Crohn’s disease and ulcerative colitis are the two major types of Inflammatory Bowel Disease (IBD). Ulcerative colitis affects the surface layers of the large intestine (colon) whereas Crohn’s disease can occur in any part of the digestive tract from the mouth to the anus. Crohn’s disease inflames the entire thickness of the intestinal wall. The symptoms of IBD vary considerably and depend on where the inflammation is located in the gastrointestinal tract and how severe it is. Symptoms include abdominal cramps and pain, irregularity of bowel movements, fever during active stages of disease and loss of appetite and weight. IBD affects approximately 1 in 250 people aged 5-40. Approximately 75,000 Australians have Crohn’s disease or ulcerative colitis and this statistic is projected to increase to 100,000 by 2022.
Cannabinoid therapy has been postulated to help ease the underlying inflammation causing Crohn’s and Colitis. Furthermore pain, nausea and motility are all modulated by the endocannabinoid system.
This image is a simplification for website aesthetics only. For more information please refer to the clinical studies referenced below.
Possible Benefits of Endocannabinoid Activation with Cannabidiol
IBD is an autoimmune disease characterized by the unwanted activation of the body’s inflammatory cascade. The resulting inflammation leads to damage of the epithelial cells in the gastrointestinal tract and causes further symptoms of IBD. Increased intestinal permeability caused by inflammation is characteristic of IBD. An inflamed and highly permeable epithelial barrier allows access to mucosal tissue that becomes increasingly and permanently exposed to antigens. This physiological process further exacerbates the inflammation.
Activation of the endocannabinoid system has been shown to modulate the inflammation by acting at a number of key junctions within the inflammatory cascade. endocannabinoid system is postulated to modulate:
- macrophage and mast cell activation
- proinflammatory cytokines
- T cell proliferation and apoptosis.
Gastric hypermotility describes the excessive or abnormal movement of the gastrointestinal (GI) tract. Hypermotility is characteristic of IBD and leads to cramps, pain and diarrhea. Patients suffering from IBD show a large increase in CB2 receptors in the GI tract. Researchers postulate that the increased expression of cannabinoid receptors and the activation of the endocannabinoid system has been shown to normalize hypermotility in patients with IBD
The inflammatory reaction inside the gut causes a release of noxious stimuli and inflammatory mediators leading to both acute and visceral painful sensations. Activation of the endocannabinoid system has been shown to reduce pain signals in both the peripheral and central nervous system; specifically via excitation of the descending antinociceptive pathway as well as inhibition of painful inflammatory mediators.
Nausea is another common symptom associated with IBD and stems from inflammation and hypermotility. In addition to helping reduce inflammation and hypermotility, activation of the endocannabinoid system has been postulated to reduce nausea in multiple clinical trials, through its ability to allosterically inhibit serotonin binding to the 5HT3 receptor in the Chemoreceptor Trigger Zone (CTZ) as well as slowing nausea signals from the gut.
IBD treatment allows patients the ability to manage the disorder with less pain. Many of the medications available work to control the abnormal inflammatory response. By controlling the inflammation, the intestinal tissues are given an opportunity to heal, decreasing the painful symptoms. Typically once symptoms of IBD are within a patient’s control, continued use of medications reduces the frequency of flare-ups and maintains remission.
Medication is almost always the ‘first line’ for IBD treatment
There are five main medicine categories
- Aminosalicylates – side effects may include nausea, vomiting, heartburn, headache and diarrhea.
- Corticosteroids – side effects may include bone loss, diabetes, high blood pressure
- Immunomodulators – side effects may include nausea, vomiting and headache
- Biological agents – side effects may include stomach pain, rash, nausea and the possibility of developing of a life threatening infection though immune suppression
- Antibiotics – side effects may include nausea, vomiting and diarrhea
Clinical studies suggest that CBD produces little to no adverse effects in the short or long term.
Over time, some people find that their prescribed medications do not offer the same result as they previously had. Some may have extensive and severe disease that is not easily controlled by the medications offered.
Surgery has often been the next option for IBD treatment. For those people suffering from severe ulcerative colitis, surgically removing the entire large bowel may cure the disease. Other health issues can still remain even after a patient has undergone surgery.
Dietary modification recommended for the treatment of IBD
Dietary modifications are highly recommended for those suffering from IBD. Since the inflammation can perpetuate nutritional deficiencies, patients must be reminded to put thought into their food choices, and get as much nutritional support as possible.
Borrelli, F., Fasolino, I., Romano, B., Capasso, R., Maiello, F., Coppola, D., … & Izzo, A. A. (2013). Beneficial effect of the non-psychotropic plant cannabinoid cannabigerol on experimental inflammatory bowel disease. Biochemical pharmacology, 85(9), 1306-1316.
Esposito, G., Filippis, D. D., Cirillo, C., Iuvone, T., Capoccia, E., Scuderi, C., … & Steardo, L. (2013). Cannabidiol in inflammatory bowel diseases: a brief overview. Phytotherapy Research, 27(5), 633-636.
Jamontt, J. M., Molleman, A., Pertwee, R. G., & Parsons, M. E. (2010). The effects of Δ9‐tetrahydrocannabinol and cannabidiol alone and in combination on damage, inflammation and in vitro motility disturbances in rat colitis. British journal of pharmacology, 160(3), 712-723.
Nagarkatti, P., Pandey, R., Rieder, S. A., Hegde, V. L., & Nagarkatti, M. (2009). Cannabinoids as novel anti-inflammatory drugs. Future medicinal chemistry,1(7), 1333-1349