humulene and Abdominal-Pain

The management of visceral pain in patients with disorders of gut-brain interaction, notably irritable bowel syndrome, presents a considerable clinical challenge, with few available treatment options. Patients are increasingly using cannabis and cannabinoids to control abdominal pain. Cannabis acts on receptors of the endocannabinoid system, an endogenous system of lipid mediators that regulates gastrointestinal function and pain processing pathways in health and disease. The endocannabinoid system represents a logical molecular therapeutic target for the treatment of pain in irritable bowel syndrome. Here, we review the physiological and pathophysiological functions of the endocannabinoid system with a focus on the peripheral and central regulation of gastrointestinal function and visceral nociception. We address the use of cannabinoids in pain management, comparing them to other treatment modalities, including opioids and neuromodulators. Finally, we discuss emerging therapeutic candidates targeting the endocannabinoid system for the treatment of pain in irritable bowel syndrome.

Topics: Abdominal Pain; Cannabinoids; Cannabis; Endocannabinoids; Humans; Irritable Bowel Syndrome

Cannabis sativa, a subspecies of the Cannabis plant, contains aromatic hydrocarbon compounds called cannabinoids. [INCREMENT]-Tetrahydrocannabinol is the most abundant cannabinoid and is the main psychotropic constituent. Cannabinoids activate two types of G-protein-coupled cannabinoid receptors: cannabinoid type 1 receptor and cannabinoid type 2 receptor. There has been ongoing interest and development in research to explore the therapeutic potential of cannabis. [INCREMENT]-Tetrahydrocannabinol exerts biological functions on the gastrointestinal (GI) tract. Cannabis has been used for the treatment of GI disorders such as abdominal pain and diarrhea. The endocannabinoid system (i.e. endogenous circulating cannabinoids) performs protective activities in the GI tract and presents a promising therapeutic target against various GI conditions such as inflammatory bowel disease (especially Crohn's disease), irritable bowel syndrome, and secretion and motility-related disorders. The present review sheds light on the role of cannabis in the gut, liver, and pancreas and also on other GI symptoms, such as nausea and vomiting, cannabinoid hyperemesis syndrome, anorexia, weight loss, and chronic abdominal pain. Although the current literature supports the use of marijuana for the treatment of digestive disorders, the clinical efficacy of cannabis and its constituents for various GI disorders remains unclear.

Topics: Abdominal Pain; Anorexia; Cannabis; Digestive System Diseases; Dronabinol; Endocannabinoids; Gastrointestinal Diseases; Gastrointestinal Motility; Humans; Inflammatory Bowel Diseases; Irritable Bowel Syndrome; Liver Cirrhosis; Medical Marijuana; Nausea; Pancreatic Diseases; Receptors, Cannabinoid; Vomiting

BACKGROUND Patients with type 1 diabetes mellitus may experience gastrointestinal symptoms, including those suggestive of diabetic gastroparesis. Cannabinoid hyperemesis syndrome (CHS) includes nausea, vomiting, and abdominal pain in the setting of chronic cannabinoid use. This report presents a case of CHS in a 23-year-old woman with uncontrolled type 1 diabetes mellitus. CASE REPORT A 23-year-old woman with chronically uncontrolled type 1 diabetes mellitus had been presenting monthly at the emergency department for the last 2 years, for acute bouts of intractable nausea and vomiting, occasionally with abdominal pain. Given her history of uncontrolled diabetes, she had been managed for diabetic gastroparesis with prokinetics. A gastric emptying study 6 months prior to admission was normal, and the patient had had multiple unremarkable abdominal computed tomography imaging scans. On this admission, she benefitted from supportive management with only temporary improvement of symptoms. On further questioning, she reported consistent use of cannabis for the last few years, and regression of acute vomiting with hot baths at home. With counseling, she ceased cannabis for 2 months and was symptom-free during this period. CONCLUSIONS This report has shown the importance of taking a comprehensive drug history in all patients, including in patients with type 1 diabetes, and is a reminder that cannabinoid use can cause severe nausea, vomiting, and abdominal pain in this patient group.

Topics: Abdominal Pain; Adult; Cannabinoids; Cannabis; Diabetes Mellitus, Type 1; Female; Gastroparesis; Humans; Nausea; Vomiting; Young Adult

Illicit drug trafficking within the body ("body packers") represents a medical-legal problem currently on the rise. Endoscopic removal of drug packets is not generally recommended because of the risk of packet rupture and subsequent overdose on the spilled substance. A 40-year-old male presented with abdominal pain and diaphoresis following the ingestion of 30 g of hashish as a means of illegal trafficking, remaining in police custody during his hospital stay.

Topics: Abdominal Pain; Adult; Cannabis; Endoscopy, Gastrointestinal; Foreign Bodies; Humans; Ileum; Illicit Drugs; Male; Tomography, X-Ray Computed

Chronic cannabis users may experience cyclical episodes of nausea and vomiting and learned behavior of hot bathing. This clinical condition, known as cannabis hyperemesis syndrome, was first reported in 2004.. Our aim was to promote early recognition of this syndrome in emergency departments (EDs) and to increase referral to addiction specialists.. Cannabis abusers were admitted to the ED for vomiting or abdominal pain from June 1, 2014 to January 1, 2015 and diagnosed with cannabis hyperemesis syndrome by a specialized addiction team. Then, medical records were examined retrospectively.. Seven young adults were included. Their mean age was 24.7 years (range 17-39 years) and the majority were men (male-to-female ratio 1.2). Biological and toxicological blood samples were taken in all patients. Tetrahydrocannabinol blood level was measured in 4 patients, with a mean blood concentration of 11.6 ng/mL. Radiographic examination including abdominal computed tomography and brain imaging were negative, as was upper endoscopy. Five patients compulsively took hot baths in an attempt to decrease the symptoms. Treatment was symptomatic. Five patients have started follow-up with the specialized addiction team.. Cannabis hyperemesis syndrome is still under-diagnosed 10 years after it was first described. Physicians should be aware of this syndrome to avoid repeated hospitalizations or esophageal complications. Greater awareness should lead to prompt treatment and prevention of future recurrence through cannabis cessation. Addiction specialists, as well as medical toxicologists, are experts in the management of cannabis abusers and can help re-establish the role of medical care in this population in collaboration with emergency physicians.

Topics: Abdominal Pain; Adolescent; Adult; Cannabis; Diagnosis, Differential; Emergency Service, Hospital; Female; Humans; Male; Marijuana Abuse; Patient Care Team; Pilot Projects; Referral and Consultation; Substance-Related Disorders; Vomiting

Drug traffic is a major concern worldwide. We report a case of a 27-year old male who presented with a diffuse abdominal plain to the emergency department. Abdominal X-ray demonstrated multiple foreign bodies along the intestinal tract, which were found to be cannabis packets. The patient was treated conservatively with a good result.

Topics: Abdominal Pain; Adult; Cannabis; Drug Trafficking; Foreign Bodies; Humans; Illicit Drugs; Intestines; Male

Body packing is a well-known means of narcotic carriage across international borders. The most common drugs carried are cocaine and heroin.. We describe 2 cases of cannabis body packing which occurred the same year in the South of France, one with complications: a 45-year-old male went to emergency for abdominal pain. A plain abdominal x-ray revealed multiple foreign bodies in the gastrointestinal tract. It was confirmed by abdominal CT. The laparatomy confirmed peritonitis secondary to colonic perforation, and 34 filled condoms packages were extracted. After calling poison centre, toxicological analysis was performed on one package. The resin wrapped in cellophane contained 15% tetrahydrocannabinol (THC). The patient was discharged on day 12.. Cannabis body packing is rarely reported, and the only known complications have a mechanic etiology. Plain abdominal x-ray is the best method for detection and it can be confirmed by abdominal CT and toxicological analysis. Cannabis is the most important illicit drug used in the word. Also cannabis body packing is probably underestimated. Health care practitioners should be aware of the possibility of body packing when someone coming back from abroad complains of abdominal pain.

Topics: Abdominal Pain; Adult; Cannabis; Condoms; Crime; Drug Packaging; Foreign Bodies; Humans; Male; Middle Aged; Radiography