Marks Colorectal Surgical Associates, Lankenau Medical Center, Wynnewood, PA.
J Clin Gastroenterol. 2020 Oct;54(9):769-788. doi: 10.1097/MCG.0000000000001287.
Cannabinoids have been known as the primary component of cannabis for decades, but the characterization of the endocannabinoid system (ECS) in the 1990s opened the doors for cannabis' use in modern medicine. The 2 main receptors of this system, cannabinoid receptors 1 and 2, are found on cells of various tissues, with significant expression in the gastrointestinal (GI) tract. The characterization of the ECS also heralded the understanding of endocannabinoids, naturally occurring compounds synthesized in the human body. Via secondary signaling pathways acting on vagal nerves, nociceptors, and immune cells, cannabinoids have been shown to have both palliative and detrimental effects on the pathophysiology of GI disorders. Although research on the effects of both endogenous and exogenous cannabinoids has been slow due to the complicated legal history of cannabis, discoveries of cannabinoids' treatment potential have been found in various fields of medicine, including the GI world. Medical cannabis has since been offered as a treatment for a myriad of conditions and malignancies, including cancer, human immunodeficiency virus/acquired immunodeficiency syndrome, multiple sclerosis, chronic pain, nausea, posttraumatic stress disorder, amyotrophic lateral sclerosis, cachexia, glaucoma, and epilepsy. This article hopes to create an overview of current research on cannabinoids and the ECS, detail the potential advantages and pitfalls of their use in GI diseases, and explore possible future developments in this field.
大麻素作为大麻的主要成分已被人们认识数十年，但内源性大麻素系统（ECS）在 20 世纪 90 年代的特征描述为大麻在现代医学中的应用开辟了道路。该系统的 2 个主要受体，即大麻素受体 1 和 2，存在于各种组织的细胞上，在胃肠道（GI）中表达明显。ECS 的特征描述也预示着内源性大麻素的理解，即人体自身合成的天然化合物。通过作用于迷走神经、伤害感受器和免疫细胞的二级信号通路，大麻素对 GI 疾病的病理生理学既有缓解作用，也有不利影响。尽管由于大麻复杂的法律历史，对内源性和外源性大麻素的作用的研究进展缓慢，但在包括 GI 领域在内的各个医学领域都发现了大麻素治疗潜力的发现。医用大麻自此已被用于治疗多种疾病和恶性肿瘤，包括癌症、人类免疫缺陷病毒/获得性免疫缺陷综合征、多发性硬化症、慢性疼痛、恶心、创伤后应激障碍、肌萎缩侧索硬化症、恶病质、青光眼和癫痫。本文希望对内源性大麻素和 ECS 的当前研究进行概述，详细说明它们在 GI 疾病中的应用的潜在优势和陷阱，并探索该领域的可能未来发展。
