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Adenusi AO, Magacha HM, Nwaneki CM, Asifat OA, Annor EN. Cannabis Use and Associated Gastrointestinal Disorders: A Literature Review. Cureus 2023; 15:e41825. [PMID: 37575784 PMCID: PMC10423018 DOI: 10.7759/cureus.41825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2023] [Indexed: 08/15/2023] Open
Abstract
Cannabis, commonly known as marijuana, is used by at least 18% of the United States (US) population, which makes it the most commonly used federally illegal drug in the United States. It is widely used for recreational purposes, while its therapeutic benefits have been extensively explored in the US. For several years, cannabis has been used for the treatment of diverse health conditions, including pain management, anti-inflammatory effects, and spasticity associated with multiple sclerosis and other neurodegenerative diseases. However, cannabis use has been associated with some acute and chronic adverse effects. This review sheds light on gastrointestinal disorders, gastroesophageal reflux disease, pancreatitis, and peptic ulcer disease that have been associated with cannabis use.
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Affiliation(s)
| | - Hezborn M Magacha
- Internal Medicine, East Tennessee State University, Johnson City, USA
| | - Chisom M Nwaneki
- Internal Medicine, Saint Peter's University Hospital, New Jersey, USA
| | - Olamide A Asifat
- Epidemiology and Biostatistics, East Tennessee State University, Johnson City, USA
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Mansour J, Zulfiqar M, Umer A, Zurcher KS, Heeger A, Menias CO. Abdominal Imaging Manifestations of Recreational Drug Use. Radiographics 2020; 40:1895-1915. [PMID: 33064622 DOI: 10.1148/rg.2020200048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Recreational drug use is a burgeoning health issue worldwide, with a variety of presenting symptoms and complications. These complications can be secondary to the toxic effects of the drug itself, drug impurities, and nonsterile injection. The abdominal radiologist is likely to encounter patients who use drugs recreationally and may be responsible for recognizing and reporting these acute conditions, which in some cases can be life threatening. Because these patients often present with an altered mental state and may deny or withhold information on drug use, the underlying cause may be difficult to determine. The most commonly used drugs worldwide include cocaine, cannabinoids, opioids, and amphetamines and their derivatives. Complications of use of these drugs that can be seen at abdominopelvic CT can involve multiple organ systems, including the soft tissue and gastrointestinal, genitourinary, vascular, and musculoskeletal systems. A diverse range of abdominal complications associated with these drugs can be seen at imaging, including disseminated infections, gastrointestinal ischemia, and visceral infarction. Radiologists should be familiar with the imaging findings of these complications to accurately diagnose these entities and help guide workup and patient treatment. ©RSNA, 2020.
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Affiliation(s)
- Joseph Mansour
- From the Department of Radiology, Saint Louis University Hospital, 3635 Vista Ave, 2nd Floor, Deslodge Tower, St Louis, MO 63103-2097 (J.M., A.U.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (J.M., M.Z.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (K.S.Z., C.O.M.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.H.)
| | - Maria Zulfiqar
- From the Department of Radiology, Saint Louis University Hospital, 3635 Vista Ave, 2nd Floor, Deslodge Tower, St Louis, MO 63103-2097 (J.M., A.U.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (J.M., M.Z.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (K.S.Z., C.O.M.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.H.)
| | - Affan Umer
- From the Department of Radiology, Saint Louis University Hospital, 3635 Vista Ave, 2nd Floor, Deslodge Tower, St Louis, MO 63103-2097 (J.M., A.U.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (J.M., M.Z.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (K.S.Z., C.O.M.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.H.)
| | - Kenneth S Zurcher
- From the Department of Radiology, Saint Louis University Hospital, 3635 Vista Ave, 2nd Floor, Deslodge Tower, St Louis, MO 63103-2097 (J.M., A.U.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (J.M., M.Z.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (K.S.Z., C.O.M.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.H.)
| | - Allen Heeger
- From the Department of Radiology, Saint Louis University Hospital, 3635 Vista Ave, 2nd Floor, Deslodge Tower, St Louis, MO 63103-2097 (J.M., A.U.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (J.M., M.Z.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (K.S.Z., C.O.M.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.H.)
| | - Christine O Menias
- From the Department of Radiology, Saint Louis University Hospital, 3635 Vista Ave, 2nd Floor, Deslodge Tower, St Louis, MO 63103-2097 (J.M., A.U.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (J.M., M.Z.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (K.S.Z., C.O.M.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.H.)
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Bjorling DE, Wang ZY. Potential of Endocannabinoids to Control Bladder Pain. Front Syst Neurosci 2018; 12:17. [PMID: 29867382 PMCID: PMC5962905 DOI: 10.3389/fnsys.2018.00017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 04/24/2018] [Indexed: 12/21/2022] Open
Abstract
Bladder-related pain is one of the most common forms of visceral pain, and visceral pain is among the most common complaints for which patients seek physician consultation. Despite extensive studies of visceral innervation and treatment of visceral pain, opioids remain a mainstay for management of bladder pain. Side effects associated with opioid therapy can profoundly diminish quality of life, and improved options for treatment of bladder pain remain a high priority. Endocannabinoids, primarily anandamide (AEA) and 2-arachidonoylglycerol (2-AG), are endogenously-produced fatty acid ethanolamides with that induce analgesia. Animal experiments have demonstrated that inhibition of enzymes that degrade AEA or 2-AG have the potential to prevent development of visceral and somatic pain. Although experimental results in animal models have been promising, clinical application of this approach has proven difficult. In addition to fatty acid amide hydrolase (FAAH; degrades AEA) and monacylglycerol lipase (MAGL; degrades 2-AG), cyclooxygenase (COX) acts to metabolize endocannabinoids. Another potential limitation of this strategy is that AEA activates pro-nociceptive transient receptor potential vanilloid 1 (TRPV1) channels. Dual inhibitors of FAAH and TRPV1 or FAAH and COX have been synthesized and are currently undergoing preclinical testing for efficacy in providing analgesia. Local inhibition of FAAH or MAGL within the bladder may be viable options to reduce pain associated with cystitis with fewer systemic side effects, but this has not been explored. Further investigation is required before manipulation of the endocannabinoid system can be proven as an efficacious alternative for management of bladder pain.
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Affiliation(s)
- Dale E Bjorling
- School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, United States
| | - Zun-Yi Wang
- School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, United States
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Fatal Mesenteric Ischemia Induced by Synthetic Cannabinoids: A Case Report and Literature Review. Case Rep Emerg Med 2017; 2017:6964078. [PMID: 29403666 PMCID: PMC5748310 DOI: 10.1155/2017/6964078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 11/10/2017] [Accepted: 11/14/2017] [Indexed: 01/18/2023] Open
Abstract
Worldwide use of synthetic cannabinoids (SCs) is rapidly increasing, in part due to the generation of numerous new compounds, sidestepping legal restrictions. Their detection using standard toxicology panels is difficult, due to their vast heterogeneity and lack of structural resemblance to cannabinoids. Sympathetic overactivity and arterial spasm play a role in some of the life-threatening reactions to SCs, such as coronary or cerebral vasoconstriction. Here we report a patient with repeated consumption of SCs that led to mesenteric ischemia and death. A 29-year-old man was frequently evaluated in the Emergency Medicine Department for recurrent transient crampy abdominal pain, associated with the use of the SCs colloquially known as “Mr. Nice Guy.” He was finally hospitalized with a protracted attack, associated with diarrhea and leukocytosis. Initial evaluation including computed tomography was unremarkable. Diarrhea and leukocytosis gradually resolved, but bouts of hypertension and abdominal pain occurred in association with repeated consumption of the SCs. On the fifth hospital day, the patient developed abrupt abdominal pain, associated with profound shock and signs of peritoneal irritation and succumbed within an hour. Postmortem CT scan was consistent with intestinal perforation most probably due to a nonobstructive mesenteric infarction. There was no evidence of a single vessel infarction.
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Manning Meurer M, Chakrala K, Gowda D, Burns C, Kelly R, Schlabritz-Loutsevitch N. A case of cannabinoid hyperemesis syndrome with Heliobacter pylori and preeclampsia during pregnancy. Subst Abus 2017; 39:9-13. [PMID: 28723278 DOI: 10.1080/08897077.2017.1356790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The condition termed cannabinoid hyperemesis syndrome (CHS) was characterized a decade ago by Allen et al. and includes cyclic episodes of nausea and vomiting and the learned behavior of hot bathing in individuals with chronic cannabis abuse. During pregnancy, the differential diagnosis of this syndrome is challenging, since it can be masked by typical symptoms of early pregnancy or by hyperemesis gravidarum, a complication of early pregnancy associated with excessive nausea and vomiting. CASE DESCRIPTION The authors herein describe the case of a 21-year-old primigravida patient diagnosed with hyperemesis gravidarum at 6 weeks of gestation and with preeclampsia at 35 weeks. At 30 weeks of gestation, a drug screen was performed that was positive for cannabis; therefore, a diagnosis of CHS was made. After labor induction, the patient delivered an infant who developed normally and had a negative drug test of the umbilical cord blood. Esophagogastroduodenoscopy was performed 9 days post delivery, with biopsies taken of the duodenal, gastric, and esophageal tissues. Moderate chronic gastritis with lymphoid aggregates and slight acute inflammation were noticed, whereas no malignancy, dysplasia, or goblet cell metaplasia was detected. A number of Helicobacter-like organisms were identified by H. pylori immunostaining. CONCLUSION Presented here is the first case reporting an association of chronic cannabis use with H. pylori colonization and preeclampsia in pregnancy, which brings to light the possible involvement of a cannabinoid-related pathway in the link between pregnancy-specific complications and bacterial colonization.
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Affiliation(s)
- Madeline Manning Meurer
- a Department of Obstetrics and Gynecology , Texas Tech University Health Sciences Center at the Permian Basin , Odessa , Texas , USA
| | - Kalyan Chakrala
- b Department of Internal Medicine , Texas Tech University Health Sciences Center at the Permian Basin , Odessa , Texas , USA
| | - Dinesh Gowda
- c Department of Pediatrics , Texas Tech University Health Sciences Center at the Permian Basin , Odessa , Texas , USA
| | - Charles Burns
- d Department of Pathology , Medical Center Hospital , Odessa , Texas , USA
| | - Randall Kelly
- a Department of Obstetrics and Gynecology , Texas Tech University Health Sciences Center at the Permian Basin , Odessa , Texas , USA
| | - Natalia Schlabritz-Loutsevitch
- a Department of Obstetrics and Gynecology , Texas Tech University Health Sciences Center at the Permian Basin , Odessa , Texas , USA
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