S3427 Cannabis in Relation to Gastroesophageal Reflux Disease

Abstract

INTRODUCTION: There is a wide distribution of cannabinoid receptors (CBR) in the enteric nervous system, highlighting the role of cannabis in GI health and disease. Of these, CB1 is most often expressed and has been shown to decrease intra-gastric pressure, affect transient LES relaxation (TLESR), and concurrently delay gastric emptying via inhibition of excitatory neurons. We compared three different articles on their studies of cannabinoid receptors in relation to the upper GI tract. The goal of this systematic review is to assess the current knowledge of cannabis implementation, effectiveness, and its adverse side effects, in addition to identifying areas for expanding research. CASE DESCRIPTION/METHODS: In a study conducted by Calabrese et al, 87 total subjects consisting of 10 controls, 39 with non-erosive esophageal reflux (NERD), and 38 with erosive esophageal reflux (ERD) who had typical symptoms for >1 year had eight specimens of macroscopically normal esophageal mucosa taken and analyzed for expression of CBRs. Beaumont et al assessed the response of 10 mg and 20 mg Δ9-THC, a cannabinoid agonist, given three doses each a week apart in healthy volunteers. LES pressure, spontaneous swallows, and reflux episodes were measured. Scarpenllini et al studied the effects of a CB1 receptor antagonist Rimonabant on fasting and postprandial LES function in healthy subjects. Twelve healthy volunteers underwent esophageal manometry studies with administration of wet swallows and a meal after 3 days of premedication with placebo or 20 mg of Rimonabant. Transient LES relaxations and reflux episodes were measured. DISCUSSION: There is a need for more research to be performed, not only on the effects of THC on the GI system, but also for dosing to determine whether or not cannabis can be used as a therapy for esophageal disorders. With increased regulation of cannabis products and further research, consumers would be able to reduce the risks of experiencing unpleasant side effects. It is important to note that cannabis use can also lead to complications, including cannabinoid hyperemesis syndrome. No definitive recommendations can be made at this time on whether or not cannabis use will be a useful therapy for GI disorders until more research is completed.