Clinical Enteric Neuroscience Translational and Epidemiological Research, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
Clinical Enteric Neuroscience Translational and Epidemiological Research, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
Clin Gastroenterol Hepatol. 2023 Dec;21(13):3217-3229. doi: 10.1016/j.cgh.2023.07.031. Epub 2023 Sep 9.
The synthesis and degradation of endocannabinoids, location of cannabinoid (CB) receptors, and cannabinoid mechanisms of action on immune/inflammatory, neuromuscular, and sensory functions in digestive organs are well documented. CB mechanisms are particularly relevant in immune and sensory functions. Increasing use of cannabinoids in the United States is impacted by social determinants of health including racial discrimination, which is associated with tobacco and cannabis co-use, and combined use disorders. Several conditions associated with emesis are related to cannabinoid use, including cannabinoid hyperemesis or withdrawal, cyclic vomiting syndrome, and nausea and vomiting of pregnancy. Cannabinoids generally inhibit gastrointestinal motor function; yet they relieve symptoms in patients with gastroparesis and diverse nausea syndromes. Cannabinoid effects on inflammatory mechanisms have shown promise in relatively small placebo-controlled studies in reducing disease activity and abdominal pain in patients with inflammatory bowel disease. Cannabinoids have been studied in disorders of motility, pain, and disorders of gut-brain interaction. The CB-receptor agonist, cannabidiol, reduced the total Gastroparesis Cardinal Symptom Index and increases the ability to tolerate a meal in patients with gastroparesis appraised over 4 weeks of treatment. In contrast, predominant-pain end points in functional dyspepsia with normal gastric emptying were not improved significantly with cannabidiol. The CB agonist, olorinab, reduced abdominal pain in inflammatory bowel disease in an open-label trial and in constipation-predominant irritable bowel syndrome in a placebo-controlled trial. Cannabinoid mechanisms alter inflammation in pancreatic and liver diseases. In conclusion, cannabinoids, particularly agents affecting CB mechanisms, have potential for inflammatory, gastroparesis, and pain disorders; however, the trials require replication and further understanding of risk-benefit to enhance use of cannabinoids in gastrointestinal diseases.
内源性大麻素的合成和降解、大麻素（CB）受体的位置以及大麻素在消化器官的免疫/炎症、神经肌肉和感觉功能中的作用机制已得到充分证实。CB 机制在免疫和感觉功能中尤为重要。美国大麻素的使用不断增加，受到健康的社会决定因素的影响，包括与烟草和大麻共同使用以及合并使用障碍相关的种族歧视。与呕吐相关的几种情况与大麻素的使用有关，包括大麻素性呕吐或戒断、周期性呕吐综合征以及妊娠恶心和呕吐。大麻素通常抑制胃肠道运动功能；然而，它们可以缓解胃轻瘫和各种恶心综合征患者的症状。在炎症机制方面，在相对较小的安慰剂对照研究中，大麻素在减轻炎症性肠病患者的疾病活动度和腹痛方面显示出了一定的前景。大麻素已在运动障碍、疼痛和肠道-大脑相互作用障碍的研究中进行了研究。CB 受体激动剂，大麻二酚，可减少胃轻瘫总卡特尔症状指数，并提高胃轻瘫患者对餐的耐受性，经过 4 周的治疗评估。相比之下，在排空正常的功能性消化不良中，以疼痛为主的终点并没有因大麻二酚得到显著改善。CB 激动剂，奥拉尼布，可减少炎症性肠病的腹痛，在开放标签试验中，在便秘为主的肠易激综合征中，在安慰剂对照试验中也可减少腹痛。大麻素机制改变了胰腺和肝脏疾病中的炎症。总之，大麻素，特别是影响 CB 机制的药物，在炎症、胃轻瘫和疼痛疾病方面具有潜力；然而，这些试验需要复制和进一步了解风险效益，以增强大麻素在胃肠道疾病中的应用。
