Cannabis for Crohn's disease

Crohn's disease, along with ulcerative colitis, is one of the most common chronic inflammatory diseases of the digestive tract. Men and women are equally affected. Most people are diagnosed between the ages of 20 and 30, but in principle inflammatory bowel diseases can develop in people of any age1. But how does the bowel disease develop? What are the symptoms of Crohn's disease, how is it diagnosed and what treatments are available? We answer these questions in the following article. We also focus on cannabis as a medicine for Crohn's disease symptoms.

Criteria for prescribing medical cannabis for Crohn's disease

The law "Cannabis as Medicine" makes it possible that the cooperating doctors of the Canify Clinics can prescribe cannabis as medicine on a narcotic prescription under certain conditions.

These conditions include the presence of a serious illness that is classified as therapy-resistant, for which no standard therapy is available or for which the side effects of the standard therapy are unacceptable. According to medical assessment, there must also be a chance that the symptoms will improve with medicinal cannabis.

What is Crohn's disease?

Crohn's disease is a chronic disease that progresses in relapses. This means that symptom-free phases alternate with symptomatic phases. In contrast to ulcerative colitis, the inflammatory foci that occur in Crohn's disease can affect the entire digestive tract. This means that the mucous membranes in the mouth can be just as inflamed as the mucous membranes in the colon. However, the lower small intestine and the transition to the large intestine are particularly typical for the disease. In most cases, all layers of the intestinal wall are affected, which can lead to thickening as the disease progresses1, 2.

The inflamed areas are often in the direct vicinity of healthy sections. Doctors therefore speak of a segmental occurrence in Crohn's disease.The consequences of the recurring inflammatory foci are often narrowing of the intestine (so-called stenoses) and newly formed inflammatory ducts (fistulas)1,2.

What are the causes of Crohn's disease?

In both Crohn's disease and ulcerative colitis, it is unclear why patients get the disease. Experts suspect that various factors contribute to the development of the diseases. For example, the bowel disease may well be genetically determined if there are changes in certain genes. In addition, the immune system seems to play a role, as it reacts more strongly than usual in sufferers and triggers inflammation. Other possible causes could be that the barrier function in the intestinal wall or the intestinal flora are disturbed. Various environmental factors, such as unhealthy eating habits or smoking, are also being discussed as causes3,4.

Symptoms of Crohn's disease

Especially at the beginning of the disease, the symptoms are usually gradual, which is why patients do not immediately suspect chronic inflammatory Crohn's disease. Those affected complain of frequent, soft bowel movements and diarrhea, which occurs both during the day and at night. Due to the nocturnal complaints, Crohn's disease patients often feel tired and weary in everyday life. Often, the quality of life is also considerably reduced1,2,3.

Accompanying symptoms include abdominal pain and flatulence. The fact that the pain is often most pronounced in the right lower abdomen is due to the fact that the last section of the small intestine is located there and is often affected by inflammation. However, the way patients describe the pain varies greatly. While some experience the pain as localized and crampy, others speak of diffuse pain in the entire abdomen1,2,3.

During an episode, many sufferers also experience a loss of appetite, nausea, vomiting and fever. The lack of appetite can also lead to weight loss1,2,3.

Diagnostics – how Crohn's disease is diagnosed

In order to confirm or exclude the diagnosis of Crohn's disease, various examinations are necessary. In the case of symptoms affecting the digestive tract, patients should ideally consult an internist, i.e. a doctor of internal medicine5.

In an internist's practice, the patient's medical history and family biography are usually the first questions asked. If a family member already has Crohn's disease, this can be a first indication of the diagnosis5.

In addition, the following procedures are part of the diagnosis of Crohn's disease:

  • Laboratory tests: When inflammation occurs in the body, it is shown by certain elevated blood levels such as C-reactive protein (CRP), white blood cells (leukocytes) and erythrocyte sedimentation rate (ESR). A blood test can also indicate a nutrient deficiency that has developed as a result of the disease, such as a lack of iron, vitamin B12, zinc, folic acid or calcium. In addition, the levels of red blood cells, platelets and blood pigment (hemoglobin) are determined. The kidney or thyroid values may also be altered if the intestinal disease has affected other organs. If diarrhea occurs frequently, a stool examination is used to rule out bacterial infections5.
  • Ultrasound: The wall of the intestine is thicker than normal when inflamed. Doctors can examine you with ultrasound imaging (sonography). Transrectal sonography is a type of sonography where doctors insert an ultrasound probe into the patient's anus to examine the rectum5.
  • Colonoscopy: In a colonoscopy, a camera is inserted into the anus via an endoscope in order to examine the patient's large intestine and the adjoining part of the small intestine. In addition, tissue samples can be taken during the examination5.
  • Gastroscopy: During gastroscopy, the endoscope is inserted into the stomach through the mouth to check for inflammation in the upper gastrointestinal tract5.
  • Computed tomography and magnetic resonance imaging: Both CT and MRI can show enlarged lymph nodes and a thickened bowel wall. It can also show fistulas (connecting ducts) and abscesses (collections of pus)5.

Once the diagnosis has been made, doctors determine the severity of Crohn's disease. This is done with the Best activity index. The method assigns numerical values for certain symptoms (e.g. frequency of stools, general complaints, intensity of pain). The combination of these values with the weight of the patient results in the Crohn's disease activity index (CDAI). Medical action is required from a CDAI of 150-2005.

Crohn's disease therapy

Crohn's disease cannot be cured, but a therapy adapted to the individual needs of the patient can slow down the inflammatory process and alleviate the symptoms5.

During an acute phase of the inflammation, many patients take hormone preparations such as cortisone and prednisone. Depending on the intensity and location of the inflammation, the treating doctor decides which medication is the drug of choice and in which dosage it should be taken. In most cases, the hormone preparations have to be taken over a period of several months, which can lead to side effects such as bone loss (osteoporosis), frequent infections and weight gain5.

Other medications that may be used during an acute episode if hormone medications are not effective enough are5:

  • Immunosuppressants: These medications are often used for long-term treatment of Crohn's disease and are meant to suppress the immune system. In some cases, a therapy consisting of cortisone and immunosuppressants is also used. Agents such as azathioprine, methotrexate or mercaptopurine are used.
  • Biologics: These are drugs that are produced by living organisms and can be prescribed for severe relapses or when cortisone is not effective enough. Biologicals that can be prescribed are, for example, TNF-alpha antibodies such as Infliximab.

The inflammatory foci in the digestive tract can prevent the absorption of important nutrients and lead to deficiencies. Regular blood tests are therefore particularly important. If necessary, those affected receive so-called supplements. These are medicines that contain the missing nutrients (e.g. B12, calcium, iron or zinc)5.

In addition, Crohn's disease symptoms are treated with specific medications. These include, for example, loperamide to counteract severe diarrhea.

Complications from the disease that make surgery necessary are common5. These complications include:

  • Permanent bowel obstruction or bowel constriction
  • Bowel rupture
  • Severe intestinal bleeding
  • Inflammation of the peritoneum
  • Formation of abscesses (pus in a mucosal cavity)
  • Fistula formation between the intestine and the urinary bladder.

In order to better cope with the psychological stresses of Crohn's disease, psychological support in the form of talk therapy can also be important.

Cannabis for Crohn's disease

Despite the various therapies available, they are often insufficient or associated with severe side effects. This does not make the treatment of Crohn's disease easy. Although the evidence for medicinal cannabis in Crohn's disease is not yet fully established, a German study showed that 1.1% of cannabis prescriptions covered by statutory health insurance were due to inflammatory bowel disease. In traditional Chinese, Indian and African medicine, cannabis has also been used in the past for ailments of the digestive tract6.

But what effect can medicinal cannabis have in the gut? Studies indicate that the inflammatory processes in the body are controlled by the endocannabinoid system, among others. This is part of the nervous system and is involved in numerous processes in the organism, such as the perception of pain, emotions, the immune system and many others. Since the associated cannabinoid receptors can be detected in almost the entire body, including the gastrointestinal tract, the potential effect of cannabinoids can be deduced from this. In particular, cannabinoid receptor 2 (CB2), which is also found in the digestive tract, seems to play an important role in inflammatory processes and can be activated by cannabinoids such as THC and CBD. CB2 could therefore be a promising target for the treatment of inflammatory diseases in the gut6.

How can medicinal cannabis reduce inflammation?

US researchers have made an interesting discovery in a study7. When the body is infected with a pathogen, it produces neutrophils (immune cells that are the most common subtype of white blood cells) to fight the pathogen. If the immune cells react too strongly, they can destroy the protective layers in the intestine (epithelium). To stop the immune cells, special molecules are sent out to stop the inflammation.

According to researchers, this process requires endocannabinoids, i.e. cannabinoids that our organism can produce itself and that have a similar effect to the cannabinoids from the cannabis plant.

In human cell lines and mice, the researchers found that the organism can no longer control the inflammatory processes if the endocannabinoids are missing. In this respect, the cannabinoids from the cannabis plant could replace the endocannabinoids and have an anti-inflammatory effect.

Clinical results

So far, it has not been clinically proven that cannabis (and cannabis products) significantly reduce the inflammation caused by Crohn's disease. However, studies have shown that there is a positive effect on other symptoms and an improvement in general well-being3,8. Further clinical studies are therefore needed to shed more light on the potential benefits of cannabis in Crohn's disease.

How can Canify Clinics help?

Canify Clinics wants to support you on your journey to medical cannabis. We understand the hurdles that people with Crohn's disease face in their daily lives. To help you on your way to medical cannabis, Canify Clinics works on the principle of telemedicine.

After you have registered on our portal without obligation, our doctors will check your documents and contact you promptly to discuss the next steps. If treatment with medicinal cannabis is an option for you, an appointment with one of our contracted doctors will follow. The follow-up appointments can take place in the comfort of your own home, and you can discuss everything important with your doctor via video chat. Only once a calendar year do you have to attend an appointment – we will be happy to help you prepare for this.

FAQ

What are the symptoms of Crohn's disease?

Crohn's disease, a chronic inflammation of the intestines, has a very different course. While some patients have mild symptoms, others have much more severe symptoms. The disease usually progresses in episodes, so that symptom-free phases alternate with phases in which the symptoms are more pronounced. A typical symptom is pain in the right lower abdomen. This is where the last section of the small intestine is located. Other symptoms may include diarrhea, weight loss, tiredness, fatigue and fever.

What causes Crohn's disease?

The exact causes of the disease are not yet known. It is assumed that various factors are involved in the development of the disease, such as genetic factors or certain environmental influences. In addition, a disturbed barrier function of the intestinal wall can be the cause, because bacteria living in the intestine penetrate the intestinal mucosa and cause an autoimmune reaction. A disturbed intestinal flora is also being discussed.

At what age can people get Crohn's disease?

Most people get Crohn's disease between the ages of 20 and 30, but generally people of any age can be affected by the inflammatory disease in the intestines. People who suffer from diarrhea, flatulence and abdominal pain over a long period of time should therefore consult an internist to find out the cause.

Disclaimer and legal information

This article is for informational purposes only and does not replace medical advice from a doctor. The content is not intended to motivate self-diagnosis or self-treatment, nor to tempt people to change their own medical treatment. Canify Clinics does not make any recommendations or promote any diagnostic methods or treatments. If you wish to change your treatment, this should always be discussed with a doctor. Furthermore, Canify Clinics cannot guarantee the accuracy, timeliness and balance of the content. Therefore, neither the authors of the texts nor Canify Clinics accept any liability for damages resulting from the independent use of the information described here.

References

  1. 1Berufsverband Deutscher Internistinnen und Internisten, Internisten im Netz, „Morbus Crohn, Ursachen & Risikofaktoren
  2. 2Kompetenznetz Darmerkrankungen e. V., „Morbus Crohn: Ursachen, Symptome, Therapie
  3. 3Nso N, Nyabera A, Nassar M, et al. Cannabis and Its Potential Protective Role Against Inflammatory Bowel Disease: A Scoping Review. Cureus 13(10): e18841. DOI 10.7759/cureus.18841 (2021)
  4. 4Hryhorowicz, S. et al. Endocannabinoid System as a Promising Therapeutic Target in Inflammatory Bowel Disease – A Systematic Review. Front Immunol 12, 5428 (2021).
  5. 5Berufsverband Deutscher Internistinnen und Internisten, Internisten im Netz, „Morbus Crohn: Untersuchungen & Diagnose
  6. 6Lowe, H., Toyang, N., Steele, B., Bryant, J. & Ngwa, W. The endocannabinoid system: A potential target for the treatment of various diseases. International Journal of Molecular Sciences vol. 22 Preprint at https://doi.org/10.3390/ijms22179472 (2021).
  7. 7Szabady, R. L. et al. Intestinal P-glycoprotein exports endocannabinoids to prevent inflammation and maintain homeostasis. J Clin Invest 128, 4044–4056 (2018).
  8. 8Bogale, K., Raup-Konsavage, W., Dalessio, S., Vrana, K. & Coates, M. D. Preclinical Science and Clinical Studies-Review Article Cannabis and Cannabis Derivatives for Abdominal Pain Management in Inflammatory Bowel Disease. (2021) doi:10.1159/000517425.