Cannabis use linked to increased GI inflammation, abnormal studies

WASHINGTON — Despite generally accepted ideas that cannabis may be used to reduce inflammation or treat gastrointestinal symptoms, a study presented at Digestive Disease Week 2018 linked regular cannabis use to increased inflammation, abdominal pain and abnormal manometry and endoscopic findings.

“Cannabis users were less likely to have a normal manometry study. This leads to the suggestion that there’s an upper GI tract motility disorder associated with chronic cannabis use possibly similar to the upper GI tract motility disorder associated with opioid use,” Shelini Sooklal, MD, of Drexel Medicine, said during her presentation. “These results suggest that cannabis use may potentiate or fail to alleviate a variety of GI complaints, which goes against current knowledge and challenges our knowledge of the interaction of cannabis use and GI symptomology.”

Sooklal and colleagues conducted a retrospective chart review of 2,371 patients from 2006 to 2017, using data mining to identify those charts with or without the terms “cannabis” or “marijuana.” They found 772 cannabis users and included 1,599 randomly selected controls for a 2:1 ratio.

Sooklal reported that the most frequent symptoms reported by the cannabis group were abdominal pain (25% vs. 8% in the control group), heartburn (15% vs. 9% in the controls) and nausea and vomiting (7% vs. 1% of controls). All of these were statistically different from the control group (P < .0001).

“Abdominal pain was the most common complaint – not nausea and vomiting as we would have expected,” she said.

Endoscopy findings showed patients using cannabis were more likely to be diagnosed with esophagitis (8% vs. 3% of controls; P < .001), non-erosive gastritis (30% vs. 15% of controls; P < .001) and erosive gastritis (14% vs. 3% of controls; P < .001).

“Increased inflammation in cannabis users – esophagitis as well as erosive and non-erosive gastritis – goes against current knowledge where small studies have shown decreased inflammation with cannabis use,” Sooklal said.

Using high-resolution esophageal manometry and impedance in 29 patients, Sooklal found that users of cannabis were more likely to have esophageal gastric junction outflow obstruction (40% vs. 24% in controls; P = .02), incomplete bolus clearance (65% vs. 17% in controls; P = .001) and hypertensive lower esophageal sphincter (27% vs. 8% of controls; P = .02). Conversely, more than half of the control group had a normal study and just 20% of cannabis users were classified as normal (P = .03).

“Hypertensive lower esophageal sphincter with impaired esophageal bolus clearance on manometry with impedance may explain increased heartburn as well as vomiting in cannabis users,” she said.

In looking at those patients who use cannabis, 64% used it daily; 20% weekly; and 16% monthly. Sooklal showed that daily users were more likely to have abdominal pain (43% vs. 18% in non-daily users; P < .001), nausea and vomiting (17% vs. 4% in non-daily users; P < .001), and heartburn (17% vs. 13%).

Sooklal, moderators and audience members pointed out a need for looking at these results in the light of comorbidities in the future, especially the concurrent use of opioids, which could contribute to physical findings. – by Katrina Altersitz

Reference :

Sooklal S, et al. Abstract 45. Presented at: Digestive Disease Week; June 2-5, 2018; Washington, D.C.

Disclosure: Sooklal reports no relevant financial disclosures. Please see the DDW faculty disclosure index for a list of all other authors’ relevant financial disclosures.