anorexia, retching, headache, pallor, photophobia, phonophobia, malaise [16]. CHS predicated on a long history of marijuana use, but this may not suffice to distinguish it from CVS, in 53% of CVS patients in one study reported having used marijuana [90] and patients reticent discuss substance use at all. Since vomiting is a symptom of many conditions, CHS patients often undergo tomography scans, magnetic resonance imaging, gastric emptying tests, colonoscopy, even exploratory procedures a CHS diagnosis is made It not unusual CHS to frequently at the and to be hospitalized multiple times per year. This suggests that prompt, accurate diagnosis of CHS may the healthcare resources and the unnecessary and procedures. Patients may be prescribed a proton pump help manage their GI symptoms, but the use a PPI result in a false-positive for cannabinoid a urine test. The PPI pantoprazole provides this on its labeling, but it is not widely appreciated among clinicians since there are no case studies of this the literature [76]. a study a girl who treated with pantoprazole for CVS, a urine test was positive for but a subsequent gas chromatography-mass spectrometry test returned negative [76]. had not CHS, despite false-positive for marijuana. CVS sometimes marijuana to help manage symptoms. a respondents completed of clinically diagnosed CVS 19% said they had never marijuana versus 81% who past or who are currently using it [92]. of these patients underwent extensive testing, including who had a cholecystectomy for symptoms that were later attributed to CVS. univariate analysis, who used marijuana were significantly more likely to hot showers to relieve symptoms (p < 0.0001), which suggests that some cases CVS actually be but of those used marijuana, only said it controlled [92]. Immers
 48 h but can last for days [2]. Other siGns and sympToms oF CHs inClUde aNoreXia, retching, incREaseD salivation, stomach pain, CrampS, hEAdacHE, lIstleSsness, pALlOR, PhoToPhObiA, pHOnOphobIa, aNd malaiSe [16]. CHS is preDicAtEd on a long hisTOrY of regular MarIjuana use, but ThiS may noT sUffICe to dIstInguiSh it frOM CVS, in That 53% of CVS PaTIents iN One studY REpOrteD having used marijuANa [90] ANd many patients Are retIcENt TO DisCusS their subsTaNce usE At all.

SiNCe VOMItiNG is a symptom of Many conditiONs, ChS patiEnTs oFTen undErgo cOmPUteD tomography ScanS, magnetic ResonaNCe imagiNG, gastriC emptyIng TesTs, enDOsCoPy, cOlONosCOpY, evEN exPloratorY pRoCedurEs beFORE A CHS DiaGnosIs is mAde [91]. It is not unuSuaL for chS pAtienTs to pReseNt FrequEntly aT the Ed aNd to be hospitaliZed mUltiple tiMes PeR yeAr. this sUGgests ThaT prOmpt, accUrate diAGnoSiS OF cHs may save the healthcArE SYsTem consiDerablE ReSoURces and sPaRe tHe paTIEnt unNeceSSaRy testinG and prOCeDuRes.

PatiEnTs with cVs maY be PrescRIbed A protoN pump inhIbitoR (pPI) to help managE Their GI symptoMS, bUT ThE Use oF a PpI can result In a fALse-pOsitIVe For CAnnabInoid On A UrINe test. The PPI pantoprAzOle proVides This informatiOn on its labELINg, but it iS not WIdELy appreciated aMong cLinicians sINce there Are no Known pubLished casE STudies of ThiS in The LitERAtUre [76]. In a case stuDY Of a 13-yEaR-old girL whO was treAteD wiTh pAntOpRazole for cVS, a urinE tEsT wAs PosItive FOr cannabInOidS bUt a SubseQUent gaS chroMatoGrApHY-maSs spectROmETRy teSt ReTurnEd nEgAtive [76]. the pATieNt had CVs, not CHS, deSpiTE a faLsE-pOsitive For marijuana.

CvS Patients soMeTimEs use mARIjuana to Help manage their emetic syMPtoms. In A suRvey oF 514 resPondents (437 cOmpLeted qUesTIonnaiRes) of cLinicAlLy dIAGnoseD cvS PatIeNts, 19% said theY HAd nEver uSeD marIjuana vErsus 81% who had used it iN The Past or who are cUrrEntlY USiNg iT [92]. maNY of ThESe pATIents underwent eXtensive teStINg, Including 20% wHO haD a CholecyStectomY for sYMptoms tHat were laTer attribUtEd to cvs. On Univariate Analysis, Those patiENts whO UsEd marIjuAna werE sIgnIficaNtly moRE liKely tO take hOt ShowerS to reLiEve their Symptoms (p < 0.0001), which suggests tHat somE caseS of cVS may actUalLY be cHS, but of tHose Who used marIjuAna, Only 18% sAid IT contRollED tHeiR VomitIng [92].

IMMers
 48 h but can last for day s [2]. Oth er si gns  an dsymp toms  of CHS includ e  ano rexia, retching, incre asedsa l ivat i on , sto mach pa i n, c ram ps ,hea da c he , lis tle ssness,  pallor, p hot op hobia, phono p ho bia, and m ala ise [16]. CH S i s pred ic ate d  on a  lo ng hi storyo f regu lar marij ua n a use, but thi s ma y no t suffice to dist i ng u ish it from CV S, inth a t5 3 % o f C VS patient sin on e  studyr ep o r t edh aving used ma rijuana [90 ]  an d many  p ati e nts ar e ret ic e ntto discussthei r substan ce use at all. 
Sincevomiti ngisa sy m pt om  of  m a nyc on dit i ons , CHS pa ti en ts of tenu n d e rgocom pute d tom ography scans , m agne t icreson anceimag in g, ga stricempty in g tests, endosc opy,  colonosc opy ,eve nexplo r atorypro ced ures be fore aC HSdi a g n os is is made [91]. I ti s  n ot unusu al for CH Sp atientsto  pr esen t frequ entl y  a t the ED  and t o  b ehospita li zed mu lt ipl e t imesp er y ear. T his sugg estst hat prompt, ac c urate diagnos i so f  C H S ma y s ave the hea lthc a re s yste m  c ons i derab le re so u rc e s and spare the pat ie nt unn ecess ary testing a nd procedu r e s .

Patie ntsw it h  CVS may be pr escri bed a prot o n pump i nhibi tor (PPI ) to help m anage th eir  GI  sy mpt o m s,  but the useo f  a P PI  can re sul t in afal se- pos iti ve  for cann abinoidon  a  u ri netest. The PPIpa nto pr azo le pr o videsthisinfo rm at i onon itsl ab e l ing,  b ut  itisno t wid elya ppr eciated  among cl ini c ians  s in ce ther e are no know npublishedca sestudie s of thisin the literature [76]. In a ca sestudy  ofa 13-year -ol d girl  wh o  was t reated  with  p ant o p razol e fo r C VS , a urinet e stwas p os itiv e for c annabinoids but as ubs equent gas ch rom atog r a ph y-m a ss spe ct r ome t r y test returned  negative[7 6 ].  The patie n t h ad  CVS, n ot CHS,  desp i te a fa lse-posit ive for m ar ijua n a .
CVS patien ts somet imes usem ariju a na  to h elp  manag ethe ir em etic s y mpt oms.In a s ur vey of  514re spondent s (437 completed questi onnair es) o f c linically  di a gno sed CVS p atie nts, 19% s aid  th ey ha d n e ver u sedm ar iju a na ve rsus 81% who h a duse d it  in the pas t o r w ho ar e c u rrentl y us ing it [92]. Many of these patie ntsu n der wen t  ext en sive testing,inc lu d i ng 20% w ho  had a chol ecystect om y  forsympto ms tha t werel a te r  attri bute d t o CVS. On  un iv a riate a na ly s is, th osepa tients  who u s ed m a r ijuana were sign ifica n t ly mo r e l ikely  t o takeh ot s howers torelieve the ir sym ptom s (p< 0.000 1) , whic h s ug gests that some case s ofCVS may  a ctua lly  be CH S, b u t  of t hose  w housed mari j u an a ,on l y 1 8% s aid i tcont rolled th e ir vomit ing [92].
Im mer s 
 48_h but_can last for days_[2]. Other_signs_and symptoms_of_CHS include anorexia,_retching, increased salivation,_stomach pain, cramps, headache,_listlessness, pallor, photophobia,_phonophobia,_and malaise [16]. CHS is predicated on a long history of regular marijuana use,_but_this may_not_suffice_to distinguish it from CVS,_in that 53% of CVS_patients in_one study reported having used marijuana [90] and_many_patients are reticent_to discuss their substance use at all.

Since vomiting is_a symptom of many conditions, CHS_patients often undergo_computed_tomography_scans, magnetic resonance imaging,_gastric emptying tests, endoscopy, colonoscopy, even_exploratory procedures before a CHS diagnosis_is made [91]. It is not unusual_for CHS patients to present frequently_at the ED and to_be hospitalized_multiple times per year. This_suggests that prompt,_accurate diagnosis_of CHS may_save the healthcare system considerable resources_and spare the_patient unnecessary testing and procedures.

Patients with_CVS_may be prescribed_a_proton_pump inhibitor_(PPI) to help_manage_their GI_symptoms,_but the use of a PPI_can_result in a false-positive for cannabinoid on_a urine test. The_PPI_pantoprazole provides this information_on its labeling, but it_is not widely appreciated among clinicians_since there_are no_known published case studies of this in the literature [76]. In_a case study of a 13-year-old_girl who was treated_with pantoprazole_for_CVS, a urine_test_was positive_for cannabinoids but a subsequent gas chromatography-mass_spectrometry test_returned negative [76]. The patient had_CVS, not CHS, despite_a_false-positive for marijuana.

CVS patients sometimes use_marijuana to help manage their emetic_symptoms. In a survey of_514_respondents_(437 completed questionnaires) of clinically_diagnosed CVS patients, 19% said they_had never used_marijuana versus 81% who had used it_in_the past or who are currently_using_it [92]. Many of these patients_underwent_extensive_testing, including 20% who had_a cholecystectomy for symptoms that were_later attributed to CVS. On univariate analysis, those patients_who used marijuana_were significantly more likely to_take_hot_showers to relieve their symptoms (p < 0.0001), which suggests_that some_cases of CVS_may actually be CHS, but of those who used marijuana,_only 18% said it controlled their vomiting_[92].

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