Division of Gastroenterology & Hepatology, Department of Medicine, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA.
Department of Pharmacology, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA.
Cannabis Cannabinoid Res. 2022 Aug;7(4):445-450. doi: 10.1089/can.2020.0155. Epub 2021 Mar 24.
Cannabis use is common in the setting of inflammatory bowel disease (IBD). Patients frequently use cannabis to treat IBD-associated symptoms, and there is evidence that cannabis and its derivatives are helpful for this purpose. However, it is unclear how the symptom profiles of active IBD cannabis users and nonusers compare and how these symptoms may relate to their underlying disease state and/or complications. We performed a retrospective cohort study using a consented IBD natural history registry from a single tertiary care referral center between January 1, 2015 and August 31, 2020. We asked patients about current cannabis use and frequency. We also abstracted demographic and clinical characteristic information, including endoscopic severity, and totals and subscores of surveys assessing IBD characteristics, presence of anxiety/depression, and IBD-associated symptoms. We compared clinical and demographic factors of cannabis users and nonusers and developed a logistic regression model to evaluate for independent associations with cannabis use. Three hundred eighty-three IBD patients met the inclusion criteria (206 females, 177 males; 258 Crohn's disease [CD], 118 ulcerative colitis, and 7 indeterminate colitis). Thirty patients (7.8%) were active cannabis users, consuming it for an average of 2.7 times per week. Cannabis users 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 those that did not use cannabis (<0.05 for each). Incidence of moderate-severe endoscopic inflammation was similar between cannabis users and nonusers, while CD-associated complications were more common in nonusers (39.1% vs. 69.7%, <0.05). The only factor that demonstrated a significant association with cannabis use on multivariable analysis was arthralgia (<0.01). Active IBD cannabis users were more likely to report a variety of symptoms, including abdominal pain, gas, tenesmus, and arthralgias. However, they did not demonstrate more frequent active disease or IBD-associated complications, suggesting that other nonluminal factors influence their symptoms and/or decision to use cannabis. These findings demonstrate the importance of evaluating for extraintestinal contributors to symptom burden in IBD cannabis users, as well as the ongoing need to develop safer and more effective methods for recognizing and managing abdominal pain and other symptoms in this setting.
在炎症性肠病（IBD）的背景下，大麻的使用很常见。患者经常使用大麻来治疗与 IBD 相关的症状，并且有证据表明大麻及其衍生物对此有帮助。然而，尚不清楚活动性 IBD 大麻使用者和非使用者的症状谱如何比较，以及这些症状如何与他们的潜在疾病状态和/或并发症相关。
我们进行了一项回顾性队列研究，使用了一家单中心三级转诊中心在 2015 年 1 月 1 日至 2020 年 8 月 31 日期间的 IBD 自然史登记处的知情同意。我们询问了患者目前的大麻使用情况和频率。我们还提取了人口统计学和临床特征信息，包括内镜严重程度，以及评估 IBD 特征、焦虑/抑郁存在情况以及 IBD 相关症状的调查的总分和子分。我们比较了大麻使用者和非使用者的临床和人口统计学因素，并建立了逻辑回归模型来评估与大麻使用相关的独立关联。
符合纳入标准的 383 名 IBD 患者（206 名女性，177 名男性；258 名克罗恩病[CD]，118 名溃疡性结肠炎，7 名不确定结肠炎）。30 名患者（7.8%）为活动性大麻使用者，平均每周使用 2.7 次。与不使用大麻的患者相比，大麻使用者更有可能报告腹痛（83.3% vs. 61.7%）、气胀（66.7% vs. 45.6%）、里急后重（70.0% vs. 47.6%）和关节痛（53.3% vs. 20.3%）（<0.05）。大麻使用者和非使用者的中重度内镜炎症发生率相似，而 CD 相关并发症在非使用者中更为常见（39.1% vs. 69.7%，<0.05）。多变量分析显示，唯一与大麻使用显著相关的因素是关节痛（<0.01）。
活动性 IBD 大麻使用者更有可能报告各种症状，包括腹痛、气胀、里急后重和关节痛。然而，他们并没有表现出更频繁的活动疾病或 IBD 相关并发症，这表明其他非腔道因素影响他们的症状和/或决定使用大麻。这些发现表明，在 IBD 大麻使用者中，评估肠道外因素对症状负担的重要性，以及开发更安全有效的方法来识别和管理该环境中的腹痛和其他症状的持续需求。
