Are you interested in prescribing cannabis for IBS? Gastroenterologists are hopping on the train to guide their patients toward better health.
IBS treatment is a tricky field to navigate. The disorder causes pain and distress and could become debilitating. Traditional approaches often fall short and don’t ease symptoms.
Medical cannabis could be a worthy therapeutic option for IBS. There’s been growing interest in the herb among gastroenterologists. Is it the solution you and your patients are seeking?
Understanding IBS: Symptoms and treatment challenges
Irritable bowel syndrome (IBS) is a gastrointestinal disorder affecting the stomach and intestines. Approximately one in five Australians struggle with symptoms related to the condition1.
Negative lifestyle habits and specific food issues often lead to IBS symptoms. Other contributors may include routine changes, infections, and emotional or psychological distress.
IBS presents differently between individuals. Common signs and symptoms include:
- Abdominal pain, tension, or bloating
- Stomach cramping
- Discomfort that only finds relief from bowel movements or flatulence
- Constipation
- Diarrhea
- Increased mucus or gas in the stool
- Changing appearance of bowel movements
- The lasting sensation of needing the toilet even after going
- Incomplete emptying of the bowels
- Nausea
- Irregular toilet routine
Infections like gastroenteritis could trigger IBS symptoms. Other potential causes include medications like pain pills, antacids, and antibiotics. Profound, prolonged stress, anxiety, or unstable moods could exacerbate the issues.
FODMAPS carbohydrates (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) are a frequent cause. Lactose, fructose, and sorbitol are common culprits.
IBS could have a significant impact on quality of life (QoL) in patients. Studies have shown the condition leads to low QoL and depression3.
Several IBS management challenges exist. It may be difficult to identify and avoid specific triggers, like stress, anxiety, and food. Some patients could struggle to find an ideal combination of healthy habits and food. Many have to use trial and error until they arrive at a solution.
There are no tests that confirm IBS diagnosis. This challenge may cause diagnostic and treatment delays.
Traditional treatment options for IBS
Traditional IBS treatment options vary. Controlling symptoms is possible with diet and lifestyle changes and stress management.
Conventional treatments include:
- Dietary changes. Avoiding high-gas foods, gluten, FODMAPs, and carbonated and alcoholic drinks.
A high-fibre diet and drinking sufficient fluids may help reduce symptoms. Eating smaller portions spread throughout the day could aid digestion.
Patients might consider recommended medications before trying cannabis for IBS. Available options include:
- Tricyclic or SSRI antidepressants. Your patient may experience IBS symptoms due to underlying depression. This factor might cause abdominal pain and constipation. Some psychiatric medications could address these issues.
Complementary and alternative therapies are worth considering. Many IBS patients are hesitant to take long-term medications. They have concerns regarding side effects and want to try more natural options.
Alternative approaches like medical cannabis aim to address the multifaceted and complex nature of IBS. Physiological, psychological, and environmental factors make traditional treatments challenging to prescribe effectively.
Cannabis for IBS: Biochemistry & potential benefits
Cannabis for IBS has received worthy recognition because of its beneficial compounds. The plant contains over 100 cannabinoids, including the well-known THC and CBD.
THC, the primary cannabis compound, produces psychoactive effects. It may provide the following benefits for the digestive system:
- Reduces nausea and stimulates appetite4.
- Combats diarrhoea and modulates gut motility4.
- Provides anti-inflammatory effects that may treat IBS or IBD5.
- Reduces intestinal inflammation5.
CBD may also benefit IBS patients by inducing the following effects:
- Reduces symptoms related to gastrointestinal disorders.
- Combats gut inflammation.
- Lowers intestinal permeability.
- Enhances gut barrier function.
- Relieves abdominal pain.
- Acts as an analgesic across the body.
Understanding the basics of cannabis is crucial for gastroenterologists. The endocannabinoid system (ECS) plays a crucial role in gut health. It helps maintain homeostasis in the gastrointestinal tract8.
The ECS contains endogenous cannabinoids and the cannabinoid receptors, CB1 and CB2. It also has enzymes that synthesise and break down the compounds.
Cannabinoids interact with the ECS to produce various effects in the gut, including:
- Influencing gut-related behaviours and sensations by modulating the gut-brain axis.
- Maintaining a healthy intestinal system by interacting with the gut microbiome.
- Regulating intestinal secretion, motility, and inflammation.
Gastrointestinal disorders may occur following ECS dysregulation. Cannabinoids could help maintain healthy functioning in IBS patients.
Evidence-based research on cannabis for IBS
Research on cannabis for IBS is continuing to grow. Several evidence-based studies provide insights into the plant’s potential therapeutic effects. They’ve garnered support for the herb’s use in gastroenterology.
Here are some key findings from recent years:
- An observational study of 13 patients with IBD highlighted the impact of cannabis treatment in 2011. It found improvements in disease activity, quality of life, and weight gain.
- A prospective, randomised, double-blind, placebo-controlled trial took place in 2013. It explored clinical responses in patients with Crohn’s Disease after cannabis ingestion.
The trial results found that cannabis cigarettes smoked twice daily led to improvements. 10 of 11 patients experienced clinical, steroid-free benefits. 5 of 11 went into complete remission.
- A 2020 review explored cannabis use in inflammatory bowel disease, functional gut disorders, and gut-related adverse effects. It highlighted that cannabis could cause endoscopic improvements.
Some research gaps exist in certain cases, necessitating the need for further studies. For example, the 2011 observational study9 lacked a control group and objective inflammation measures. The full details of the 2020 review11 are also not yet published.
On a positive note, available evidence relating to cannabis for IBS shows promise. Extensive studies on cannabinoids reveal they could provide symptomatic relief for patients.
Risks and considerations for gastroenterologists
Mixed evidence highlights the long-term risks of cannabis use in the general population. The likelihood of developing IBS is higher if patients and doctors don’t control usage. Those who experience cannabis use disorder are more prone to IBS symptoms.
Other potential side effects of cannabis include:
- A disrupted endocannabinoid system following chronic use. It may cause dysregulation in gastrointestinal function.
- Profibrotic reactions, leading to the development of fibrosis. It could also cause stricturing (abnormal narrowing) in the intestines.
- Increased anxiety, paranoia, and stress, which may worsen IBS symptoms.
- Episodes of psychosis or development of schizophrenia.
- Decreased memory, learning, and cognitive function.
- Cannabis use disorder.
- Cannabinoid hyperemesis syndrome, which causes severe, repetitive vomiting. This side effect may occur in patients who use cannabis long term.
Legal and ethical considerations are crucial for gastroenterologists. Australia’s regulations on medicinal cannabis are complex and still evolving. Some territories have introduced access schemes, but strict rules exist.
Keep the following hurdles in mind when prescribing cannabis for IBS:
- The Therapeutic Goods Administration is the leading authority for medication registration in Australia. It hasn’t approved medicinal cannabis products for some medical conditions, including IBS.
- Concerns exist regarding patients crossing into recreational cannabis use following medicinal prescriptions. There’s a lack of transparent guidelines on appropriate therapeutic use.
- Medicinal cannabis prescriptions require special approval processes. These regulations vary between jurisdictions. Prescribing may remain off label, which poses ethical concerns.
- Professional medical bodies in Australia are still developing clear cannabis use recommendations. They need to create guidelines on its applications in IBS. Other gastrointestinal conditions also require further stipulations.
Adhering to the relevant guidelines and regulations as a gastroenterologist is crucial.
The need for patient education and monitoring is apparent. Raise awareness when seeing your clients so they understand potential risks. Check up on them regularly to catch any adverse effects if they occur.
Experts developed the Lower-Risk Cannabis Use Guidelines (LRCUG) for prescribing and dosing. It’s a valuable tool to take advantage of in your gastroenterology practices. There are 10 recommendations for finding the right approach for your patients.
Guidelines for integrating cannabis into IBS treatment
Integrating cannabis into IBS treatment involves careful considerations and planning. Your patients will be unique, so finding the right approach is vital.
Gastroenterologist guidelines provide a foundation for formulating patient-specific treatment. Follow the steps below when prescribing cannabis for IBS:
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Assess patient symptoms and medical history. Evaluating suitability for cannabis treatment depends on individual cases. Create a checklist for IBS symptoms, including abdominal pain, bloating, constipation, and diarrhoea.
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Review the patient’s medical history. Gather information on previous treatments and their effectiveness. Determine whether they’re prone to addictive behaviours.
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Identify possible interactions. Note current medications the patient is taking. Ensure none of them interact with cannabis. Consider underlying diseases and family history of psychosis or schizophrenia.
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Determine patient eligibility. Ensure the patient meets the criteria for cannabis treatment. Keep local laws and regulations in mind. Discuss potential benefits and risks regarding the suggested therapeutic regimen.
- Provide follow-ups. Monitor the patient’s responses to cannabis treatment regularly. Observe their improvements, changes in symptoms, and adverse effects. Ask them to check in with you to ensure the regimen is working.
Dosage recommendations and administration methods are as follows:
Educate patients and collaborate with them to formulate personalised treatment plans. Discuss the importance of low doses and keeping you informed on all changes.
Education is key: Be the best gastroenterologist with Planted
The role of cannabis for IBS is extensive and potentially life-changing. The cannabinoids in the plant may ease gut inflammation and pain. They could combat nausea, constipation, and diarrhoea, while preventing exacerbated symptoms.
Traditional treatment options may not provide the desired outcomes. Every IBS case is unique, so individualised patient care is crucial.
Consider all options when approaching cannabis treatment. Tailor prescriptions based on patient history and goals to find the right regimen.
Do you want to increase your knowledge of cannabis for IBS? Explore our wealth of educational resources at Planted. Share your experiences and work with others towards a brighter future for gastroenterology.
References
- Better Health Channel. “Irritable Bowel Syndrome (IBS).” Victoria State Government: Better Health Channel, 2012. www.betterhealth.vic.gov.au/health/conditionsandtreatments/irritable-bowel-syndrome-ibs.
- Altomare, Annamaria; Di Rosa, Claudia; Imperia, Elena; Emerenziani, Sara; Cicala, Michele; Pier Luca Guarino, Michele. “Diarrhea Predominant-Irritable Bowel Syndrome (IBS-D): Effects of Different Nutritional Patterns on Intestinal Dysbiosis and Symptoms.” Nutrients, vol. 13, no. 5, 1 May 2021, p. 1506. www.ncbi.nlm.nih.gov/pmc/articles/PMC8146452/
https://doi.org/10.3390/nu13051506.
- Kopczyńska, Magdalena; Mokros, Łukasz; Pietras, Tadeusz; Małecka-Panas, Ewa. “Quality of Life and Depression in Patients with Irritable Bowel Syndrome.” Gastroenterology Review, vol. 13, no. 2, 2018, pp. 102–108. https://doi.org/10.5114/pg.2018.75819.
- Pietrangelo, Ann. “The Effects of Marijuana on Your Body.” Healthline, 26 Apr. 2021. www.healthline.com/health/effects-of-cannabis-on-body.
- Ahmed, Waseem, and Seymour Katz. “Therapeutic Use of Cannabis in Inflammatory Bowel Disease.” Gastroenterology & Hepatology, vol. 12, no. 11, 2016, pp. 668–679. www.ncbi.nlm.nih.gov/pmc/articles/PMC5193087/.
- Havranek, Russell. “How the Endocannabinoid System Affects Gut Health.” Russell Havranek, MD, 2 May 2021. russellhavranekmd.com/endocannabinoid-system/.
- Bolen, Barbara. “The Usefulness of Medical Marijuana to Ease IBS Symptoms.” Verywell Health, 6 June 2022. www.verywellhealth.com/medical-marijuana-for-ibs-4115436.
- Srivastava, Raj Kamal; Lutz, Beat; Ruiz de Azua, Inigo. “The Microbiome and Gut Endocannabinoid System in the Regulation of Stress Responses and Metabolism.” Frontiers in Cellular Neuroscience, vol. 16, 11 May 2022, p. 867267. www.ncbi.nlm.nih.gov/pmc/articles/PMC9130962/
https://doi.org/10.3389/fncel.2022.867267.
- Lahat, Adi; Lang, Alon; Ben-Horin, Shomron. “Impact of Cannabis Treatment on the Quality of Life, Weight and Clinical Disease Activity in Inflammatory Bowel Disease Patients: A Pilot Prospective Study.” Digestion, vol. 85, no. 1, Jan. 2012, pp. 1–8. www.karger.com/Article/Abstract/332079.
https://doi.org/10.1159/000332079.
- Naftali, Timna; Bar-Lev Schleider, Lihi; Dotan, Iris; Philip Lansky, Ephraim; Sklerovsky Benjaminov, Fabiana; Meir Konikoff, Fred. “Cannabis Induces a Clinical Response in Patients with Crohn’s Disease: A Prospective Placebo-Controlled Study.” Clinical Gastroenterology and Hepatology: The Official Clinical Practice Journal of the American Gastroenterological Association, vol. 11, no. 10, 1 Oct. 2013, pp. 1276-1280.e1. www.ncbi.nlm.nih.gov/pubmed/23648372.
https://doi.org/10.1016/j.cgh.2013.04.034.
- Nasser, Yasmin; Woo, Matthew; Andrews, Christopher N. “Cannabis in Gastroenterology: Watch Your Head! A Review of Use in Inflammatory Bowel Disease, Functional Gut Disorders, and Gut-Related Adverse Effects.” Current Treatment Options in Gastroenterology, vol. 18, 21 Nov. 2020, pp. 1–12. pubmed.ncbi.nlm.nih.gov/33250629/
https://doi.org/10.1007/s11938-020-00323-w.
- Fischer, Benedikt; Russell, Cayley; Sabioni, Pamela; van den Brink, Wim; Le Foll, Bernard; Hall, Wayne; Rehm, Jürgen; Room, Robin. “Lower-Risk Cannabis Use Guidelines: A Comprehensive Update of Evidence and Recommendations.” American Journal of Public Health, vol. 107, no. 8, 12 July 2017. ajph.aphapublications.org/doi/full/10.2105/AJPH.2017.303818.