E0697 - Steroid Treatment for Patient With Intractable Nausea, Vomiting and Abdominal Pain With Underlying Autoimmune Gastritis

Tahmid Ahmed, ¹, Sarabdeep Mann, MD², Shifat Ahmed, MD^3
1University of Arizona College of Medicine, Phoenix, AZ; ²Arizona Digestive Health, Phoenix, AZ; ³Creighton University School of Medicine (Phoenix) Program/Saint Joseph's Hospital Medical Center, Phoenix, AZ

Introduction: Gastritis and cannabinoid hyperemesis syndrome (CHS) share many overlapping symptoms: nausea and vomiting (N&V), and abdominal pain.1 With the continued legalization and adoption of marijuana in the United States, it will become crucial to determine the etiology of the aforementioned cardinal symptoms to improve treatment plans.

Case Description/Methods: Pleasant 29-year-old male with PMH of N&V in teen years presents with onset of nausea and episodes of vomiting over the last few months. Patient complained of heightened baseline nausea, exacerbations of post-prandial N&V, and occasional N&V without food. Claims bloating and denied dysphagia, GERD, headaches, or visual changes. Minimal relief with use of marijuana and ondansetron and adverse symptoms with promethazine. EGD was performed with subsequent gastric biopsy positive for H pylori with concurrent autoimmune gastritis and underlying intestinal metaplasia; erythema and erosions found in the antrum and stomach body. Progressive worsening of symptoms, 20 lbs weight loss and LLQ abdominal pain prompted EGD and colonoscopy six weeks after initial upper endoscopy. Prior to EGD/Colonoscopy, patient reported previous history of yearly idiopathic pericarditis which is believed to be autoimmune in nature. Gastric mapping upon his second EGD showed ongoing autoimmune gastritis of the gastric body (lesser and greater curve). Prednisone 40 mg was started for patient with full resolution of GI symptoms in three weeks.

Discussion: Patient’s initial symptoms were believed to be related to CHS. However, further EGD evaluation and patient’s updated PMH of pericarditis suggest a possible autoimmune origin. With steroid use, patient found resolution with N&V and abdominal pain.

Hallmark symptoms of CHS are abdominal pain and recurring episodes of N&V with the cessation of adverse symptoms when cannabis use is stopped. If symptoms persist past cessation of cannabinoids, other sources of intractable N&V need to be evaluated. In the setting of autoimmune gastritis, with intractable nausea, vomiting, and abdominal pain, a trial of short-term steroids can be considered in a patient that has otherwise refractory GI symptoms, despite treatment of H Pylori and conservative pharmacologic management.


Disclosures:


Tahmid Ahmed, ¹, Sarabdeep Mann, MD², Shifat Ahmed, MD³. E0697 - Steroid Treatment for Patient With Intractable Nausea, Vomiting and Abdominal Pain With Underlying Autoimmune Gastritis, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.