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Crohn's disease is a type of inflammatory bowel disease that is believed to occur due to a combination of bacterial, immune, and environmental factors. The disease is progressive and incurable, causing a number of severe symptoms and weakness. There is strong evidence that cannabis can help control symptoms.

Anti-inflammatory

Inflammatory processes are the main mechanism of Crohn's disease. The disease can affect any part of the gastrointestinal (GI) tract, from the mouth to the anus, but the areas most often affected are the colon and ileum (the large and small intestine), particularly the end of the ileum that connects with the colon. Chronic inflammation in these areas can lead to diarrhea, bleeding and tearing of the lining of the gastrointestinal tract, as well as intestinal obstructions. In severe cases, parts of the intestine may need to be completely removed.

A significant portion of Crohn's sufferers use cannabis as a form of self-medication, and there are anecdotal reports in which patients describe how it provides them with a subjective and substantial improvement of most symptoms, including inflammatory pain. As is well known, inflammation is regulated by the endocannabinoid system, which plays a critical role in inflammatory diseases of the GI tract, as the intestine contains very high levels of cannabinoid receptors.

Antidiarrheal

Diarrhea is the main symptom of Crohn's disease. Depending on which part of the gastrointestinal tract is affected, the stool can be mixed with mucus, pus, or blood, and can be more or less watery. A sense of urgency to defecate is common, along with a sensation of incomplete evacuation (known as tenesmus).

Cannabis has been used for thousands of years to treat diarrhea, and modern research has provided empirical evidence of its efficacy. Crohn's patients are believed to suffer from diarrhea due to inflammation of the intestinal mucosa (the mucous membrane that lines the GI tract), as well as increased fluid secretion, a reduced ability to absorb fluids, and the presence of of bacterial agents. Cannabis can alleviate the symptoms of diarrhea in Crohn's disease due to its antibacterial properties, as well as its anti-inflammatory effects.

Analgesic

Up to 70% of Crohn's sufferers suffer from chronic pain. In the early stages of terminal ileitis (the form of Crohn's disease that affects the terminal ileum), pain in the lower right abdomen is common, and is often mistaken for appendicitis. Pain is usually the result of chronic inflammation, but can be the result of tearing or denudation of the intestinal lining, abdominal distention, or intestinal obstructions.

Cannabis can help improve pain symptoms in Crohn's patients by acting directly to reduce inflammation by reducing the severity of bloating, and by relieving symptoms of diarrhea by reducing intestinal spasms and inhibiting fluid release.

Appetite stimulant (orexigen)

Cannabis use can increase appetite in Crohn's patients by reducing abdominal pain and inhibiting excessive peristalsis. However, it also helps increase hunger by directly agonizing certain receptors in the gastrointestinal tract that generally respond to the presence of ghrelin (an important 'hunger hormone' that has also proven to be a useful treatment for Crohn's disease).

Various studies have shown that the presence of ghrelin or cannabinoid agonists, such as THC, causes an increase in the production of an AMP enzyme, activated by protein kinase (AMPK), in the hypothalamus. The enzyme is crucial for the metabolic processes that regulate energy homeostasis (energy balance) in the body, and is produced in response to stimulation of the GHS-R1a ghrelin receptors found in the GI tract. Therefore, THC can do the job of ghrelin effectively by activating the receptors and directly stimulating the brain to produce the sensation of hunger.