CBD-rich cannabis oil improved Crohn's symptoms and quality of life but not gut inflammation | Research

The takeaway

In a double-blind RCT of 56 Crohn's disease patients, 8 weeks of CBD-rich cannabis oil significantly improved symptom scores and quality of life compared to placebo, but endoscopic scores and inflammatory markers were unchanged.

Gastroenterologists, Crohn's disease patients, and anyone interested in the evidence for cannabis in inflammatory bowel disease.

Symptoms improved (P < 0.05) but gut inflammation unchanged (P = 0.75)

What the researchers found

CDAI dropped from 282 to 166 in the cannabis group vs 264 to 237 in placebo (P < 0.05). Quality of life improved from 74 to 91 in cannabis vs 74 to 75 in placebo (P = 0.004). However, endoscopic scores (SES-CD) did not differ between groups (P = 0.75), and CRP and calprotectin remained unchanged.

Why it matters

This is one of the few controlled trials of cannabis in Crohn's disease with endoscopic endpoints. The dissociation between symptom improvement and unchanged inflammation raises a critical question: is cannabis treating the disease or just masking symptoms?

The numbers in context

56 patients (30 cannabis, 26 placebo); CBD:THC 160:40 mg/ml; CDAI: 282→166 cannabis vs 264→237 placebo; QOL: 74→91 vs 74→75; SES-CD: P = 0.75; CRP and calprotectin unchanged

How the study worked

Double-blind, randomized, placebo-controlled, single-center trial. 56 patients received either CBD-rich cannabis oil (160/40 mg/ml CBD/THC) or placebo orally for 8 weeks. Disease activity (CDAI), endoscopic score (SES-CD), quality of life, and inflammatory markers were assessed.

What this study cannot tell us

Single center. Small sample. 8-week duration may be insufficient for endoscopic improvement. Fixed CBD:THC ratio may not be optimal. No long-term follow-up.

How to read the evidence

Well-designed double-blind RCT with endoscopic endpoints, though single center and relatively small sample.

When this study was published

Published in 2021.

The bigger picture

The finding that patients feel better without objective improvement in gut inflammation is a double-edged sword. Symptom relief improves quality of life, but if patients reduce evidence-based therapies because they feel better, untreated inflammation could lead to complications.

Questions still open

Would longer treatment produce endoscopic improvement? Is a different CBD:THC ratio more effective? Should cannabis be used as adjunctive therapy alongside conventional IBD treatments? Is there a risk of patients discontinuing effective therapies because cannabis makes them feel better?

Common questions

Does cannabis help Crohn's disease?

CBD-rich cannabis oil improved symptoms and quality of life in this trial, but did not reduce gut inflammation as measured by endoscopy and blood markers. This suggests cannabis may help patients feel better without treating the underlying disease.

Should Crohn's patients replace their medications with cannabis?

The researchers cautioned that cannabis treatment should only be used in the context of clinical trials until more data is available, particularly since inflammation was not reduced despite symptom improvement.

Read the original research

Oral CBD-rich Cannabis Induces Clinical but Not Endoscopic Response in Patients with Crohn's Disease, a Randomised Controlled Trial.

Journal of Crohn's & colitis, 15(11), 1799-1806

View on PubMed ↗Publisher’s paper ↗

Citation

Naftali, Timna; Bar-Lev Schleider, Lihi; Almog, Shlomo; Meiri, David; Konikoff, Fred M. (2021). Oral CBD-rich Cannabis Induces Clinical but Not Endoscopic Response in Patients with Crohn's Disease, a Randomised Controlled Trial.. Journal of Crohn's & colitis, 15(11), 1799-1806. https://doi.org/10.1093/ecco-jcc/jjab069