Background and Aims: Inflammatory bowel disease (IBD) patients suffer from significant morbidity and diminished life quality. The plant cannabis is beneficial in various gastrointestinal diseases, stimulating appetite and causing weight gain. Our aims were to assess whether treatment with inhaled cannabis improves quality of life, disease activity and promotes weight gain in these patients. Methods: Patients with long-standing IBD who were prescribed cannabis treatment were included. Two quality of life questionnaires and disease activity indexes were performed, and patient’s body weight was measured before cannabis initiation and after 3 months’ treatment. Results: Thirteen patients were included. After 3 months’ treatment, patients reported improvement in general health perception (p = 0.001), social functioning (p = 0.0002), ability to work (p = 0.0005), physical pain (p = 0.004) and depression (p = 0.007). A schematic scale of health perception showed an improved score from 4.1 ± 1.43 to 7 ± 1.42 (p = 0.0002). Patients had a weight gain of 4.3 ± 2 kg during treatment (range 2–8; p = 0.0002) and an average rise in BMI of 1.4 ± 0.61 (range 0.8–2.7; p = 0.002). The average Harvey-Bradshaw index was reduced from 11.36 ± 3.17 to 5.72 ± 2.68 (p = 0.001). Conclusions: Three months’ treatment with inhaled cannabis improves quality of life measurements, disease activity index, and causes weight gain and rise in BMI in long-standing IBD patients.

1.
Love JR, Irvine EJ, Fedorak RN: Quality of life in IBD. J Clin Gastroenterol 1992;14:15–19.
[PubMed]
2.
Casellas F, Arenas JI, Baudet JS, et al: Impairment of health-related quality of life in patients with inflammatory bowel disease: a Spanish multicenter study. Inflamm Bowel Dis 2005;11:488–496.
[PubMed]
3.
Rubin GP, Hungin AP, Chinn DJ, et al: Quality of life in patients with established inflammatory bowel disease: a UK general practice survey. Aliment Pharmacol Ther 2004;19:529–535.
[PubMed]
4.
Casellas F, López-Vivancos J, Badia X, et al: Influence of inflammatory bowel disease on different dimensions of quality of life. Eur J Gastroenterol Hepatol 2001;13:567–572.
[PubMed]
5.
Canavan C, Abrams KR, Hawthorne B, et al: Long-term prognosis in Crohn’s disease: factors that affect quality of life. Aliment Pharmacol Ther 2006;23:377–385.
[PubMed]
6.
Hjortswang H, Järnerot G, Curman B, et al: The influence of demographic and disease-related factors on health-related quality of life in patients with ulcerative colitis. Eur J Gastroenterol Hepatol 2003;15:1011–1020.
[PubMed]
7.
Gearry RB, Barclay ML, Burt MJ, et al: Thiopurine drug adverse effects in a population of New Zealand patients with inflammatory bowel disease. Pharmacoepidemiol Drug Saf 2004;13:563–567.
[PubMed]
8.
Fraser AG, Orchard TR, Jewell DP: The efficacy of azathioprine for the treatment of inflammatory bowel disease: a 30-year review. Gut 2002;50:485–489.
[PubMed]
9.
Colombel JF, Loftus EV Jr, Tremaine WJ, et al: The safety profile of infliximab in patients with Crohn’s disease: the Mayo clinic experience in 500 patients. Gastroenterology 2004;126:19–31.
[PubMed]
10.
Schnitzler F, Fidder H, Ferrante M, et al: Long-term outcome of treatment with infliximab in 614 patients with Crohn’s disease: results from a single-centre cohort. Gut 2009;58:492–500.
[PubMed]
11.
Sandborn WJ, Loftus EV: Balancing the risks and benefits of infliximab in the treatment of inflammatory bowel disease. Gut 2004;53:780–782.
[PubMed]
12.
Lichtenstein GR, Feagan BG, Cohen RD, et al: Serious infections and mortality in association with therapies for Crohn’s disease: TREAT registry. Clin Gastroenterol Hepatol 2006;4:621–630.
[PubMed]
13.
Pertwee RG: Pharmacology of cannabinoid CB1 and CB2 receptors. Pharmacol Ther 1997;74:129–180.
[PubMed]
14.
Shook JE, Burks TF: Psychoactive cannabinoids reduce gastrointestinal propulsion and motility in rodents. J Pharmacol Exp Ther 1989;249:444–449.
[PubMed]
15.
Izzo AA, Mascolo N, Pinto L, et al: The role of cannabinoid receptors in intestinal motility, defaecation and diarrhoea in rats. Eur J Pharmacol 1999;384:37–42.
[PubMed]
16.
Landi M, Croci T, Rinaldi-Carmona M, et al: Modulation of gastric emptying and gastrointestinal transit in rats through intestinal cannabinoid CB(1) receptors. Eur J Pharmacol 2002;450:77–83.
[PubMed]
17.
Hornby PJ, Prouty SM: Involvement of cannabinoid receptors in gut motility and visceral perception. Br J Pharmacol 2004;141:1335–1345.
[PubMed]
18.
Stander S, Schmelz M, Metze D, Luger T, Rukwied R: Distribution of cannabinoid receptor 1 (CB1) and 2 (CB2) on sensory nerve fibers and adnexal structures in human skin. J Dermatol Sci 2005;38:177–188.
[PubMed]
19.
Klein TW: Cannabinoid-based drugs as anti-inflammatory therapeutics. Nat Rev Immunol 2005;5:400–411.
[PubMed]
20.
Klein TW, Newton C, Larsen K: The cannabinoid system and immune modulation. J Leukoc Biol 2003;74:486–496.
[PubMed]
21.
Samson MT, Small-Howard A, Shimoda LM, et al: Differential roles of CB1 and CB2 cannabinoid receptors in mast cells. J Immunol 2003;170:4953–4962.
[PubMed]
22.
Yuan M, Kiertscher SM, Cheng Q, et al: Delta 9-tetrahydrocannabinol regulates Th1/Th2 cytokine balance in activated human T cells. J Neuroimmunol 2002;133:124–131.
[PubMed]
23.
Klein TW, Newton C, Larsen K, et al: Cannabinoid receptors and T helper cells. J Neuroimmunol 2004;147:91–94.
[PubMed]
24.
Facchinetti F, Del Giudice E, Furegato S, et al: Cannabinoids ablate release of TNFalpha in rat microglial cells stimulated with lipopolysaccharide. Glia 2003;41:161–168.
[PubMed]
25.
Abel EL: Cannabis: effects on hunger and thirst. Behav Biol 1975;15:255–281.
[PubMed]
26.
Berry EM, Mechoulam R: Tetrahydrocannabinol and endocannabinoids in feeding and appetite. Pharmacol Ther 2002;95:185–190.
[PubMed]
27.
Di Marzo V, Matias I: Endocannabinoid control of food intake and energy balance. Nat Neurosci 2005;8:585–589.
[PubMed]
28.
Kirkham TC: Endocannabinoids in the regulation of appetite and body weight. Behav Pharmacol 2005;16:297–313.
[PubMed]
29.
Sharkey KA, Pittman QJ: Central and peripheral signaling mechanisms involved in endocannabinoid regulation of feeding: a perspective on the munchies. Sci STKE 2005;277:15.
30.
Pagotto U, Marsicano G, Cota D, et al: The emerging role of the endocannabinoid system in endocrine regulation and energy balance. Endocr Rev 2006;27:73–100.
[PubMed]
31.
Harvey R, Bradshaw J: A simple index of Crohn’s disease activity. Lancet 1980;i:514.
32.
Lewis JD, Chuai S, Nessel L, et al: Use of the noninvasive components of the Mayo score to assess clinical response in ulcerative colitis. Inflamm Bowel Dis 2008;14:1660–1666.
[PubMed]
33.
Izzo AA ,Mascolo N, Tonini M, et al: Modulation of peristalsis by cannabinoid CB1 ligands in the isolated guinea pig ileum. Br J Pharmacol 2000;129:984–990.
[PubMed]
34.
Heinemann A, Shahbazian A, Holzer P: Cannabinoid inhibition of guinea pig intestinal peristalsis via inhibition of excitatory and activation of inhibitory neural pathways. Neuropharmacology 1999;38:1289–1297.
[PubMed]
35.
Shook JE, Burks TF: Psychoactive cannabinoids reduce gastrointestinal propulsion and motility in rodents. J Pharmacol Exp Ther 1989;249:444–449.
[PubMed]
36.
Krowicki ZK, Moerschbaecher JM, Winsauer PJ, et al: Δ9-tetrahydrocannabinol inhibits gastric motility in the rat through cannabinoid CB1 receptors. Eur J Pharmacol 1999;371:187–196.
[PubMed]
37.
Coruzzi G, Adami M, Coppelli G, et al: Inhibitory effect of the cannabinoid receptor agonist WIN 55,212–2 on pentagastrin-induced gastric acid secretion in the anaesthetized rat. Naunyn Schmiedebergs Arch Pharmacol 1999;360:715–718.
[PubMed]
38.
Nalin DR, Rhead J, Rennels M, et al: Cannabis, hypochlorhydria and cholera. Lancet 1978;ii:859–862.
39.
Mechoulam R: The pharmacohistory of Cannabis sativa; in Mechoulam R (ed): Cannabinoids as Therapeutic Agents. Boca Raton, CRC Press, 1986, pp 1–19.
40.
Izzo AA, Fezza F, Capasso R, et al: Cannabinoid CB1-receptor mediated regulation of gastrointestinal motility in mice in a model of intestinal inflammation. Br J Pharmacol 2001;134:563–570.
[PubMed]
41.
Mathison R, Ho W, Pittman QJ, et al: Effects of cannabinoid receptor-2 activation on accelerated gastrointestinal transit in lipopolysaccharide-treated rats. Br J Pharmacol 2004;142:1247–1254.
[PubMed]
42.
Kimball ES, Schneider CR, Wallace NH, et al: Agonists of cannabinoid receptor 1 and 2 inhibit experimental colitis induced by oil of mustard and by dextran sulfate sodium. Am J Physiol Gastrointest Liver Physiol 2006;291:G364–G371.
[PubMed]
43.
Richardson JD, Aanonsen L, Hargreaves KM: Antihyperalgesic effects of spinal cannabinoids. Eur J Pharmacol 1998;345:145–153.
[PubMed]
44.
Siegling A, Hofmann HA, Denzer D, et al: Cannabinoid CB(1) receptor upregulation in a rat model of chronic neuropathic pain. Eur J Pharmacol 2001;415:R5–R7.
[PubMed]
45.
Sanson M, Bueno L, Fioramonti J: Involvement of cannabinoid receptors in inflammatory hypersensitivity to colonic distension in rats. Neurogastroenterol Motil 2006;18:949–956.
[PubMed]
46.
Hillsley K, McCaul C, Aerssens J, et al: Activation of the cannabinoid 2 (CB2) receptor inhibits murine mesenteric afferent nerve activity. Neurogastroenterol Motil 2007;19:769–777.
[PubMed]
47.
Lynn AB, Herkenham M: Localization of cannabinoid receptors and nonsaturable high-density cannabinoid binding sites in peripheral tissues of the rat: implications for receptor-mediated immune modulation by cannabinoids. J Pharmacol Exp Ther 1994;268:1612–1623.
[PubMed]
48.
Kulkarni-Narla A, Brown DR: Localization of CB1-cannabinoid receptor immunoreactivity in the porcine enteric nervous system. Cell Tissue Res 2000;302:73–80.
[PubMed]
49.
Roth MD, Baldwin GC, Tashkin DP: Effects of delta-9-tetrahydrocannabinol on human immune function and host defense. Chem Phys Lipids 2002;121:229–239.
[PubMed]
50.
Chang YH, Lee ST, Lin WW: Effects of cannabinoids on LPS-stimulated inflammatory mediator release from macrophages: involvement of eicosanoids. J Cell Biochem 2001;81:715–723.
[PubMed]
51.
Facchinetti F, Del Giudice E, Furegato S, et al: Cannabinoids ablate release of TNFalpha in rat microglial cells stimulated with lipopolysaccharide. Glia 2003;41:161–168.
[PubMed]
52.
Small-Howard AL, Shimoda LM, Adra CN, et al: Anti-inflammatory potential of CB1-mediated cAMP elevation in mast cells. Biochem J 2005;388:465–473.
[PubMed]
53.
Vannacci A, Passani MB, Pierpaoli S, et al: Nitric oxide modulates the inhibitory effect of cannabinoids on the immunological activation of guinea pig mast cells. Inflamm Res 2003;52(suppl 1):S7–S8.
54.
Pacher P, Batkai S, Kunos G: The endocannabinoid system as an emerging target of pharmacotherapy. Pharmacol Rev 2006;58:389–462.
[PubMed]
55.
Jamshidi N, Taylor DA: Anandamide administration into the ventromedial hypothalamus stimulates appetite in rats. Br J Pharmacol 2001;134:1151–1154.
[PubMed]
56.
Lynch ME, Young J, Clark AJ: A case series of patients using medicinal marihuana for management of chronic pain under the Canadian Marihuana Medical Access Regulations. J Pain Symptom Manage 2006;32:497–501.
[PubMed]
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