humulene and Colitis--Ulcerative

Increased interest in cannabis as a potential treatment and/or adjuvant therapy for inflammatory bowel disease (IBD) has been driven by patients with refractory disease seeking relief as well those who desire alternatives to conventional therapies. Available data have shown a potential role of cannabis as a supportive medication, particularly in pain reduction; however, it remains unknown whether cannabis has any impact on the underlying inflammatory process of IBD. The purpose of this review article is to summarize the available literature concerning the use of cannabis for the treatment of IBD and highlight potential areas for future study.

Topics: Cannabis; Colitis, Ulcerative; Crohn Disease; Humans; Inflammatory Bowel Diseases; Medical Marijuana

Topics: Animals; Anti-Inflammatory Agents; Biomarkers; Cannabinoids; Cannabis; Clinical Studies as Topic; Colitis, Ulcerative; Crohn Disease; Cytokines; Disease Susceptibility; Drug Evaluation, Preclinical; Humans; Inflammation Mediators; Inflammatory Bowel Diseases; Molecular Structure; Treatment Outcome

Inflammatory bowel diseases (IBDs) are chronic, idiopathic, inflammatory, gastrointestinal disorders. The endocannabinoid system may have a role in the pathogenesis of IBD. We aimed to assess whether cannabis treatment influences endocannabinoids (eCBs) level and clinical symptoms of IBD patients.. Thirteen patients with Crohn's disease (CD) and nine patients with ulcerative colitis (UC) were treated with cannabis. Seventeen patients with CD and 10 with UC served as placebo groups. In all CD patients, the levels of eCBs remained unaltered during the treatment period. In UC patients treated with placebo, but not in those treated with cannabis, the levels of PEA, AEA, and AA decreased significantly. The percent reduction in bowel movements was negatively correlated with changes observed in the circulating AEA and OEA, whereas improvement in quality of life was positively correlated with the levels of 2-AG. In the biopsies from UC patients, FAAH levels increased over the study period. In Caco-2 cells, both cannabis extracts increased NAPE-PLD levels but reduced FAAH expression levels.. Our study supports the notion that cannabis use affects eCB "tone" in UC patients and may have beneficial effects on disease symptoms in UC patients.

Topics: Adult; Aged; Aged, 80 and over; Amidohydrolases; Caco-2 Cells; Cannabis; Colitis, Ulcerative; Colon; Crohn Disease; Double-Blind Method; Endocannabinoids; Female; Humans; Male; Medical Marijuana; Middle Aged; Phospholipase D; Young Adult

Cannabis-based medicinal products (CBMPs) have shown promising preclinical activity in inflammatory bowel disease (IBD). However, clinical trials have not demonstrated effects on inflammation. This study aims to analyze changes in health-related quality of life (HRQoL) and adverse events in IBD patients prescribed CBMPs.. A case series from the UK Medical Cannabis Registry was performed. Primary outcomes included changes from baseline in the Short Inflammatory Bowel Disease Questionnaire (SIBDQ), Generalized Anxiety Disorder-7 (GAD-7), Single-Item Sleep Quality Scale (SQS), and EQ-5D-5L Index score at 1 and 3 months. Statistical significance was defined using p < 0.050.. Seventy-six patients with Crohn's disease (n = 51; 67.11%) and ulcerative colitis (n = 25; 32.89%) were included. The median baseline SIBDQ score improved at 1 and 3 months. EQ-5D-5L index values, GAD-7, and SQS also improved after 3 months (p < 0.050). Sixteen (21.05%) patients reported adverse events with the majority being classified as mild to moderate in severity.. Patients treated with CBMPs for refractory symptoms of Crohn's disease and ulcerative colitis demonstrated a short-term improvement in IBD-specific and general HRQoL. Prior cannabis consumers reported greater improvement compared to cannabis-naïve individuals.

Topics: Cannabinoid Receptor Agonists; Cannabis; Colitis, Ulcerative; Crohn Disease; Humans; Inflammatory Bowel Diseases; Medical Marijuana; Quality of Life; United Kingdom

While major efforts were made studying the complex etiology of inflammatory bowel disease (IBD) including environmental factors, less is known about underlying causes leading to the heterogeneous and highly variable course of disease. As cigarette smoking cessation is the best-known environmental factor with beneficial effect in Crohn's disease (CD), more exposome factors are likely involved. Further insights into the role of the exposome in heterogeneity of disease might not only further knowledge of underlying pathways, but also allow for better risk stratification.. Seven hundred twenty-eight IBD patients completed the validated Groningen IBD Environmental Questionnaire, collecting exposome data for 93 exposome factors. Associations with disease course, that is, for need for surgery or biological therapy, were evaluated using univariate and multivariate-adjusted logistic regression modeling.. No significant associations were seen after Bonferroni correction. However, 11 novel exposome factors were identified with P < 0.05. Two factors were associated with course of CD and ulcerative colitis (UC): beer (CD OR0.3/UC OR0.3) and cannabis (0.5/2.2). While in CD, carpet flooring (0.5) was associated with biological use, and four factors were associated with surgery: working shifts (1.8), appendectomy (2.4), frequent tooth brushing (2.8), and large household size (0.1). For UC, migrants more often required biologicals (10.2). Childhood underweight (3.4), amphetamine use (6.2), and cocaine use (4.8) were associated with surgery. Five factors were replicated.. We identified 16 environmental factors nominally associated with biological use and surgery in established IBD. These new insights form an important stepping stone to guide research on biological pathways involved, risk stratification, tailor-made interventions, and preventive strategies in IBD.

Topics: Adult; Appendectomy; Beer; Biological Factors; Cannabis; Cigarette Smoking; Colitis, Ulcerative; Crohn Disease; Exposome; Female; Floors and Floorcoverings; Humans; Male; Middle Aged; Risk; Shift Work Schedule; Smoking Cessation; Surveys and Questionnaires; Toothbrushing

We aimed to assess the use of and attitudes towards cannabis use (medicinal and recreational) by people with IBD in New Zealand.. People with IBD were invited to complete an anonymous online questionnaire. Participants were recruited via postal mail using a hospital database of patients with IBD (developed by the Gas-troenterology Department at Dunedin Public Hospital) and via online recruitment (advertised on the Crohn's and Colitis New Zealand website, Facebook page and e-mail list). Inclusion criteria were ages 18+ and self-reported confirmed IBD diagnosis.. In total, 378 participants completed the questionnaire, with 334 eligible responses. Partici-pants were predominantly New Zealand European (84%) and female (71%). Sixty-one percent of re-spondents had CD and 34% UC. Overall, 51% of respondents reported having ever used cannabis. Of those, 63% reported use as recreational and 31% for reduction of IBD symptoms. Users were more likely to be younger (on average by 6.4 years), with on-going symptoms, unemployed or self-employed and current or ex-smokers. There were no differences by disease status or severity. Symp-toms most reported as improved by cannabis use were abdominal pain/cramping, nausea/vomiting and loss of appetite. Fifty-four percent of participants reported that if cannabis were legal, they would request it for medicinal use to help manage their symptoms.. Overall, our research aligns with previous observational research that reports im-provements in symptoms of IBD with cannabis use. Studies of a higher evidence level (eg, RCTs) would be needed to guide prescribing. In the meantime, this research provides useful background to clini-cians about patients' views and experiences.

Topics: Adolescent; Adult; Aged; Attitude; Cannabis; Colitis, Ulcerative; Crohn Disease; Drug Utilization; Female; Humans; Inflammatory Bowel Diseases; Male; Middle Aged; New Zealand; Phytotherapy; Plant Extracts; Self Medication; Self Report; Young Adult

 Progressive legalization and increasing utilization of medical cannabis open up potential new applications, including for inflammatory bowel disease (IBD). This study aimed to collect current figures on the use of and experience with cannabis among IBD patients in Germany..  A 71-item questionnaire was mailed to a randomly selected representative sample of 1000 IBD patients..  Questionnaires were returned by 417 patients (mean age 49.1 ± 17.0 years; 55.8 % women; 43.4 % ulcerative colitis and 54.7 % Crohn's disease). Seventy-three respondents (17.5 %) stated past cannabis use for recreational purposes, while 12 users mentioned usage at the time the questionnaire was completed (2.9 %). Seventeen patients (4.1 %) indicated past use of cannabis, and 18 participants (4.3 %) reported current use of cannabis to treat IBD. Perceived benefits of cannabis use by its users included reduced abdominal pain, improved sleep quality, and relief of unease and worry. They reported lower quality of life and higher levels of anxiety or depression than non-users. Of notice, 52.9 % of cannabis users obtained their cannabis from the black market. A total of 76.5 % of former and 50 % of current users did not report their cannabis use to the physician..  This survey reveals the largest data set on cannabis use among IBD patients in Germany, with the potential for further research. Cannabis is mainly procured from the black market, with unknown quality.. Die fortschreitende Legalisierung und zunehmende Nutzung von medizinischem Cannabis eröffnet potenzielle neue Anwendungsgebiete, z. B. im Bereich der entzündlichen Darmerkrankungen (CED). Ziel dieser Studie war es, aktuelle Zahlen über den Gebrauch von und die Erfahrungen mit Cannabis bei IBD-Patienten in Deutschland zu erheben. Ein 71 Punkte umfassender Fragebogen wurde an eine zufällig ausgewählte repräsentative Stichprobe von 1000 CED-Patienten verschickt. Die Fragebögen wurden von 417 Patienten zurückgeschickt (Durchschnittsalter 49,1 ± 17,0 Jahre, 55,8 % Frauen, 43,4 % Colitis ulcerosa und 54,7 % Morbus Crohn). 73 Befragte (17,5 %) gaben an, in der Vergangenheit Cannabis zu Freizeitzwecken konsumiert zu haben, während 12 Nutzer den Konsum zum Zeitpunkt des ausfüllens des Fragebogens erwähnten (2,9 %). 17 Patienten (4,1 %) gaben einen früheren Cannabiskonsum an, und 18 Teilnehmer (4,3 %) berichteten über einen aktuellen Cannabiskonsum zur Behandlung von CED. Zu den von den Nutzern wahrgenommenen Vorteilen des Cannabiskonsums gehörten: eine Reduzierung der Bauchschmerzen, eine Verbesserung der Schlafqualität und eine Linderung von Unruhe und Ängsten. Sie berichteten über eine geringere Lebensqualität und ein höheres Maß an Ängsten oder Depressionen als Nicht-Konsumenten. Auffällig war, dass 52,9 % der Cannabiskonsumenten ihr Cannabis vom Schwarzmarkt bezogen. Insgesamt 76,5 % der ehemaligen und 50 % der aktuellen Konsumenten meldeten ihren Cannabiskonsum nicht dem behandelnden Arzt. Diese Umfrage zeigt die größte Erhebung in Deutschland zum Thema Cannabiskonsum bei CED-Patienten, mit Potenzial für weitere Forschung. Cannabis wird hauptsächlich auf dem Schwarzmarkt beschafft, mit unbekannter Qualität.

Topics: Adult; Aged; Cannabis; Colitis, Ulcerative; Cross-Sectional Studies; Germany; Humans; Inflammatory Bowel Diseases; Middle Aged; Quality of Life

Tobacco use patterns and effects in patients with Inflammatory Bowel Disease have been extensively studied, however the role and patterns of cannabis use remains poorly defined. Our aim was to evaluate patterns of marijuana use in a large population based survey.. Cases were identified from the NHANES database from the National Center for Health Statistics for the time period from January, 2009 through December, 2010 as having ulcerative colitis or Crohn's disease, and exact matched with controls using the Propensity Score Module of SPSS, based on age, gender, and sample weighted using the nearest neighbor method.. After weighting, 2084,895 subjects with IBD and 2013,901 control subjects were identified with no significant differences in demographic characteristics. Subjects with IBD had a higher incidence of ever having used marijuana/hashish (M/H) (67.3% vs. 60.0%) and an earlier age of onset of M/H use (15.7 years vs. 19.6 years). Patients with IBD were less likely to have used M/H every month for a year, but more likely to use a heavier amount per day (64.9% subjects with IBD used three or more joints per day vs. 80.5% of subjects without IBD used two or fewer joints per day). In multivariable logistic regression, presence of IBD, male gender, and age over 40 years predicted M/H use.. Our study is the first to evaluate marijuana patterns in a large-scale population based survey. Older, male IBD patients have the highest odds of marijuana use.

Topics: Adult; Age Factors; Aged; Cannabis; Colitis, Ulcerative; Crohn Disease; Databases, Factual; Female; Humans; Incidence; Inflammatory Bowel Diseases; Logistic Models; Male; Marijuana Smoking; Middle Aged; Nutrition Surveys; Sex Factors; Surveys and Questionnaires; United States

Cannabinoids are used by patients with inflammatory bowel disease (IBD) to alleviate their symptoms. Little is known on patient motivation, benefit, or risks of this practice. Our aim was to assess the extent and motives for Cannabis use in patients with IBD and the beneficial and adverse effects associated with self-administration of Cannabis.. Consecutive patients with IBD (n = 313) seen in the University of Calgary from July 2008 to March 2009 completed a structured anonymous questionnaire covering motives, pattern of use, and subjective beneficial and adverse effects associated with self-administration of Cannabis. Subjects who had used Cannabis specifically for the treatment of IBD or its symptoms were compared with those who had not. Logistic regression analysis was used to identify variables predictive of poor IBD outcomes, specifically surgery or hospitalization for IBD.. Cannabis had been used by 17.6% of respondents specifically to relieve symptoms associated with their IBD, the majority by inhalational route (96.4%). Patients with IBD reported that Cannabis improved abdominal pain (83.9%), abdominal cramping (76.8%), joint pain (48.2%), and diarrhea (28.6%), although side effects were frequent. The use of Cannabis for more than 6 months at any time for IBD symptoms was a strong predictor of requiring surgery in patients with Crohn's disease (odds ratio = 5.03, 95% confidence interval = 1.45-17.46) after correcting for demographic factors, tobacco smoking status, time since IBD diagnosis, and biological use. Cannabis was not a predictor for hospitalization for IBD in the previous year.. Cannabis use is common in patients with IBD and subjectively improved pain and diarrheal symptoms. However, Cannabis use was associated with higher risk of surgery in patients with Crohn's disease. Patients using Cannabis should be cautioned about potential harm, until clinical trials evaluate efficacy and safety.

Topics: Adult; Cannabis; Colitis, Ulcerative; Crohn Disease; Drug Utilization; Female; Follow-Up Studies; Hospitalization; Humans; Male; Odds Ratio; Phytotherapy; Severity of Illness Index; Surveys and Questionnaires; Tertiary Care Centers; Treatment Outcome

Experimental evidence suggests the endogenous cannabinoid system may protect against colonic inflammation, leading to the possibility that activation of this system may have a therapeutic role in inflammatory bowel disease (IBD). Medicinal use of cannabis for chronic pain and other symptoms has been reported in a number of medical conditions. We aimed to evaluate cannabis use in patients with IBD.. One hundred patients with ulcerative colitis (UC) and 191 patients with Crohn's disease (CD) attending a tertiary-care outpatient clinic completed a questionnaire regarding current and previous cannabis use, socioeconomic factors, disease history and medication use, including complimentary alternative medicines. Quality of life was assessed using the short-inflammatory bowel disease questionnaire.. A comparable proportion of UC and CD patients reported lifetime [48/95 (51%) UC vs. 91/189 (48%) CD] or current [11/95 (12%) UC vs. 30/189 (16%) CD] cannabis use. Of lifetime users, 14/43 (33%) UC and 40/80 (50%) CD patients have used it to relieve IBD-related symptoms, including abdominal pain, diarrhoea and reduced appetite. Patients were more likely to use cannabis for symptom relief if they had a history of abdominal surgery [29/48 (60%) vs. 24/74 (32%); P=0.002], chronic analgesic use [29/41 (71%) vs. 25/81 (31%); P<0.001], complimentary alternative medicine use [36/66 (55%) vs. 18/56 (32%); P=0.01] and a lower short inflammatory bowel disease questionnaire score (45.1±2.1 vs. 50.3±1.5; P=0.03). Patients who had used cannabis [60/139 (43%)] were more likely than nonusers [13/133 (10%); P<0.001 vs. users] to express an interest in participating in a hypothetical therapeutic trial of cannabis for IBD.. Cannabis use is common amongst patients with IBD for symptom relief, particularly amongst those with a history of abdominal surgery, chronic abdominal pain and/or a low quality of life index. The therapeutic benefits of cannabinoid derivatives in IBD may warrant further exploration.

Topics: Adult; Cannabis; Colitis, Ulcerative; Complementary Therapies; Crohn Disease; Cross-Sectional Studies; Drug Utilization; Female; Humans; Inflammatory Bowel Diseases; Male; Ontario; Phytotherapy; Plant Extracts; Quality of Life; Self Medication

Topics: Administration, Oral; Anemia; Animals; Atrophy; Behavior, Animal; Bone Marrow; Cannabis; Colitis, Ulcerative; Depression, Chemical; Dronabinol; Drug Tolerance; Haplorhini; Hyperplasia; Injections, Intravenous; Kidney Diseases; Macaca; Pancreas; Time Factors; Water-Electrolyte Balance