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Cannabis use amongst patients with inflammatory bowel disease

Lal, Simona,b; Prasad, Neerajb; Ryan, Manijeha; Tangri, Sabrenaa; Silverberg, Mark S.a; Gordon, Allana; Steinhart, Hillarya

European Journal of Gastroenterology & Hepatology: October 2011 - Volume 23 - Issue 10 - p 891–896
doi: 10.1097/MEG.0b013e328349bb4c
Original Articles: Inflammatory Bowel Disease

Background 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.

Methods 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.

Results 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.

Conclusion 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.

aThe IBD Clinic, Mount Sinai Hospital, Toronto, Ontario, Canada

bIntestinal Failure Unit, Salford Royal NHS Foundation Trust, Salford, UK

Correspondence to Simon Lal, MD, PhD, Intestinal Failure Unit, Salford Royal NHS Foundation Trust, Eccles Old Road, Salford, M6 8HD, UK Tel: +44 161 206 5148; fax: +44 161 206 4690; e-mail: simon.lal@srft.nhs.uk

Received March 15, 2011

Accepted June 9, 2011

© 2011 Lippincott Williams & Wilkins, Inc.