C0270 - The Contribution of Psychiatric Comorbidity and Cannabis Usage to Cyclic Vomiting Syndrome Severity

Monday, October 24, 2022

3:00 PM – 5:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Katheryn G. Kiser, BA

Massachusetts General Hospital
Boston, MA

Katheryn G. Kiser, BA, Braden Kuo, MD, Helen Burton Murray, PhD, Kyle Staller, MD, MPH
Massachusetts General Hospital, Boston, MA

Introduction: Cyclic vomiting syndrome (CVS) is a disorder characterized by sporadic, repeated episodes of intense nausea vomiting. Psychiatric comorbidities (up to 84% for anxiety and 78% for depression) and cannabis use (up to 53%) are common among patients with CVS. However, the relationship between cannabis usage and psychological symptom severity using validated surveys is unknown. Among adults with CVS, we aimed to identify: (a) the frequency of comorbid psychiatric disorders and current cannabis use, (b) the severity of anxiety and depression symptoms and relationship to cannabis use.

Methods: Adults diagnosed by a gastroenterologist with CVS at a tertiary gastrointestinal (GI) clinic were sequentially enrolled in an observational registry. Self-report of psychiatric disease diagnosis and current cannabis use were captured in addition to validated measures including anxiety/depression (Hospital Anxiety and Depression Scale; HADS); general quality of life (Short Form-36); and upper GI symptom severity (Patient Assessment of Gastrointestinal Disorders-Symptoms Severity Index; PAGI-SYM) and related quality of life (Patient Assessment of Upper Gastrointestinal Disorders-Quality of Life; PAGI-QOL).

Results: Enrolled CVS patients (N=48; ages 19-64 years; 61% female) had frequent psychiatric comorbidity, with anxiety disorders (n=32; 97%) and depression (n=22; 46%) most common (Table 1). Current cannabis use was present in 28 (58%) and significantly associated with higher HADS-depression scores (p=0.02) and lower SF-36 Mental Component Summary (MCS) scores (p=0.02), but not HADS-anxiety, SF-36 Physical Component Summary, PAGI-SYM, PAGI-QOL scores. Using age-adjusted logistic regression, higher HADS-depression scores were independently associated with an increased likelihood of current cannabis use (OR=1.4, 95% CI 1.1–1.8, p=0.01). Similarly, a separate age-adjusted logistic regression showed that better SF-36 MCS scores were associated with a decreased likelihood of current cannabis use (OR=0.95, 95% CI 0.9-1.0, p=0.02).  

Discussion: Despite high prevalence of cannabis use in a CVS registry, it was not cross-sectionally associated with worse gastrointestinal symptom severity or related quality of life. Instead, both depression and poor mental health-related quality of life were associated with cannabis use, suggesting that cannabis use may be a marker of comorbid psychiatric disease and mental health distress in a CVS population.

	Overall Study Cohort  (N=48)	Current Cannabis Use (n=28)	No Current Cannabis Use  (n=20)	P-valueⁱ
Age, M(SD)	34 (12.6)	33 (11.1)	36 (14.6)	0.65
Sex-Female, n (%)	29 (61%)	16 (57%)	13 (65%)	0.80
Race, n (%)ⁱⁱ
American Indian or Alaskan Native	0 (0%)	0 (0%)	0 (0%)	--
Asian	0 (0%)	0 (0%)	0 (0%)	--
Black or African   American	1 (2%)	1 (4%)	0 (0%)	--
White	48 (100%)	28 (100%)	20 (100%)	--
Other	0 (0%)	0 (0%)	0 (0%)	--
Ethnicity, n (%)
Hispanic/Latino	1 (2%)	1 (4%)	0 (0%)	--
Not Hispanic/Latino	46 (96%)	26 (93%)	20 (100%)	--
Unknown	1 (2%)	1 (4%)	0 (100%)	--
Comorbid Psychiatric Disorders, n (%)ⁱⁱⁱ
Any Psychiatric Disorder	32 (67%)	20 (71%)	14 (70%)	1.00
Anxiety Disorder^iv	32 (67%)	18 (64%)	14 (70%)	0.92
Depression	22 (46%)	15 (54%)	7 (35%)	0.33
Obsessive Compulsive Disorder (OCD)	3 (7%)	1 (4%)	2 (10%)	0.76
Schizophrenia	0 (0%)	0 (0%)	0 (0%)	0.25
Bipolar Disorder	3 (7%)	1 (4%)	2 (10%)	0.76
Substance Abuse	2 (5%)	1 (4%)	1 (5%)	1.00
Post-Traumatic Stress Disorder (PTSD)	5 (90%)	5 (18%)	0 (0%)	0.13
Attention Deficient Hyperactive Disorder (ADHD)	1 (3%)	0 (0%)	1 (5%)	0.86
Patient Assessment of Gastrointestinal Disorders-Symptoms Severity Index (PAGI-SYM), M(SD)
Total	1.3 (0.91)	1.5 (0.93)	1.2 (0.88)	0.30
Heartburn/Regurgitation	1.4 (1.1)	1.5 (1.2)	1.1 (0.90)	0.32
Fullness/Satiety	1.6 (1.3)	1.9 (1.3)	1.2 (1.2)	0.04
Nausea/Vomiting	1.5 (0.95)	1.5 (0.90)	1.6 (1.1)	1.00
Bloating/Distension	1.3 (1.2)	1.4 (1.2)	1.2 (1.1)	0.40
Upper Abdominal Pain	1.1 (1.0)	1.2 (1.1)	0.88 (0.97)	0.40
Lower Abdominal Pain	0.78 (0.99)	0.89 (1.1)	0.63 (0.78)	0.48
Patient Assessment of Upper Gastrointestinal Disorders-Quality of Life (PAGI-QOL), M(SD)
Total	1.7 (1.2)	2.0 (1.3)	1.3 (0.8)	0.07
Daily Activities	1.9 (1.3)	2.2 (1.4)	1.6 (1.2)	0.12
Clothing	1.1 (1.5)	1.4 (1.7)	0.75 (1.3)	0.19
Diet and Food Habits	2.1 (1.6)	2.3 (1.5)	1.8 (1.6)	0.21
Relationship	1.1 (1.5)	1.5 (1.7)	0.62 (0.7)	0.16
Psychological Well-Being/Distress	1.9 (1.5)	2.4 (1.6)	1.3 (1.0)	0.03
Short Form-36 (SF-36), M(SD)
Physical Component Summary (PCS)	44 (11)	45 (10)	42 (13)	0.93
Mental Component Summary (MCS)	40 (15)	36 (14)	46 (14)	0.01
Hospital Anxiety and Depression Score (HADS), M(SD)
Anxiety	11 (2.2)	11 (2.5)	11 (1.8)	0.36
Depression	6.3 (3.1)	7.3 (3.3)	5.0 (2.0)	0.02

Table: Table 1: Demographics and clinical characteristics of adults with cyclic vomiting syndrome.

Footnotes:
i. Continuous variables analyzed with Kruskal Wallis H-Tests for non-normally distributed data. Categorical variables analyzed with Pearson’s Chi-squared Tests for descriptive purposes.
ii. Subjects could select more than one race category.
iii. Subjects could select more than one psychiatric disorder.
iv. Anxiety disorders included generalized anxiety disorder and panic disorder.

Disclosures:

Katheryn Kiser indicated no relevant financial relationships.

Braden Kuo: Medtronic – Grant/Research Support, Speakers Bureau. Phathom – Consultant. Takeda – Consultant, Grant/Research Support.

Helen Burton Murray indicated no relevant financial relationships.

Kyle Staller: Arena Pharmaceuticals, Gelesis, GI Supply, and Shire (Takeda Pharmaceutical Company Ltd) – Consultant. Ironwood Pharmaceuticals, Inc. and Urovant Sciences, Inc. – Grant/Research Support.

Katheryn G. Kiser, BA, Braden Kuo, MD, Helen Burton Murray, PhD, Kyle Staller, MD, MPH. C0270 - The Contribution of Psychiatric Comorbidity and Cannabis Usage to Cyclic Vomiting Syndrome Severity, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.