Cannabis and GI Disorders

Pylorospasm reflux

Pylorospasm
Failure of normal relaxation of the pylorus which causes symptoms of pain and vomiting due to gastric outlet obstruction.  It may be seen with anthritis, both infective and chemical, this latter often due to bile reflux and ulceration and during the development of  hypertrophic pyloric stenosis.   It is also seen in apprehensive children, a particular problem in performing upper gastrointestinal contrast studies.  During ultrasound, there is failure of relaxation of the pylorus by normal measurements.  The canal fails to relax and open normally during fluoroscopy.

What exactly is meant by pylorospasm?  During conventional radiological examinations, with the patient in the erect position, and in the absence of an organic lesion in the upper gastrointestinal tract, it is not unusual to observe a delay in gastric emptying of liquid barium suspension.  This, in many instances, is still considered to be caused by pylorospasm,  by which is implied spasm of the pyloric ring, which is equated with the sphincter.  The question may well be asked whether the ring is spastic in these cases.  If it were, it could be expected to remain spastic irrespective of the position of the patient.

There has been much uncertainty about the concept "pylorospasm".  For many years radiologists considered pylorospasm to be due to spasm of the pyloric ring, where the ring was equated with the pyloric sphincter. It was thought that spasm of the ring (or "sphincter") closed the pyloric aperture, thereby delaying gastric emptying and causing retention.  In other words, whenever the barium-filled stomach showed delayed emptying, or failed to empty within a certain prescribed time (in the absence of an organic lesion), older radiologists were inclined to label the condition "pylorospasm".   This commonly made diagnosis, was usually accepted by clinicians, and probably had an erroneous bearing on the perception of many intra-abdominal conditions.  Pylorospasm reflux is a chronic condition.

Definition of REFLUX-a flowing back. 

The Role of Cannabinoids in the GI System

Symptoms of GI disorders often include cramping, abdominal pain, inflammation of the lining of the large and/or small intestine, chronic diarrhea, rectal bleeding and weight loss.  Although several anecdotal reports and a handful of case reports exist in the scientific literature supporting the use of cannabinoids to treat symptoms of GI disorders, virtually no clinical trial work has been performed in this area, aside from a 2007  clinical study assessing the impact of oral THC on colonic motility. 

However, numerous preclinical studies demonstrate that activation of the CB1 and CB2 cannabinoid receptors exert biological functions on the gastrointestinal tract.  Effects of t heir activation in animals include suppression of gastrointestinal motility, inhibition of intestinal secretion, reduced acid reflux, and protection from inflammation, as well as the promotion of epithelial wound healing in human tissue.  As a result, many experts now believe that cannabinoids and/or modulation of the endogenous cannabinoid system represents a novel therapeutic approach for the treatment of numerous GI disorders .

CANNABIS AND GI DISORDERS

The effectiveness of cannabis for treating symptoms related to gastrointestinal disorders is widely recognized.  Its value as an anti-emetic and analgesic has been proven in numerous studies and has been acknowledged by several comprehensive, government-sponsored reviews, including those conducted by the Institute of Medicine (IOM), the U.K. House of Lords Science and Technology Committee, the Australian National Task Force on Cannabis, and others. The IOM concluded, "For patients who suffer simultaneously from severe pain, nausea, and appetite loss, cannabinoid drugs might offer broad-spectrum relief not found in any other single medication."

The most common gastrointestinal disorders-Irritable Bowel Syndrome and Inflammatory Bowel Disease-affect millions of people.  The disorders are different, but each causes a great deal of discomfort and distress and both can be disabling. Painful cramping, chronic diarrhea or constipation, nausea, and inflammation of the intestines are all symptoms of these GI disorders that can be alleviated by cannabis.

Irritable Bowel Syndrome (IBS) is a common disorder of the intestines that leads to stomach pain, gassiness, bloating, constipation, diarrhea or both.  Chronic, painful abdominal cramping is common.  The cause of IBS is not known, and there is no cure.  Researchers have found that the colon muscle of a person with IBS begins to spasm after only mild stimulation.  IBS is at least partly a disorder affecting colon motility and sensation.

Inflammatory Bowel Disease (IBD) refers to both Ulcerative Colitis and Crohn's Disease.  Ulcerative colitis causes inflammation of the lining of the large intestine, while Crohn's disease causes inflammation of the lining and wall of the large and/or small intestine.  The causes of IBD are not known, but there are indications that the disease has a genetic component.  The immune system changes that accompany IBD suggest that it may be an immune disorder.

The most common symptoms of Crohn's Disease are pain in the abdomen, diarrhea, and weight loss.  There may also be rectal bleeding and fever.  The most common complications of Crohn's Disease are blockage of the intestine and ulceration that breaks through into surrounding tissues.  Surgery is sometimes required.

The symptoms of Ulcerative Colitis include diarrhea, abdominal cramps, and rectal bleeding.  Some people may be very tired and have weight loss, loss of appetite, abdominal pain, and loss of body fluids and nutrients. Joint pain, liver problems, and redness and swelling of the eyes can also occur.  Hospitalization and surgery are sometimes needed. 

Research on cannabis and GI disorders

Research suggests that cannabis is effective in treating the symptoms of these GI disorders in part because it interacts with the endogenous cannabinoid receptors in the digestive tract, which can result in calming spasms, assuaging pain, and improving motility.  Cannabis has also been shown to have anti-inflammatory properties  and recent research has demonstrated that cannabinoids are immune system modulators, either enhancing or suppressing immune response.
Cannabis has a long documented history of use in treating GI distress, going back more than a century in western medicine, and far longer in the east.  While clinical studies on the use of cannabis for the treatment of gastrointestinal disorders have been largely limited to investigations on nausea suppression and appetite stimulation—two conditions for which cannabis has been consistently shown to be highly effective—the evidence in support of cannabis therapy for other gastrointestinal diseases and disorders is also strong. There is now extensive anecdotal evidence from patients with IBS, Crohn's disease and other painful GI disorders that cannabis eases cramping and helps modulate diarrhea, constipation and acid reflux.  Recent laboratory research on the endogenous cannabinoid system in humans has identified that there are many cannabinoid receptors located in both the large and small intestines.

Cannabis and new cannabinoid drugs are attractive for GI treatment because they can address a number of symptoms at once with minimal side effects.  Cannabinoids alter how the gut feels, affect the signals the brain sends back and forth to the gut and modulate the actions of the GI tract itself.
Beginning in the 1970s, a series of human clinical trials established cannabis' ability to stimulate food intake and weight gain in healthy volunteers.  In a randomized trial, THC significantly improved appetite and nausea in comparison with placebo.  There were also trends towards improved mood and weight gain. Unwanted effects were generally mild or moderate in intensity.  Cannabis helps combat the painful and often debilitating cramping that accompanies many GI disorders because cannabinoids relax contractions of the smooth muscle of the intestines.  In fact, smooth-muscle relaxant properties of cannabinoids are so well established that preparations of guinea-pig intestine are routinely used as an in vitro screening tool to test the potency and function of synthetic cannabinoids.

Research on a variety of rodents has shown that endogenous cannabinoids play crucial neuromodulatory roles in controlling the operation of the gastrointestinal system, with synthetic and natural cannabinoids acting powerfully to control gastrointestinal motility and inflammation.  Cannabinoid receptors comprise G-protein coupled receptors that are predominantly in enteric and central neurones (CB1R) and immune cells (CB2R).  The digestive tract contains endogenous cannabinoids (anandamide and 2-arachidonylglycerol) and cannabinoid CB1 receptors can be found on myenteric and submucosal nerves. Activating cannabinoid receptors has been demonstrated to inhibit gastrointestinal fluid secretion and inflammation in animal models.

In the last decade, evidence obtained from the use of selective agonists and inverse agonists/antagonists indicates that manipulation of CB1R can have significant results.  Research has also shown that in the case of intestinal inflammation, the body will increase the number of cannabinoid receptors in the area in an attempt to regulate the inflammation by processing more cannabinoids.
Cannabinoids have a demonstrated ability to block spinal, peripheral and gastrointestinal mechanisms that promote pain in IBS and related disorders.   Animal  research also indicates that cannabinoids work well in controlling gastroesophageal reflux disease, a condition in which gastric acids attack the esophagus and for which commonly prescribed medications, such as atropine, have serious adverse side effects.

From this evidence, many researchers have concluded that pharmacological modulation of the endogenous cannabinoid system provides new treatment options for a number of gastrointestinal diseases, including nausea and vomiting, gastric ulcers, irritable bowel syndrome, Crohn's disease, secretory diarrhea, paralytic ileus and gastroesophageal reflux disease.  The experience of patients with these GI disorders shows that for broad-spectrum relief, cannabis is highly effective and frequently helps when other treatment options prove ineffective.

How Cannabis Compares to Other Treatments

The medications currently employed to fight chronic GI disorders include many that produce serious side effects.  These side effects frequently threaten the health of the patient and require other medications to combat them.  Drugs commonly prescribed to combat GI disorders include:

Megestrol acetate (Megace)

an anticachectic. Serious side effects of this medicine include high blood pressure, diabetes, inflammation of the blood vessels, congestive heart failure, seizures, and pneumonia. Less serious side effects of this medicine include diarrhea, flatulence, nausea, vomiting, constipation, heartburn, dry mouth, increased salivation, and thrush; impotence, decreased libido, urinary frequency, urinary incontinence, urinary tract infection, vaginal bleeding and discharge; disease of the heart, palpitation, chest pain, chest pressure, and edema; pharyngitis, lung disorders, and rapid breathing; insomnia, headache, weakness, numbness, seizures, depression, and abnormal thinking.

Prednisone (Delatasone)

like all steroids, can have serious adverse musculoskeletal, gastrointestinal, dermatologic, neurological, endocrine, and ophthalmic side effects.  These include: congestive heart failure in susceptible patients, potassium loss, hypokalemic alkalosis, sodium retention, and hypertension.  Muscle weakness, steriod myopathy, loss of muscle mass, osteoporosis, tendon rupture, vertebral compression fractures, aseptic necrosis of femoral and humeral heads, and pathologic fracture of long bones.  Peptic ulcer with possible perforation and hemorrhage;  pancreatitis; abdominal distention;  ulcerative esophagitis. Impaired wound healing, thin fragile skin, petechiae and ecchymoses, facial erythema.  Increased intracranial pressure (pseudo-tumor cerebri) usually after treatment, convulsions, vertigo, and headache. Menstrual irregularities;  development of Cushingoid state;  secondary adrenocortical and pituitary unresponsiveness;  decreased carbohydrate tolerance; manifestations of latent diabetes mellitus.  Posterior subcapsular cataracts, increased intraocular pressure, glaucoma, and exophthalmos.

Metronidazole (Flagyl)

has been shown to be carcinogenic in mice and rats.  Two serious adverse reactions reported in patients treated with Metronidazole have been convulsive seizures and peripheral neuropathy, the latter characterized mainly by numbness or paresthesia of an extremity.  The most common adverse reactions reported have been referable to the gastrointestinal tract, particularly nausea reported by about 12% of patients, sometimes accompanied by headache, anorexia, and occasionally vomiting;  diarrhea;  epigastric distress, and abdominal cramping.  Constipation has been reported.

Sulfasalazine (Azulfidine)

The most common adverse reactions associated with sulfasalazine are anorexia, headache, nausea, vomiting, gastric distress, and apparently reversible oligospermia. These occur in about one-third of the patients.  Less frequent adverse reactions are pruritus, urticaria, fever, Heinz body anemia, hemolytic anemia and cyanosis, which may occur at a frequency of one in every thirty patients or less.

Chlordiazepoxide/Clidinium (Librax)

Drowsiness, ataxia and confusion have been reported in some patients, particularly the elderly and debilitated.  Adverse effects reported with use of Librax are those typical of anticholinergic agents,  i.e., dryness of the mouth, blurring of vision, urinary hesitancy and constipation.  Withdrawal symptoms, similar in character to those noted with barbiturates and alcohol (convulsions, tremor, abdominal and muscle cramps, vomiting and sweating), have occurred following abrupt discontinuance of chlordiazepoxide.

Hyoscyamine Sulfate (Levsin)

Adverse reactions may include dryness of the mouth; urinary hesitancy and retention; blurred vision; tachycardia; palpitations; mydriasis; cycloplegia; increased ocular tension; loss of taste; headache; nervousness; drowsiness; weakness; dizziness; insomnia; nausea; vomiting; impotence; suppression of lactation; constipation; bloated feeling; allergic reactions or drug idiosyncrasies; urticaria and other dermal manifestations; ataxia; speech disturbance; some degree of mental confusion and/or excitement (especially in elderly persons); and decreased sweating.

Mesalamine CR (Pentasa)

The most common side effects are diarrhea, headache, nausea, abdominal pain, dyspepsia, vomiting, and rash.

Phosphorated carbohydrate (Emetrol)

Side effects include: fainting; swelling of face, arms, and legs; unusual bleeding; vomiting; weight loss; yellow eyes or skin. Less common-more common with large doses: Diarrhea; stomach or abdominal pain.

Dicyclomine (Bentyl)

The most common side effects occurring with dicyclomine are due to its anticholinergic activity: dry mouth, blurred vision, confusion, agitation, increased heart rate, heart palpitations, constipation, difficulty urinating, and occasionally seizures can occur. Other potential side effects include changes in taste perception, difficulty swallowing, headache, nervousness, drowsiness, weakness, dizziness, impotence, flushing, difficulty falling asleep, nausea, vomiting, rash, and a bloated feeling.

Ciprofloxacin (Cipro)

The most frequent side effects include nausea, vomiting, diarrhea, abdominal pain, rash, headache, and restlessness.  Rare allergic reactions have been described, such as hives and anaphylaxis.

Methotrexate (Rheumatrex, Trexall)

can cause severe toxicity that is usually related to the dose taken. The most frequent reactions include mouth sores, stomach upset, and low white blood counts. Methotrexate can cause severe toxicity of the liver and bone marrow, which require regular monitoring with blood testing. It can cause headache and drowsiness, which may resolve if the dose is lowered. Methotrexate can cause itching, skin rash, dizziness, and hair loss.  A dry, non-productive cough can be a result of a rare lung toxicity.

Diphenoxylate and atropine (Lotomil)

The most common side effects include drowsiness, dizziness, and headache, nausea or vomiting, and dry mouth. Euphoria, depression, lethargy, restlessness, numbness of extremities, loss of appetite, and abdominal pain or discomfort have been reported less frequently. Although the dose of atropine in Lomotil is too low to cause side effects when taken in the recommended doses, side effects of atropine (including dryness of the skin and mucous membranes, increased heart rate, urinary retention, and increased body temperature) have been reported, particularly in children under two. span>

Cannabis

By comparison, the side effects associated with cannabis are typically mild and are classified as "low risk."  Euphoric mood changes are among the most frequent side effects.  Cannabinoids can exacerbate schizophrenic psychosis in predisposed persons.  Cannabinoids impede cognitive and psychomotor performance, resulting in temporary impairment.  Chronic use can lead to the development of tolerance. Tachycardia and hypotension are frequently documented as adverse events in the cardiovascular system.  A few cases of myocardial ischemia have been reported in young and previously healthy patients.  Inhaling the smoke of cannabis cigarettes induces side effects on the respiratory system.  Cannabinoids are contraindicated for patients with a history of cardiac ischemias.

In summary,  a low risk profile is evident from the literature available.  Serious complications are very rare and are not usually reported during the use of cannabinoids for medical indications.

Is Cannabis Safe?

"The smoking of cannabis, even long term, is not harmful to health...." So began a 1995 editorial statement of Great Britain's leading medical journal, The Lancet.  
The long history of human use of cannabis also attests to its safety—nearly 5,000 years of documented use without a single death.  In the same year as the Lancet editorial, Dr. Lester Grinspoon, a professor emeritus at Harvard Medical School who has published many influential books and articles on medical use of cannabis, had this to say in an article in the Journal of the American Medical Association (1995):
"One of marihuana's greatest advantages as a medicine is its remarkable safety.  It has little effect on major physiological functions.  There is no known case of a lethal overdose; on the basis of animal models, the ratio of lethal to effective dose is estimated at 40,000 to 1.  By comparison, the ratio is between 3 and 50 to 1 for secobarbital and between 4 and 10 to 1 for ethanol.  Marihuana is also far less addictive and far less subject to abuse than many drugs now used as muscle relaxants, hypnotics, and analgesics.  The chief legitimate concern is the effect of smoking on the lungs.  Cannabis smoke carries even more tars and other particulate matter than tobacco smoke.  But the amount smoked is much less, especially in medical use, and once marihuana is an openly recognized medicine, solutions may be found;  ultimately a technology for the inhalation of cannabinoid vapors could be developed."  (vaporizer)!!

The technology Dr. Grinspoon imagined in 1995 now exists in the form of "vaporizers," (which are widely available through stores and by mail-order) and recent research attests to their efficacy and safety. Additionally, pharmaceutical companies have developed sublingual sprays and tablet forms of the drug. Patients and doctors have found other ways to avoid the potential problems associated with smoking, though long-term studies of even the heaviest users in Jamaica, Turkey and the U.S. have not found increased incidence of lung disease or other respiratory problems.  As Dr. Grinspoon goes on to say, "the greatest danger in medical use of marihuana is its illegality, which imposes much anxiety and expense on suffering people, forces them to bargain with illicit drug dealers, and exposes them to the threat of criminal prosecution."  This was the same conclusion reached by the House of Lords report, which recommended rescheduling and decriminalization, both of which were enacted in Great Britain in 2004.

Endogenous Cannabinoids (Endocannabinoids)

Endocannabinoids are produced 'on demand' from fatty acid precursors and are released into the extracellular space to bind to CBs (Figure 1).  The first endocannabinoids investigated in the GI tract were anandamide and 2-arachidonoylglycerol (2-AG) during croton oil-induced intestinal inflammation in mice.  Basal levels of 2-AG are higher than those of anandamide in mouse and human gut  but despite this difference, anandamide may have more importance in CB signaling than 2-AG owing to its stronger affinity to CB1 and higher activity of its synthetic and degradative enzymes.   Anandamide is also known to activate transient receptor potential vanilloid receptor (TRPV)1, the capsaicin receptor,  which may be important in the induction of neurogenic inflammation and hypersensitivity in the GI tract.

Cannabis and Gastrointestinal Disorders

Studies indicate that cannabinoids in marijuana bind with cannabinoid receptors in the digestive tract, especially the small and large intestine, causing muscle relaxation, reduction of inflammation, analgesia, increased nerve-muscle coordination, anti-emesis, and relief of spasms

 Medical benefits of marijuana for people with gastrointestinal disorders were backed up by the United States Institute of Medicine ( medical marijuana study).   According to the Institute, "For patients who suffer simultaneously from severe pain, nausea, and appetite loss, cannabinoid drugs might offer broad-spectrum relief not found in any other single medication."

Irritable Bowel Syndrome (IBS) can cause pain, bloating, flatulence, cramps, spasms, motility loss, constipation, and diarrhea.  Medical cannabis has been a blessing for people with Irritable Bowel Syndrome and Inflammatory Bowel Disease.  These diseases cause diarrhea or constipation, nausea, and intestinal inflammation, pain and the inability of the digestive system to absorb nutrients.

Inflammatory Bowel Disease (IBD) is a term that describes Ulcerative Colitis and Crohn's Disease. Ulcerative colitis inflames the lining of the large intestine.  Crohn's disease causes inflammation of the lining and wall of the large and/or small intestine.  The typical symptoms of Crohn's are diarrhea, weight loss, abdominal pain, rectal bleeding and fever.  Crohn’s can cause intestinal blockages and ulcerations that might require surgery.   Ulcerative Colitis can cause abdominal cramps, sharp pain, low energy, weight loss, arthritic symptoms, eye problems, and liver disease.   These disorders can be crippling.  In extreme cases, they may result in long-term hospitalization or surgery.  The unique ability of medical cannabis to alleviate most of these symptoms is becoming more widely known in the medical community.

Recreational and medical marijuana users have long known that cannabis has an effect on appetite.  The increase in appetite that often accompanies cannabis use has been called "the munchies."
Scientists studying this phenomenon note that it probably involves blood sugar levels and other physiological markers affected by cannabis.  Many professional studies have shown that cannabis stimulates appetite and weight gain.  Researchers say that medical cannabis users have to be careful to moderate their intake of carbohydrates and sugars when they are responding to the munchies.  It is best to eat less carbos and sugars and eat more organic vegetables, fruits and protein, rather than to pig out on candy or ice cream.

Cannabis helps combat cramping that accompanies many GI disorders because cannabinoids  relax contractions of the smooth muscle of the intestines.  Research shows that the body’s own cannabinoids, known as anandamides, affect neurological systems that control the gastrointestinal system.  External and internal cannabinoids strongly control gastrointestinal motility and inflammation.  They also have the ability to decrease gastrointestinal fluid secretion and inflammation.  This means that cannabis can be useful to stop ulcers and other syndromes.

The chronic pain and spasms that accompany many gastrointestinal disorders are a life hindrance to those who suffer from IBS and other diseases.  Medical cannabis is a very effective pain reliever.  It blocks spinal, peripheral and gastrointestinal mechanisms that promote pain in IBS and related disorders.  The chronic pain and spasms that accompany many gastrointestinal disorders are a life hindrance to those who suffer from IBS and other diseases.  Medical cannabis is a very effective pain reliever.  It blocks spinal, peripheral and gastrointestinal mechanisms that promote pain in IBS and related disorders.  It also can be used against gastroesophageal reflux disease (acid reflux).  When acid reflux occurs, gastric acids attack the esophagus. The pharmaceutical medicines that doctors prescribe for this condition are in some ways as bad as the condition itself.  They prescribe drugs like atropine, for example, which have severe side-effects.

 

The overall opinion of enlightened people in the medical community is that medical cannabis can interact with the endogenous cannabinoid system to reduce problems associated with nausea, vomiting, gastric ulcers, irritable bowel syndrome, Crohn's disease, secretory diarrhea, paralytic ileus and gastroesophageal reflux disease.

Cannabinoids for gastrointestinal diseases: potential therapeutic applications

Giulia Di Carlo & Angelo A Izzo†

Δ9-Tetrahydrocannabinol (the active ingredient of marijuana), as well as endogenous and synthetic cannabinoids, exert many biological functions by activating two types of cannabinoid receptors, CB1 and CB2 receptors., CB1 receptors have been detected on enteric nerves, and pharmacological effects
of their activation include gastroprotection, reduction of gastric and intestinal motility and reduction of intestinal secretion.  The digestive tract also contains endogenous cannabinoids (i.e., the endocannabinoids anandamide and 2-aracidonylglycerol) and mechanisms for endocannabinoid inactivation (i.e.,
endocannabinoids uptake and enzymatic degradation).  Cannabinoid receptors, endocannabinoids and the proteins involved in endocannabinoids inactivation are collectively referred as the ‘endogenous cannabinoid system’.  A pharmacological modulation of the endogenous cannabinoid system could

provide new therapeutics for the treatment of a number of gastrointestinal diseases, including nausea and vomiting, gastric ulcers, irritable bowel syndrome, Crohn’s disease, secretory diarrhoea, paralytic ileus and gastroesophageal reflux disease.  Some cannabinoids are already in use clinically, for example, nabilone and Δ9-tetrahydrocannabinol are used as antiemetics.
These include sedation, cognitive dysfunction, ataxia and immunosuppressant effects, as well as psychotropic effects. 
Finally, animal studies suggest that the cannabimimetic substance palmitoylethanolamide (a fatty acid ethanolamide coreleased with anandamide from nerves) possesses antiinflammatory and antimotility actions which are not mediated by cannabinoid receptor activation .  These effects open up the possibility that this compound, which, unlike anandamide, has weak psychotropic effects, can be used as a possible therapeutic drug for the treatment of intestinal hypermotility during inflammatory bowel diseases.
Gastrointestinal (or GI) problems can include difficulty taking in food/nourishment (appetite or nausea and vomiting problems), inadequate absorption of nutrients, elimination problems (constipation, diarrhea, irritable bowel) and/or cancer developing anywhere along the GI tract from mouth to esophagus to stomach to the small and large intestines, ending at the anus. Anecdotal experiences are numerous among patients suffering from Crohn's disease, Ulcerative Colitis, Irritable Bowel Syndrome in their use of medicinal cannabis. The anti-inflammatory and relaxant effects of cannabis may be responsible for some of their relief.

Nausea and vomiting can occur as a result of a variety of conditions such as acute viral illness (the flu), cancer, cancer chemotherapy or side effects from other medications, radiation treatment, post-operative recovery, pregnancy, motion sickness and poisoning.  There is clear evidence-based research that supports the anti-emetic effects of cannabis for persons suffering from nausea and vomiting.  The 1999 IOM report, Marijuana and Medicine:   Assessing the Science Base, agreed that the evidence supported the anti-emetic effects of cannabis, but expressed concern related to smoking the plant material.  While inhalation allows for immediate relief, clinicians should be recommending vaporization rather than smoking to eliminate this concern.

Mainz, Germany:  Cannabinoids protect the gastrointestinal (GI) tract from inflammation and abnormally high gastric secretions, and could potentially treat numerous GI-related disorders such as Crohn's disease and irritable bowl syndrome, according to review data published in the Journal of Endocrinological Investigation.

Investigators at Germany's Johannes Gutenberg University report that activation of the body's cannabinoid receptors protect the gastrointestinal tract from inflammation and modulate gastric secretions and intestinal motility.  "For such protective activities, the endocannabinoid system may represent a new promising therapeutic target against different GI disorders, including inflammatory bowel diseases, functional bowel diseases, and secretion and motility disorders,"  they conclude.

Though the use of cannabis to treat symptoms of GI disorders has been reported anecdotally for several decades, virtually no clinical trials on the subject have been conducted.  Survey data reported last fall in O'Shaughnessy's:   The Journal of Cannabis in Clinical Practice, found that Crohn's patients experienced subjective benefits from cannabis, including pain relief and increased appetite.  German investigators at the University Hospital in Munich are now assessing the efficacy of cannabis extracts for the treatment of Crohn's.

Researchers in the United Kingdom also reported last year that cannabinoids promote healing in the gastrointestinal membrane.

Authors Notes

All the research seems to agree that cannabis is an excellent treatment for gastrointestinal difficulties.  Cannabis  works as a cure for symptoms but also as a treatment ( and cure ) for the disorders themselves. 

Recommendation:

Whole plant extracts taken as tinctures, teas, sprays, edibles, suppositories and vaporizer.  A Sativa x Indica hybrid.

References


[1] Gahlinger, Paul M. 1984. Gastrointestinal illness and cannabis use in a rural Canadian community. Journal of
Psychoactive Drugs 16: 263-265.
[2] Swift et al. 2005. Survey of Australians using cannabis for medical purposes. Harm Reduction Journal 4: 2-18.
[3] Baron et al. 1990. Ulcerative colitis and marijuana. Annals of Internal Medicine 112: 471.
[4] Jeff Hergenrather. 2005. Cannabis alleviates symptoms of Crohn’s Disease. O’Shaughnessy’s 2: 3.
[5] Esfandyari et al. 2007. Effects of a cannabinoid receptor agonist on colonic motor and sensory functions in humans: a
randomized, placebo-controlled study. American Journal of Physiology, Gastrointestinal and Liver Physiology 293: 137-145. REFERENCES
[1] Gahlinger, Paul M. 1984. Gastrointestinal illness and cannabis use in a rural Canadian community. Journal of
Psychoactive Drugs 16: 263]265.
[2] Swift et al. 2005. Survey of Australians using cannabis for medical purposes. Harm Reduction Journal 4: 2]18.
[3] Baron et al. 1990. Ulcerative colitis and marijuana. Annals of Internal Medicine 112: 471.
[4] Jeff Hergenrather. 2005. Cannabis alleviates symptoms of Crohnfs Disease. OfShaughnessyfs 2: 3.
[5] Esfandyari et al. 2007. Effects of a cannabinoid receptor agonist on colonic motor and sensory functions in humans: a
randomized, placebo]controlled study. American Journal of Physiology, Gastrointestinal and Liver Physiology 293: 137]145.

Research Articles on Cannabis and Gastrointestinal Disorders

Coutts, A. A., & Izzo, A. A. (2004). The gastrointestinal pharmacology of cannabinoids: an update. Curr Opin Pharmacol, 4(6), 572-579.
Di Carlo, G., & Izzo, A. A. (2003). Cannabinoids for gastrointestinal diseases: potential therapeutic applications. Expert Opin Investig Drugs, 12(1), 39-49.
Gabbay, E., Avraham, Y., Ilan, Y., Israeli, E., & Berry, E. M. (2005). Endocannabinoids and liver disease--review. Liver Int, 25(5), 921-926.
Massa, F., & Monory, K. (2006). Endocannabinoids and the gastrointestinal tract. J Endocrinol Invest, 29(3 Suppl), 47-57.
Pertwee, R. G. (2001b). Cannabinoids and the gastrointestinal tract. Gut, 48(6), 859-867.
Russo, E. B. (2004). Clinical endocannabinoid deficiency (CECD): Can this concept explain therapeutic benefits of cannabis in migraine, fibromyalgia, irritable bowel syndrome and other treatment-resistant conditions? Neuroendocrinol Lett, 25(1-2), 31-39.
Sylvestre, D. L., Clements, B. J., & Malibu, Y. (2006). Cannabis use improves retention and virological outcomes in patients treated for hepatitis C. Eur J Gastroenterol Hepatol, 18(10), 1057-1063.
Wright, K., Rooney, N., Feeney, M., Tate, J., Robertson, D., Welham, M., et al. (2005). Differential expression of cannabinoid receptors in the human colon: cannabinoids promote epithelial wound healing. Gastroenterology, 129, 437-453.