Borinsky Stephanie A, Weir Alexandra A, LaFata Sean S, Gee Timothy S, Thel Hannah L, Cameron Brenderia A, Xue Angela Z, Kiran Akshatha, Ocampo Adolfo A, McCallen Justin, Lee Christopher J, Redd Walker D, Barlowe Trevor S, Kaakati Rayan N, Cotton Cary C, Eluri Swathi, Reed Craig C, Dellon Evan S
Pediatric Gastroenterology, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
Dis Esophagus. 2025 Jan 7;38(1). doi: 10.1093/dote/doae080.
Cannabis use is becoming increasingly common, both for recreational and medical purposes. However, there is a paucity of data regarding cannabis use in the context of eosinophilic esophagitis (EoE). We aimed to determine the impact of cannabis use on presentation and treatment response in EoE. To this end, we conducted a retrospective cohort study at a large academic medical center of newly diagnosed EoE patients age ≥ 12 years. Self-reported cannabis use status, baseline characteristics, and treatment response to topical corticosteroids and dietary therapy data were extracted. Bivariate and multivariable analyses were used to compare cannabis users and non-users at time of EoE diagnosis and to assess treatment response. Of 983 EoE patients, 80 reported using cannabis, with the majority reporting daily use and administration by inhalation. Baseline symptoms and peak eosinophil count were similar between cannabis users and non-users; cannabis users were less likely to have baseline endoscopic findings of exudates, edema, and stricture, and lower total Endoscopic Reference Score. On multivariable analysis, younger age, male sex, non-White race, and psychiatric diagnosis were independently associated with history of cannabis use at EoE presentation and stricture was independently associated with cannabis non-use. Post-treatment symptom and histologic responses were similar between cannabis users and non-users though there was a higher odds of post-treatment endoscopic inflammatory features with cannabis use. In conclusion, despite presenting with milder initial endoscopic findings, cannabis users exhibited greater inflammatory findings after treatment, highlighting a potential negative influence of cannabis use on EoE management.
大麻的使用正变得越来越普遍，无论是用于娱乐还是医疗目的。然而，关于嗜酸性食管炎（EoE）背景下大麻使用的数据却很匮乏。我们旨在确定大麻使用对EoE的表现和治疗反应的影响。为此，我们在一家大型学术医疗中心对年龄≥12岁的新诊断EoE患者进行了一项回顾性队列研究。提取了自我报告的大麻使用状况、基线特征以及局部皮质类固醇和饮食疗法的治疗反应数据。采用双变量和多变量分析来比较EoE诊断时的大麻使用者和非使用者，并评估治疗反应。在983例EoE患者中，80例报告使用过大麻，大多数报告每天使用且通过吸入方式给药。大麻使用者和非使用者之间的基线症状和嗜酸性粒细胞峰值计数相似；大麻使用者出现渗出物、水肿和狭窄等基线内镜检查结果的可能性较小，内镜参考总分也较低。多变量分析显示，年龄较小、男性、非白人种族和精神疾病诊断与EoE发病时的大麻使用史独立相关，而狭窄与不使用大麻独立相关。大麻使用者和非使用者治疗后的症状和组织学反应相似，不过大麻使用者治疗后内镜下炎症特征的几率更高。总之，尽管大麻使用者最初的内镜检查结果较轻，但治疗后炎症表现更明显，这突出了大麻使用对EoE治疗的潜在负面影响。
