As reported in the Journal, Inflammatory Bowel Disease,1 inflammatory bowel disease (IBD) is a complex, multifactorial, lifelong disease of the gastrointestinal (GI) tract that is divided into two predominant phenotypes: Crohn’s disease and ulcerative colitis. IBD is characterized by chronic inflammation of the GI tract and causes symptoms such as abdominal pain, bloody diarrhea, and weight loss, as well as symptoms specific to pediatric-onset IBD including growth failure, impaired bone mineralization, and pubertal delay. With an estimated annual disease-attributable direct cost in the United States in excess of $6.3 billion2 and an estimated 1.6 million effected people in the United States,3 IBD is one of the most prevalent and costly GI disorders whose annual incidence and prevalence is on the rise. IBD places a significant burden on effected individuals because of the detrimental effects on quality of life, growth and development, and risk of malignancy later in life.4 The cause of IBD and its flare-ups is thought to involve dysregulation of the immune response, and the conventional treatment includes immunosuppression to induce and maintain remission.
Current immunosuppressive therapies available for the treatment of IBD offer limited benefits, lose effectiveness rapidly, and carry multiple long-term risks including malignancy, infection, and low bone density.5 These faults of the available therapies, as well as their known complications, expose a significant need for the development of highly novel therapies for the treatment of IBD.
CBD to the Rescue?
One pathway that may offer a novel approach to enhance the impaired host regulatory system in patients with IBD is the endogenous cannabinoid (endocannabinoid) pathway. Although cannabinoids are traditionally characterized as being synonymous with plant-derived Cannabis or marijuana (MJ), there is an innate, mammalian endocannabinoid system (ECS) that includes endogenous ligands termed endocannabinoids, their cannabinoid receptors, and the proteins involved in endocannabinoid biosynthesis and degradation. Several physiological effects and pathophysiological roles have been proposed for the ECS in the GI tract, including effects on epithelial growth and regeneration, immune function, motor function, appetite control, and secretion.6
In a study investigating the effect of CBD on intestinal biopsies from patients with ulcerative colitis (UC) and from intestinal segments of mice with LPS-induced intestinal inflammation, researchers found CBD markedly counteracted reactive enteric gliosis in LPS-mice through the massive reduction of astroglial signalling neurotrophin S100B. CBD targets enteric reactive gliosis, counteracts the inflammatory environment induced by LPS in mice and in human colonic cultures derived from UC patients. These actions lead to a reduction of intestinal damage mediated by PPAR gamma receptor pathway. Our results therefore indicate that CBD indeed unravels a new therapeutic strategy to treat inflammatory bowel diseases.7
The science on cannabinoids is still relatively in its early stages and much more research is needed. Cannabiniods are now known to reduce intestinal inflammation. They are worth exploring as part of an overall approach to treating IBD. Discuss any new therapy with your health care professional.
- Leinwand, Kristina L. DO; Gerich, Mark E. MD; Hoffenberg, Edward J. MD; Collins, Colm B. PhD Manipulation of the Endocannabinoid System in Colitis: A Comprehensive Review Inflammatory Bowel Diseases: February 2017 Volume 23, Issue 2, p 192–9.
- Kappelman MD, Rifas-Shiman SL, Porter CQ, et al. Direct health care costs of Crohn’s disease and ulcerative colitis in US children and adults. Gastroenterology. 2008;135:1907–13.
- Kappelman MD, Rifas-Shiman SL, Kleinman K, et al. The prevalence and geographic distribution of Crohn’s disease and ulcerative colitis in the United States. Clin Gastroenterol Hepatol. 2007;5:1424–9.
- Cuffari C. Inflammatory bowel disease in children: a pediatrician’s perspective. Minerva Pediatr. 2006;58:139–57.
- Hanauer SB, Feagan BG, Lichtenstein GR, et al. Maintenance infliximab for Crohn’s disease: the ACCENT I randomised trial. Lancet. 2002;359:1541–9.
- Izzo AA1, Camilleri M. Emerging role of cannabinoids in gastrointestinal and liver diseases: basic and clinical aspects. Gut. 2008 Aug;57(8):1140–55. doi: 10.1136/gut.2008.148791. Epub 2008 Apr 8.
- De Filippis D1, Esposito G, Cirillo C, Cipriano M, De Winter BY, Scuderi C, Sarnelli G, Cuomo R, Steardo L, De Man JG, Iuvone T. Cannabidiol reduces intestinal inflammation through the control of neuroimmune axis. PLoS One. 2011;6(12):e28159. doi: 10.1371/journal.pone.0028159. Epub 2011 Dec 6.