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Cannabis in liver disorders

a friend or a foe?

Goyal, Hemanta; Rahman, M. Rubayatb; Perisetti, Abhilashe; Shah, Niharc; Chhabra, Rajivd

European Journal of Gastroenterology & Hepatology: November 2018 - Volume 30 - Issue 11 - p 1283–1290
doi: 10.1097/MEG.0000000000001256
Review Articles
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The recent legalization of recreational marijuana use in some parts of the world, the discovery of new indications for the clinical application of cannabis, and the acceptance of the use of cannabis in practice has been paralleled by extensive research on the active components of cannabis and the endocannabinoid system within the human body. In this review, we evaluate the available evidence on cannabis and its constituents and the application of this evidence in clinical practice, focusing particularly on the liver and liver diseases. Constituents of cannabis, such as cannabidiol and Δ9-tetrahydrocannabinol, have shown anti-inflammatory, antioxidant, and hepatoprotective effects both in in vitro and clinical studies, and appear to have potential in the symptom management and treatment of various liver diseases that were previously considered difficult to manage conservatively. In addition, the manipulation of the inherent endocannabinoid response system has found favor in many clinical fields and has generated considerable research and clinical interest. Moreover, evidence with regard to the adverse effects of marijuana use in liver diseases is weak, which has led to raise a question on the prior rules, with regard to a denial of liver transplantation to marijuana users. All in all, the recent trends in research, clinical experiences, as well as the legislature, has opened up new avenues towards the widespread clinical application of cannabis and its derivatives as well as modifiers of the components of the endocannabinoid system. More research is required to fully exploit these new evidences.

aDepartment of Medicine, Mercer University School of Medicine, Macon, Georgia

bDepartment of Internal Medicine, Texas Tech University, Lubbock, Texas

cDepartment of Gastroenterology, Division of Gastroenterology, Hepatology and Nutrition, University of Louisville School of Medicine, Louisville, Kentucky

dDepartment of Gastroenterology, Saint Luke’s Hospital, University of Missouri Kansas City (UMKC) School of Medicine, Kansas City, Missouri

eDivision of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA

Correspondence to Hemant Goyal, MD, FACP, Department of Medicine, Mercer University School of Medicine, 707 Pine St, Macon, GA 31201, USA Tel: +1 478 301 5862; fax: +1 467 301 5841; e-mail: doc.hemant@yahoo.com

Received May 28, 2018

Accepted August 4, 2018

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