Cannabis Use in Patients Presenting to a Gastroenterology Clinic: Associations with Symptoms, Endoscopy Findings, and Esophageal Manometry

Meet Parikh,Asyia Ahmad,Shelini Sookal

doi:10.3390/gidisord1030025

Abstract

Recreational cannabis use is increasing with its legalization in many states. Animal studies suggest cannabis can reduce transient lower esophageal sphincter relaxations (TLESRS), reflux and vomiting, while human studies report conflicting findings. There are currently no large studies investigating gastrointestinal symptoms in patients with chronic cannabis use. This was a retrospective case-control study including patients who presented to an outpatient Gastroenterology office, with documented cannabis use. Their main presenting complaint, demographics, frequency and duration of cannabis use, endoscopic and high-resolution esophageal manometry (HREM) with impedance findings were recorded. Cannabis users were more likely to complain of abdominal pain (25% vs. 8%, p < 0.0001), heartburn (15% vs. 9%, p < 0.0001), and nausea & vomiting (7% vs. 1%, p < 0.0001). They were also more likely to have findings of esophagitis (8% vs. 3%, p = 0.0002), non-erosive gastritis (30% vs. 15%, p = 0.0001) and erosive gastritis (14% vs. 3%, p < 0.0001) on upper endoscopy. Cannabis users were more likely to have impaired esophageal bolus clearance (43% vs. 17%, p = 0.04) and a hypertensive lower esophageal sphincter (LES) (29% vs. 7%, p = 0.04). This study is the largest to date evaluating GI complaints of patients with chronic recreational cannabis use. Our results suggest that cannabis use may potentiate or fail to alleviate a variety of GI symptoms which goes against current knowledge.

Highlights

Extracts of the Cannabis sativa plant has been used medicinally for centuries [1], and in current times cannabis use for medicinal, recreational and therapeutic purposes has increased exponentially
Of 30,091 charts that were analyzed over the 12-year study period, 772 cannabis users were identified and 1599 randomly selected controls were included
This is the largest study to date assessing the gastrointestinal complaints of a cohort of patients with chronic cannabis use, who were evaluated in a gastroenterology outpatient clinic

Summary

Introduction

Extracts of the Cannabis sativa plant has been used medicinally for centuries [1], and in current times cannabis use for medicinal, recreational and therapeutic purposes has increased exponentially. In 2014, the National Institute of Health reported the percentage of Americans who reported cannabis use during period from 2012–2013 doubled, as compared to 2001–2002 [2], which hints at the changing cultural and societal norms regarding cannabis use. This poses a novel challenge to physicians who encounter the public health challenges of habitual cannabis use, as well as the controversial effects of cannabis on the gastrointestinal tract. Animal model research has identified the cannabinoid, delta-9 tetrahydrocannabinoid (THC), to have a potent effect on the GI tract by suppressing gastric acid secretion, decreasing the number of transient lower esophageal sphincter relaxations (TLESRs), reducing gastric emptying, decreasing emesis, and decreasing lower esophageal sphincter (LES)

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Results

Discussion

Conclusion