Cannabinoids Dramatically Improve Symptoms of Refractory Gastroparesis

Abstract

Introduction: Cannabinoids, primarily delta—9—tetrahydrocannabinol (THC) and cannabidiol (CBD), are increasingly used for medicinal purposes. Dronabinol, a THC analogue, is used for nausea, vomiting and anorexia in HIV and cancer. Medical marijuana in New York is permitted to treat neuropathy with severe nausea. Gastroparesis is a neuromuscular disorder that causes many difficult—to—treat symptoms. Neuropathy plays a large role in its pathogenesis. We showed that cannabinoids significantly improve symptoms in patients with refractory gastroparesis. Methods: The effects of cannabinoids on gastroparesis symptoms were assessed in 24 patients. All patients' symptoms were refractory to standard therapies for gastroparesis including dietary modification, medications (prokinetics, antiemetics, neuromodulators), endoscopic therapy, and some patients had gastric stimulators. Patients were prescribed either Dronabinol, medical cannabis, or both for symptom management. Patients who received both treatments were prescribed them sequentially (Dronabinol then marijuana) if Dronabinol did not adequately relieve symptoms. Medical marijuana was taken via vaporized inhalation or sublingual drops and prescribed as needed at varying THC: CBD ratios. Dosage of Dronabinol ranged from 2—10mg twice daily to four times daily. All patients completed a ‘Gastroparesis Cardinal Symptom Index’ (GCSI), a validated symptom index for gastroparesis, before and after treatment. Results: Six patients were prescribed Dronabinol, ten were prescribed marijuana and eight were prescribed Dronabinol then marijuana. Baseline patient characteristics were collected (Table 1). Paired sample T—tests were performed and statistically significant improvement in GCSI total symptom composite score was seen in patients who received either cannabinoid treatment (mean score difference of 14.097, CI 11.487—16.707; p—value < 0.001). Patients prescribed marijuana experienced statistically significant improvement in every symptom subgroup, while the Dronabinol group experienced statistically significant improvement in all symptom subgroups except ‘bloating/distention’ (Table 2, Figure 1).1203_A Figure 1. Patient baseline characteristicsConclusion: Our study shows that cannabinoids significantly improve symptoms of gastroparesis, which is a notoriously difficult condition to manage. Therapeutic options for gastroparesis are limited, so cannabinoids can play an important role in the treatment of the condition, especially in patients with refractory symptoms.1203_B Figure 2. Paired sample T—tests and differences of the mean for composite symptom score and symptom subgroup scores before and after cannabinoid treatment [abbreviations: SD = Standard Deviation; SER = Standard Error of Mean]1203_C Figure 3. Comparison of composite symptom score and symptom subgroup scores before and after cannabinoid treatment (either marijuana or Dronabinol), marijuana treatment alone, and Dronabinol treatment alone