Study: Improvement of symptoms in patients with chronic pouchitis

Cannabis inhalation results in improved symptoms in patients with chronic pouchitis

Daily use of cannabis flowers brings long-lasting relief to patients with chronic pouchitis, researchers say. published data in the journal ACG Case Reports. pouchitis is an inflammatory condition that commonly occurs in patients who have undergone surgery to treat ulcerative colitis.

Israeli researchers evaluated cannabis use in nine patients with treatment-resistant pouchitis. Patients inhaled one gram of herbal cannabis (16% THC) daily in addition to their regular medications. The patients were followed for one year.

Data were collected before cannabis use and 8-12 and 52 weeks after starting cannabis use. Data included patient symptoms, physical examination, complete blood count, liver enzyme and kidney function tests, C-reactive protein and fecal calprotectin, and pocket endoscopy. Patients completed quality of life (abbreviated 36-item quality of life survey) and side effects questionnaires at the same time points. SPSS for Windows, version 25 (IBM, Armonk, NY), was used for statistical analysis.

The investigators reported the following: “Eight out of nine patients reported improvement in symptoms, including abdominal pain and swelling, nausea, appetite, and general well-being. Mood, memory, concentration, sleep, alertness and daily functions were also improved. Patients did not report hallucinations, negative behavioral effects, agitation, or confusion. None reported exacerbation of IBD [inflammatory bowel disease]" page (in French).

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They concluded: “To our knowledge, this is the first report of the effect of cannabis use in patients with chronic pouchitis. … Cannabis use resulted in significant improvement in symptoms and improved quality of life in this group of patients with refractory pouchitis. Larger controlled studies are needed to better assess the role of cannabis in the treatment of chronic pouchitis.”

Previous studies have shown that cannabis can alleviate symptoms associated with various gastrointestinal disorders, including inflammatory bowel disease, ulcerative colitis, the disease Crohn and gastroparesis. To our knowledge, this is the first report on the effect of cannabis use in patients with chronic pouchitis. All patients reported significant symptomatic improvement, including improvement in PDAI, decrease in bowel movements and nocturnal diarrhea, a reduction in faecal incontinence and, consequently, a better quality of life. This positive effect was maintained after 1 year.

Treatment of pouchitis fails in up to two-thirds of patients, and in 6-10% of patients, pouch failure leads to an ileostomy. Despite the importance of endoscopic remission as the primary goal of treatment, symptom reduction is the patient's first priority. Symptomatic improvement is the cardinal factor that enables normal daily function in all dimensions, including work, social life, and family relationships. Therefore, improvement in symptoms is as important as decrease in inflammatory markers or endoscopic scores, especially in patients with refractory pouchitis in whom other treatment options have failed.

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Activation of the endocannabinoid system delays colonic transit, increases pain thresholds and reduces fluid secretions. Cannabis improves colitis in experimental rodent models of UC and in human patients. Patients in our study received cannabis of well-known composition, containing 16% Δ-9-tetrahydrocannabinol and only traces of cannabidiol. Endoscopic scores improved in 5 of 8 patients who underwent second (week 12) and third (week 52) endoscopy. Fecal calprotectin increased between Visits 1 and 2, but it should be noted that although objective, fecal calprotectin has not been validated or well studied in pouchitis to date. Further research into various cannabis compounds is needed to identify those with maximum anti-inflammatory effects.

In conclusion, cannabis use resulted in significant symptomatic improvement and better quality of life in this group of patients with refractory pouchitis. Larger controlled studies are needed to further assess the role of cannabis in the treatment of chronic pouchitis.

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