Inflammatory bowel diseases (IBD), such as Crohn’s disease (MC), ulcerative colitis (CU), and some lesser-known forms, impose an immense burden on sufferers in terms of daily life and life satisfaction. The incidence of IBD is also steadily increasing, with the number of people affected worldwide rising from 3.7 million in 1990 to 6.8 million in 2017 [1]. Recent studies suggest that cannabinoids may improve patients’ quality of life.
All inflammatory bowel diseases have in common that the inflammation levels of the affected persons are elevated in blood and stool. In addition, active phases of the disease with severe diarrhea, abdominal pain and weight loss alternate with symptom-free intervals (“remission”). The goal of any therapy is therefore to alleviate the distressing symptoms and reduce the number of disease episodes. A complete cure is currently not possible, although long-lasting periods of rest can be achieved.
How are inflammatory bowel diseases treated?
Which drugs are used depends on which part of the intestine is affected by the inflammation. A distinction is also made between treatment of the acute episode and therapy during the symptom-free intervals.
For drug therapy, the following are considered:
- Corticosteroids
- Anti-inflammatory drugs such as aminosalicylates and Janus kinase inhibitors
- Immunosuppressants
- Biologics (so-called monoclonal antibodies)
Severe cases sometimes require surgery [2].
Side effects of drug therapy
Unfortunately, steroid therapy brings some unpleasant side effects, such as osteoporosis or weight gain. Treatment with immunosuppressants also increases the risk of fungal and viral infections because the body’s defenses are suppressed.
Many people with IBD therefore seek alternative treatment options, even though it is usually not possible to completely avoid taking steroids.
Is medical cannabis an alternative treatment for IDB?
Cannabinoids have anti-inflammatory and analgesic properties that can relieve the distressing symptoms of IBD patients.
High acceptance of cannabinoids among IBD patients
Thus, cannabis already seems to be popular among patients: In a 2017 meta-analysis, Austrian researchers concluded that affected individuals attribute positive effects on their disease to cannabis – for example, less diarrhea, abdominal pain, or nausea [3].
A cross-sectional survey from Germany (2021) came to a similar conclusion: according to the respondents, cannabis-based medicines improve symptoms typical for IBD, such as abdominal pain, inner restlessness, or anxiety [4].
Better quality of life with medical cannabis in Crohn’s disease
In a placebo-controlled study, a team of Israeli researchers was able to improve the still thin data on the improvement of Crohn’s disease symptoms with medical cannabis.
A total of 56 people were recruited for the study. One group received a cannabis oil high in cannabidiol and low in tetrahydrocannabinol (160/40 mg/ml CBD/THC) for eight weeks. The other group received a placebo. Disease parameters – including inflammation levels and endoscopic changes in the intestine – were collected beforehand.
In the cannabis group, significant clinical improvement in “health-related quality of life” was measured after two months. In contrast, there were no significant improvements in inflammatory parameters and endoscopic changes in the intestine [5].
Bowel diseases: Less anxiety and better sleep with pharmaceutical cannabis
IBD is often accompanied by severe psychological stress – especially during active episodes of the disease. Medical cannabis seems to be able to help here as well: A recent evaluation from Imperial College in London shows that cannabis medicines can improve anxiety and sleep quality in patients with Crohn’s disease and ulcerative colitis. The analysis included data from 76 subjects who were interviewed in writing before treatment with medical cannabis and again after one and three months [6].
Benefits of cannabinoids in IBD
- Anti-inflammatory effect
- Improve the mobility of the intestine
- Relieve pain
- Increase the sense of well-being
- Less need for steroids
Conclusion
The therapy of inflammatory bowel diseases often resembles a tightrope walk: in acute phases of the disease, steroids are usually indispensable, while at the same time the active substances cause unpleasant side effects. It therefore remains the challenging task of patients and their therapists to find those measures that enable the best individual therapeutic success.
Medical cannabis can be a component within this therapy planning, as it has an anti-inflammatory and pain-relieving effect and increases the patients’ life satisfaction.
Sources:
[1] Alatab, S., Sepanlou, S. G., Ikuta, K., Vahedi, H., Bisignano, C., Safiri, S., Sadeghi, A., Nixon, M. R., Abdoli, A., Abolhassani, H., Alipour, V., Almadi, M. A. H., Almasi-Hashiani, A., Anushiravani, A., Arabloo, J., Atique, S., Awasthi, A., Badawi, A., Baig, A. A. A., & Bhala, N. (2020). The global, regional, and national burden of inflammatory bowel disease in 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet Gastroenterology & Hepatology, 5(1), 17–30. https://doi.org/10.1016/s2468-1253(19)30333-4
[2] Das Gastroenterologie-Portal: CED – Chronisch entzündliche Darmerkrankungen. (n.d.). Dasgastroenterologieportal.de. Retrieved January 11, 2023, from https://dasgastroenterologieportal.de/CED_Chronisch_entzuendliche_Darmerkrankungen.html
[3] Hasenoehrl, C., Storr, M., & Schicho, R. (2017). Cannabinoids for treating inflammatory bowel diseases: where are we and where do we go? Expert Review of Gastroenterology & Hepatology, 11(4), 329–337. https://doi.org/10.1080/17474124.2017.1292851
[4] Langhorst, J., & Häuser, W. (n.d.). Querschnittserhebung: Cannabiskonsum von CED- Betroffenen in Deutschland. Bauchredner, 1/2022, 82–89.
[5] Naftali, T., Bar-Lev Schleider, L., Almog, S., Meiri, D., & Konikoff, F. M. (2021). Oral CBD-rich Cannabis Induces Clinical but Not Endoscopic Response in Patients with Crohn’s Disease, a Randomised Controlled Trial. Journal of Crohn’s and Colitis. https://doi.org/10.1093/ecco-jcc/jjab069
[6] Dalavaye, N., Erridge, S., Nicholas, M., Pillai, M., Bapir, L., Holvey, C., Coomber, R., Rucker, J. J., Hoare, J., & Sodergren, M. H. (2022). The effect of medical cannabis in inflammatory bowel disease: analysis from the UK Medical Cannabis Registry. Expert Review of Gastroenterology & Hepatology, 1–14. https://doi.org/10.1080/17474124.2022.2161046