What is Inflammatory Bowel Disease?

Inflammatory Bowel Disease (IBD) is a group of inflammatory disorders that can affect multiple parts of the gastrointestinal (GI) tract. The two most well-known classes of IBD are Ulcerative Colitis. and Crohn’s Disease. The inflammation of Ulcerative Colitis starts from the rectum and ascends through the colon, with the inflammation limited to mostly superficial parts of the colon. The inflammation of Crohn’s Disease can be anywhere in the GI tract, has a tendency to skip regions, and is involves a larger amount of colonic tissue. Prevalence of these diseases, at a combined approximately 450 per 100,000 people, is among the highest in the United States. [1]

Most patients will develop the disease between the ages of 15 and 40 years, with some studies showing that there is also a second peak later in life. [2] Unfortunately, there is no exact etiology of IBD as of now, but we do know of many risk factors, some of which are:

  • Age: as mentioned before, the disease peaks between the ages of 15-40 years
  • Gender: women are at increased risk of the disease compared to men [3]
  • Race/Ethnicity: increased rate of IBD in Jewish populations [4]; decreased rate of IBD in black and Hispanic populations [5]
  • Cigarettes: smoking cigarettes is associated with an increased risk of Crohn’s Disease [6], but may actually be protective in Ulcerative Colitis [7], although the reason is unknown.
  • Diet: diets high in fats, processed foods, sugar, and artificial additives may increase the risk of IBD [8-10]
  • Antibiotics: one hypothesis is that an altered gut microbiome contributes to the development of disease, and antibiotics are known causes of such alterations. One meta-analysis found that antibiotic exposure was associated with increased incidence of Crohn’s Disease. [11]
  • Genetics: many patients with IBD have close relatives with the disease [12-13], and sometimes have the same disease as their relative [14]

Common Signs and Symptoms of Inflammatory Bowel Disease:

  • Abdominal pain
  • Cramping
  • Nausea and vomiting
  • Diarrhea, with or without blood
  • Decreased appetite
  • Weight loss
  • Malnutrition
  • Fever
  • Fatigue
  • Depression and anxiety

Standard Treatment for Inflammatory Bowel Disease

Although there is no cure yet for any of the groups of IBD, there are multiple treatments available aimed at decreasing inflammation and treating complications of the disease. The goal at any level of severity is to induce remission and then maintain the response. For mild disease, medications are aimed at decreasing inflammation (ex: mesalamine, steroids, antibiotics). As severity of disease increases, immunomodulatory drugs (such as Humira – adalimumab and Remicade – infliximab) are used to impact the mechanisms of inflammation that have gone out of control. And finally, for severe complications or intractable disease, surgery may be the only option. At all levels of disease, it is important to maintain a healthy diet, as nutritional deficiencies can occur due to malabsorption, and supplementation is sometimes needed. Regardless of how it is treated though, there is no guarantee that symptoms do not recur.

Inflammatory Bowel Disease and Medical Cannabis

Cannabis has actually been used for thousands of years as a natural remedy for a variety of gastrointestinal symptoms and diseases. Modern studies have shown that cannabis can impact gut transit time and sensitivity to pain, which may explain why it has been used in the past (and to this date in some regions of the world), for diseases with diarrhea and abdominal pain. Animal models have even demonstrated improvements in the inflammatory reaction of IBD. Recent studies of the impact of cannabis on IBD have even suggested that patients may have improved symptoms, with a decreased need for medications or surgery. [14] Another study even suggested that cannabis can improve quality of life for patients with IBD, with an imprvement in perception of general health, social functioning, ability to work, physical pain, and depression. along with a better quality of life Today, a growing number of states in the U.S. are allowing patients to seek medical marijuana treatments for a host of conditions – including Crohn’s disease. In Ohio, Crohn’s Disease is one of more than 20 qualifying medical conditions for medical marijuana.

There are currently many different strains of medical cannabis with different quantities of active components, such as THC (tetrahydrocannabinol) and CBD (cannabidiol). Some may be better for appetite stimulation and weight gain, whereas the antiinflammatory properties of other strains may help attenuate disease in the future. Even though cannabis may provide benefit to patients today, it is important to continue research efforts to provide maximal benefit in the future. It is important to discuss with either a pharmacist or a trained dispensary technician which strain can provide the most benefit on an individual patient level.


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