Cannabis is associated with clinical but not endoscopic remission in ulcerative colitis: A randomized controlled trial

Abstract

Background Cannabis is often used by patients with ulcerative colitis, but controlled studies are few. We aimed to assess the effect of cannabis in improving clinical and inflammatory outcomes in ulcerative colitis patients. Methods In a double-blind, randomized, placebo-controlled trial, patients received either cigarettes containing 0.5 g of dried cannabis flowers with80mgTetrahydrocannabinol (THC)or placebo cigarettes for 8 weeks. Parameters of disease including Lichtiger disease activity index, C reactive protein (CRP), calprotectin, Mayo endoscopic score and quality of life (QOL) were assessed before, during and after treatment. Results The study included 32 patients. Mean age was 30 years, 14 (43%) females. Lichtiger index improved in the cannabis group from 10.9 (IQR 9–14) to5 (IQR 1–7), (p<0.000), and in the placebo group from 11 (IQR 9–13) to 8 (IQR 7–10)(p = 0.15, p between groups 0.001). QOL improved in the cannabis group from 77±4 to 98±20 (p = 0.000) but not in the placebo group (78±3 at week 0 and 78±17 at week 8;p = 0.459; p between groups 0.007). Mayo endoscopic score changed in the cannabis group from 2.13±1 to 1.25±2 (p = 0.015) and in the placebo group from 2.15±1to 1.69±1 (p = 0.367, p between groups 0.17). Conclusion Short term treatment with THC rich cannabis induced clinical remission and improved quality of life in patients with mild to moderately active ulcerative colitis. However, these beneficial clinical effects were not associated with significant anti-inflammatory improvement in the Mayo endoscopic score or laboratory markers for inflammation.(clinicaltrials.gov NCT01040910).

Endocannabinoid Levels in Ulcerative Colitis Patients Correlate With Clinical Parameters and Are Affected by Cannabis Consumption

“…A previous study that analyzed mRNA levels of ECS-related genes (synthesizing and degrading enzymes and cannabinoid receptors) found that intestinal mucosal biopsies from UC and CD patients showed different patterns of gene expression between the two and between those of healthy people ( 24 ). Interestingly, while in UC patients there was an improvement in the endoscopic activity in the cannabis treated patients, and to a lesser degree in the placebo group, no endoscopic improvement was observed in the CD group ( 14 , 15 ). The fact that the differences in eCBs level were observed only in the group with endoscopic improvement reinforced our results.…”

“…These parameters included abdominal pain, general wellbeing, and number of bowel movements per day (BM); the relevant disease activity index (Lichtiger or CDAI) was finally calculated. Quality of life (QOL) was assessed by using the SF36 questionnaire ( 14 , 17 ).…”

“…In the current study, in order to shed some light on potential mechanisms of cannabis treatment in IBD, we assessed whether treating IBD patients with cannabis affects eCBs level and whether these changes correlate with clinical symptoms. To that end, we used sera collected in previous studies ( 14 , 15 ). These sera were analyzed for eCBs level in UC and CD patients before and after 8 weeks of treatment with cannabis or placebo.…”

Inflammatory Bowel Disease and Cannabis: A Practical Approach for Clinicians

“…Patients were given either cigarettes containing 0.5 g of dried cannabis flowers with 80 mg of THC or placebo cigarettes. The study determined that smoking cannabis did not contribute to an improvement in Mayo endoscopic score or a reduction in serum inflammatory markers, like CRP and calprotectin [ 20 ].…”

Emerging Comorbidities in Inflammatory Bowel Disease: Eating Disorders, Alcohol and Narcotics Misuse

“…Meanwhile, 81% of them would recommend cannabis use for IBD [ 113 ]. Although clinical response in CD and UC has been described many times, recent studies have not confirmed cannabinoid influence on objective outcomes like mucosal healing or concentration of inflammatory factors [ 114 , 115 ].…”