IBD patients who use cannabis report more symptoms but do not have worse underlying disease | Research

The takeaway

Among 383 IBD patients, cannabis users reported more abdominal pain, gas, tenesmus, and joint pain than non-users, but did not have more active disease or complications, suggesting non-disease factors drive their symptom burden.

Gastroenterologists, IBD patients using or considering cannabis, and medical cannabis researchers.

More symptoms but no worse disease in cannabis-using IBD patients

What the researchers found

Cannabis users (7.8% of the cohort, average 2.7 times/week) were more likely to report abdominal pain (83.3% vs. 61.7%), gas (66.7% vs. 45.6%), tenesmus (70.0% vs. 47.6%), and arthralgias (53.3% vs. 20.3%) compared to non-users. However, they did not have more frequent active disease or IBD-associated complications on endoscopy.

Why it matters

The disconnect between more reported symptoms and no worse disease activity in cannabis users suggests these patients may have greater symptom sensitivity, more extraintestinal manifestations, or may be using cannabis to manage symptoms that standard IBD treatment does not address.

The numbers in context

383 IBD patients; 30 (7.8%) were active cannabis users; average 2.7 times/week. Higher rates of abdominal pain, gas, tenesmus, and arthralgias (all p<0.05). No difference in active disease or complications.

How the study worked

Retrospective cohort study of 383 IBD patients from a consented natural history registry at a single tertiary center (2015-2020). Current cannabis use, frequency, demographics, clinical characteristics, endoscopic severity, and validated symptom surveys compared between users and non-users with logistic regression.

What this study cannot tell us

Retrospective, single-center study. Small number of cannabis users (n=30). Self-reported cannabis use. Cannot determine whether cannabis is ineffective or whether sicker patients self-select into use. Cross-sectional comparison.

How to read the evidence

Single-center retrospective cohort with small cannabis user group, but includes endoscopic validation.

When this study was published

Published in 2022 with data from 2015-2020.

The bigger picture

This finding challenges the assumption that cannabis helps IBD symptoms: cannabis users reported more symptoms, not fewer. This may reflect reverse causation (sicker patients turn to cannabis) or cannabis's inability to address certain symptom types.

Questions still open

Are cannabis users sicker before they start using, or does cannabis fail to help? Would specific cannabinoid formulations work better for IBD symptoms? Should clinicians look for extraintestinal causes when IBD patients use cannabis?

Common questions

Does cannabis help IBD symptoms?

In this study, IBD patients who used cannabis actually reported more symptoms (abdominal pain, gas, tenesmus, joint pain) than non-users. However, their underlying disease was not worse, suggesting the relationship between cannabis use and symptoms is complex.

Why might cannabis users report more symptoms?

The most likely explanation is reverse causation: patients with more symptoms turn to cannabis for relief. It is also possible that cannabis does not adequately treat certain IBD-related symptoms, or that extraintestinal factors contribute.

Read the original research

Symptoms and Extraintestinal Manifestations in Active Cannabis Users with Inflammatory Bowel Disease.

Cannabis and cannabinoid research, 7(4), 445-450

View on PubMed ↗Publisher’s paper ↗

Citation

Coates, Matthew D; Dalessio, Shannon; Walter, Vonn; Stuart, August; Bernasko, Nana; Tinsley, Andrew; Razeghi, Sanam; Williams, Emmanuelle D; Clarke, Kofi; Vrana, Kent. (2022). Symptoms and Extraintestinal Manifestations in Active Cannabis Users with Inflammatory Bowel Disease.. Cannabis and cannabinoid research, 7(4), 445-450. https://doi.org/10.1089/can.2020.0155