3110 A Case of Reflux Esophagitis Mimicking Globus Sensation in a Patient With Cannabis Abuse

Abstract

INTRODUCTION: Cannabis is a widely used drug of abuse in the United States (US). It is mostly commonly abused by young individuals and is known for it's psychedelic effects. Cannabis is also utilized by the medical field for a number of medicinal purposes. We present a case of a young male who presented with sudden onset dysphagia and had a significant history of marijuana abuse for several years. CASE DESCRIPTION/METHODS: 28 year old Caucasian male with a past medical history of ADHD presented with dysphagia. The symptoms started 2 days ago. He felt like the food was stuck in his throat. Every time he attempted to drink water or liquids it regurgitated. He also reported several episodes of nausea and vomiting since the onset of his symptoms. Review of systems was negative for odynophagia, fever, drooling, weight loss, chest pain, diarrhea, constipation or acid reflux. Denied any allergies, surgical history or family history. He denied alcohol or cigarette smoking. He agreed to smoking marijunana 2-3 times per day for over 4 years. Physical examination revealed a healthy non obese male with blood pressure and pulse of 120/80 mmhg and 86 per minute respectively. Rest of his examination was unremarkable. Upper endoscopy was performed on the day of admission which revealed LA Grade D esophagitis with multiple superficial ulcers extending 5 cm from GE junction. Patient was started on proton pump inhibitors twice daily. His symptoms improved and was eventually discharged. Biopsies were suggestive of changes consistent with chronic reflux esophagitis. DISCUSSION: Tetrahydrocannabinol (THC) is the active ingredient derived from Cannabis Sativum. THC works by stimulating the G protein-coupled cannabinoid receptors (CBR) receptors. The presence of CBRs in the esophagus, specifically those affecting transient lower esophageal sphincter relaxations (TLESRs), offers a potential therapeutic target for treating GERD. Using Delta (9)-THC, Beaumont et al. demonstrated decreased rate of TLESRs in healthy volunteers who received 10 and 20 mg of Δ9-THC on three occasions a week apart. However, in the high dose of ΔDelta (9)-THC (20 mg) group, central activity led to increased nausea, vomiting and reflux symptoms. With ongoing discussions for the legalization of recreational cannabis use in US, we may encounter an increase in the number of reflux esophagitis cases. With this in mind, additional studies would be beneficial to determine potential risk factors for developing severe reflux esophagitis with extensive marijuana use.