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Hot-Water Bathing Improves Symptoms in Patients with Cyclic Vomiting Syndrome and Is Modulated by Chronic Cannabis Use

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Abstract

Background

Cyclic vomiting syndrome (CVS) is a chronic functional GI disorder; a characteristic compulsive “hot-water bathing” pattern is reported to alleviate symptoms during an acute episode. There is limited data on this bathing pattern: proposed mechanisms include core temperature increase via effects on cannabinoid type 1 receptors in the brain, skin transient receptor potential vanilloid 1 receptor stimulation, and blood flow shift from viscera to skin.

Aims

We thus sought to characterize the hot-water bathing pattern in patients with CVS and identify differences between heavy cannabis users in comparison to occasional and non-users.

Methods

We conducted a cross-sectional study of 111 patients with CVS at a single tertiary referral center. Questionnaires regarding clinical characteristics, hot-water bathing, and cannabis use were administered. Patients were classified based on cannabis usage into regular cannabis users (≥ 4 times/week), and occasional + non-users (< 4 times/week and no current use).

Results

A total of 81 (73%) respondents reported the hot-water bathing behavior during an episode. The majority (> 80%) noted a marked improvement in nausea, vomiting, abdominal pain and symptoms associated with panic. Regular cannabis users were more likely to use “very-hot” water (50% vs. 16%, p = 0.01) and time to relief of symptoms was longer (> 10 min) in this group, compared to the rest of the cohort.

Conclusions

Hot-water bathing relieves both GI and symptoms related to panic in most patients which appear to be modulated by chronic cannabis use. These findings can help inform future physiologic studies in CVS pathogenesis.

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Acknowledgments

We are grateful to Mark Oium for support with REDCap.

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None.

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Author notes

  1. Sheldon Rosen and Robert Diaz have contributed equally to this body of work.

Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA

    Vishnu Charan Suresh Kumar, Shashank R. Thyarala & Thangam Venkatesan

  2. Division of Gastroenterology and Hepatology, University of Washington, Seattle, WA, USA

    Sheldon Rosen

  3. Pharmacology and Toxicology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA

    Robert Diaz & Cecilia J. Hillard

  4. Department of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, 53226, USA

    Zhuping Garacci

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  1. Sheldon Rosen
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  2. Robert Diaz
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  3. Zhuping Garacci
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  4. Vishnu Charan Suresh Kumar
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Correspondence to Thangam Venkatesan.

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Conflict of interest

Thangam Venkatesan is an ad hoc consultant for Takeda and Alnylam Pharmaceuticals. This does not have any bearing on the contents of this article. Cecilia Hillard serves on the scientific advisory boards for Beryl Therapeutics and Phytecs, Inc. and this does not pose any conflict of interest. The other authors have no relevant disclosures.

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Rosen, S., Diaz, R., Garacci, Z. et al. Hot-Water Bathing Improves Symptoms in Patients with Cyclic Vomiting Syndrome and Is Modulated by Chronic Cannabis Use. Dig Dis Sci 66, 1153–1161 (2021). https://doi.org/10.1007/s10620-020-06343-x

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  • DOI: https://doi.org/10.1007/s10620-020-06343-x

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