Impact of cannabinoids on symptoms of refractory gastro-paresis

cannabis gastroparesis

A monocentric experiment on the symptoms of refractory gastroparesis

Cannabinoids are increasingly used for medicinal purposes, including the neuropathy. Gastroparesis is a neuromuscular disorder and neuropathy plays an important role in its pathogenesis. It is therefore reasonable that cannabinoids may play a beneficial role in the management of gastroparesis. This new study assesses the effect of cannabinoids on symptoms of gastro-paresis.


Gastroparesis is a chronic neuromuscular disorder that causes delayed gastric emptying in the absence of mechanical obstruction. This condition causes many symptoms that are difficult to treat, including nausea, vomiting, early satiety, bloating, anorexia, and abdominal pain. Idiopathic gastroparesis and diabetes mellitus account for the majority of gastroparesis cases, although other etiologies are well described, including post-surgical, collagen-vascular diseases, neuromuscular disorders (e.g. Parkinson's disease, multiple sclerosis), malignancies, hypothyroidism, medications, and end-stage renal disease.

The socio-economic impact and the adverse effect on quality of life resulting from gastroparesis are significant and increasing in recent years. More than 10% of patients reported having a disability due to their condition, while many other gastroparetics report missing days of work and therefore losing significant income. Hospitalizations for gastroparesis increased> 150% from 1995-2004 and> 300% from 1997-2013. Although the exact prevalence of gastroparesis in the United States is unknown, it appears to be an underdiagnosed and therefore undertreated disorder.

The pathophysiology leading to symptoms of gastroparesis is not fully understood, although neuropathy probably plays an important role in its pathogenesis. Impairment of normal phasic motor activity in the distal stomach produces the clinical manifestations associated with delayed gastric emptying. The frequency and direction of phasic motor activity is regulated by the gastric slow wave, a rhythmic electrical oscillation, which is generated by the interstitial Cajal cells in the proximal gastric body - this area is therefore known as the 'pacemaker' area. cardiac 'of the stomach. 

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Treatments for gastroparesis often focus on improving gastric motility, although evidence regarding the correlation between the degree of delayed gastric emptying and symptom manifestations varies. Other treatments for gastroparesis aim to control its associated symptoms and include antiemetics and neuromodulators. This latter group of drugs has often been used to specifically treat abdominal pain, despite a lack of efficacy seen in clinical trials.


In this study, 24 patients with gastroparesis and refractory symptoms were selected from a single gastroenterology practice associated with a tertiary care medical center. The effects of cannabinoids on symptoms of gastroparesis were evaluated prospectively in these XNUMX patients.

 Patients included in the study first needed a confirmed diagnosis of gastroparesis via a gastric emptying study using scintigraphy: which is used to determine how quickly food is transported from the stomach to the stomach. small intestine. This showed delayed gastric emptying, and by oesophagogastroduodenoscopies (EGD) which ruled out any mechanical obstruction (stopping intestinal transit). Only patients with symptoms refractory to standard treatments for gastroparesis were included (diet modification, medications (prokinetics, antiemetics, and neuromodulators), endoscopic therapy (eg, botulinum toxin injections) and some patients had implantable gastric pacemakers. and / or surgical pyloroplasty).

Patients were prescribed either dronabinol, medical cannabis, or both for symptom management. Those who received both treatments were prescribed them successively (dronabinol then marijuana) if dronabinol did not relieve the symptoms sufficiently. Marijuana was prescribed as needed, at varying THC / CBD levels (at the discretion of the cannabis dispensary) and taken by vaporised inhalation or sublingual drops. The dose of dronabinol ranged from 2 to 10 mg twice a day to four times a day. Patients completed a GCSI form, a valid symptom index for gastroparesis, before and after treatment

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The " Gastroparesis Cardinal Symptom Index  (GCSI) and an abdominal pain analog scale were applied to prospectively assess the effect of cannabinoids, in the form of dronabinol and medical cannabis, on symptoms of refractory gastroparesis. Patients completed a GCSI form and assessed their abdominal pain, before and after treatment. There were at least 60 days of cannabinoid use between the reporting intervals. Composite GCSI symptom total scores, symptom subset GCSI scores, and abdominal pain scores were calculated before and after treatment.

Cannabinoids, primarily delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD), are increasingly being studied and used for medicinal purposes. Dronabinol, a synthetic analogue of THC, is used for nausea, vomiting, and anorexia in human immunodeficiency virus (HIV) and cancer, although it has been used for symptom management in d 'other conditions. Newer and more effective treatment options for gastroparesis are needed, and cannabinoids are a promising option. The study aimed to assess the effects of cannabinoids on symptoms of refractory gastroparesis.


In conclusion, a significant improvement in the overall composite GCSI symptom score was observed with either cannabinoid treatment (mean score difference 12,8, 95% confidence interval 10,4-15,2 ; p-value <0,001). All 24 patients experienced statistically significant improvement in each GCSI symptom subgroup. A significant improvement in abdominal pain score was also observed with either cannabinoid treatment (mean score difference 1,6; p-value <0,001).

Cannabinoids dramatically improve symptoms of gastroparesis. In addition, improving abdominal pain with cannabinoids represents a breakthrough in the treatment of abdominal pain associated with gastroparesis, for which there is currently no validated treatment.

Tags : AlimentaryEtudeMedicalSearchTreatment
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