Crohn’s disease (CD) is an inflammatory bowel disease (IBD), which is an umbrella term that also includes ulcerative colitis (UC) and celiac disease. These are autoimmune diseases that cause inflammation of the colon and small intestine.
Crohn’s is a lifelong condition with no cure, and it can significantly affect quality of life. IBDs like Crohn’s and irritable bowel syndrome (IBS) share symptoms like abdominal pain, cramps, and bowel issues. However, IBD is more severe and can lead to anemia, weight loss, and fever, unlike IBS.
In 2020, about 2.39 million Americans had IBD, with Crohn’s disease having an annual incidence ranging from 3 to 20 cases per 100,000. Before the age of 45, both men and women had similar incidence rates for UC, with Crohn’s being more prevalent in women in all age groups. After the age of 45, men have a higher incidence rate of UC.
IBD also reduces life expectancy, with the highest differences seen between women with and without IBD. In 2018, the total annual U.S. healthcare costs for IBD were about $8.5 billion.
Cannabis may help reduce Crohn’s and other IBD symptoms like pain, swelling, and inflammation due to its anti-inflammatory effects. The anti-anxiety and stress-busting effects of cannabis compounds may also benefit IBD patients.
Crohn’s disease causes
Crohn’s disease is a chronic inflammatory bowel disease (IBD) characterized by inflammation of the gastrointestinal (GI) tract. The exact cause of Crohn’s disease is unknown, but contributing factors include:
- Genetics: Family history increases risk, with mutations in certain genes (e.g., NOD2) being implicated
- Immune system dysregulation: An abnormal immune response targeting the gut’s microbiota leads to chronic inflammation
- Environmental factors: Smoking, diet, and exposure to certain pathogens may trigger or exacerbate the disease
- Microbiome imbalance: Alterations in gut flora may contribute to disease onset and progression
- Potential triggers: Common triggers include antibiotics, NSAIDs, anxiety, stress, depression, insomnia, smoking, alcohol, and certain dietary components like gluten (for celiac disease)
Crohn’s disease symptoms & health effects
Symptoms:
Symptoms of Crohn’s disease vary depending on the affected GI tract region but commonly include:
- Digestive issues: Abdominal pain, diarrhea (sometimes with blood), and rectal bleeding
- Systemic symptoms: Fatigue, weight loss, and fever
- Complications: Fistulas, abscesses, and intestinal obstruction
Health Effects:
- Malnutrition: Poor nutrient absorption leads to deficiencies in vitamins and minerals
- Chronic inflammation: Increases the risk of bowel perforation and colorectal cancer
- Extraintestinal manifestations: Joint pain, skin disorders, and eye inflammation
Crohn’s disease diagnosis
Diagnosing Crohn’s disease involves:
- Clinical evaluation: Assessing symptoms, medical history, and family history
- Laboratory tests: Blood tests (elevated inflammatory markers like c-reactive protein (CRP) and stool tests to rule out infections
- Endoscopic procedures: Colonoscopy and upper endoscopy with biopsy to visualize and confirm inflammation
- Imaging studies: MRI, CT scans, or capsule endoscopy to detect complications like strictures or fistulas
Crohn’s disease prognosis
The prognosis for Crohn’s disease varies widely:
- Chronic nature: While incurable, disease management can achieve long-term remission
- Factors influencing outcomes: Early diagnosis, adherence to treatment, and lifestyle changes improve prognosis
- Complications: Patients with severe or untreated disease face higher risks of surgery and long-term complications
In Crohn’s disease, any part of the digestive tract can be inflamed, while ulcerative colitis affects only the large intestine. Blood in stools is more common in ulcerative colitis. People with IBD are at higher risk for cancers like colorectal cancer and other complications like liver and kidney disease.
Those with IBD may also be more likely to suffer from other autoimmune diseases, such as lupus, rheumatoid arthritis, and type-1 diabetes, as PTPN22 gene mutations are implicated in the development of them all.
Crohn’s disease treatments
First-line treatments
- Anti-inflammatory drugs:
- Aminosalicylates: Such as mesalamine, for mild-to-moderate cases
- Corticosteroids: Short-term use for flare-ups
- Immunosuppressants: Azathioprine, mercaptopurine, or methotrexate to reduce immune activity
- Biologic therapies: Monoclonal antibodies targeting TNF-α (e.g., infliximab) or integrins (e.g., vedolizumab)
Other treatments
- Antibiotics: To treat secondary infections or complications like abscesses
- Surgical interventions: For complications such as strictures, fistulas, or severe disease resistant to medical therapy
Adjunctive therapy & alternative treatments
- Nutritional therapy: Special diets (e.g., low-residue or enteral nutrition) to manage symptoms and malnutrition
- Probiotics: Potentially beneficial in restoring gut microbiota balance
- Mind-body therapies: Stress management through mindfulness or yoga may alleviate symptoms
Cannabis for Crohn’s disease
Emerging evidence suggests that medical cannabis may provide symptom relief for Crohn’s disease:
- Symptom management: Cannabinoids may reduce abdominal pain, diarrhea, and nausea through anti-inflammatory, stress-busting, and analgesic effects
- Immune modulation: Cannabinoids interact with CB2 receptors in the GI tract, potentially reducing inflammation
- The gut endocannabinoid system (ECS): The gut ECS and microbiome plays a role in stress regulation and immune response
- Appetite stimulation: Cannabis may improve appetite and prevent weight loss
- Clinical evidence: Studies show improvements in quality of life and symptom scores, though more research is needed to confirm efficacy
Cannabis compounds for IBD
Cannabinoids and terpenes of particular interest for IBD include:
- Cannabinoids:THC, CBD, CBG, CBC
- Terpenes:Beta-caryophyllene, limonene, pinene, and myrcene for their anti-stress and anti-inflammatory properties
- Flavonoids: Compounds like cannflavin A, B, and C, quercetin, kaempferol, hesperetin, and luteolin may work synergistically (“entourage effect”) to manage inflammation, anxiety, and stress-related triggers
Additional information for patients
- Medical guidance: Always consult a healthcare provider before using medical cannabis or other alternative treatments
- Tailored approach: Treatment plans should be personalized, considering disease severity and patient preferences
- Lifestyle modifications: Diet, smoking cessation, and stress management are essential for long-term management
- Support networks: Patient organizations and peer groups can offer emotional and practical support. One such example is the Crohn’s & Colitis Foundation.
Crohn’s disease FAQs
Can Crohn’s disease be cured?
There is currently no cure, but treatments aim to induce and maintain remission.
Is medical cannabis safe for Crohn’s disease?
For many patients, cannabis is safe when used under medical supervision. However, risks include dependency and exacerbation of mental health conditions.
What forms of medical cannabis are most effective for Crohn’s disease?
CBD-dominant products or balanced THC:CBD formulations are often preferred to minimize psychoactive effects while offering therapeutic benefits. THC does, however, provide anti-inflammatory and analgesic properties, which can help manage chronic pain associated with Crohn’s.
How is medical cannabis administered for Crohn’s disease?
- Methods: Inhalation (vaporization), oral capsules, tinctures, and edibles
- Specific Strains: Products high in CBD and terpenes like myrcene and beta-caryophyllene may offer anti-inflammatory benefits.
Are there dietary recommendations for Crohn’s disease?
Low-residue, high-calorie, and nutrient-dense diets are often recommended. Some patients benefit from avoiding dairy, gluten, or high-fiber foods.
Resources
- IBD Facts and Stats: https://www.cdc.gov/inflammatory-bowel-disease/php/facts-stats/index.html
- Crohn’s Disease Basics: https://www.cdc.gov/inflammatory-bowel-disease/about/crohns-disease-basics.html
- Inflammatory Bowel Disease Prevalence: Surveillance data from the U.S. National Health and Nutrition Examination Survey: https://pmc.ncbi.nlm.nih.gov/articles/PMC10201824/
- Incidence, Prevalence, and Racial and Ethnic Distribution of Inflammatory Bowel Disease in the United States: https://www.sciencedirect.com/science/article/abs/pii/S0016508523047765
- Crohn Disease: Epidemiology, Diagnosis, and Management: https://www.sciencedirect.com/science/article/abs/pii/S0025619617303130
- Use of Medical Cannabis in Patients With Inflammatory Bowel Disease: https://pmc.ncbi.nlm.nih.gov/articles/PMC6366240/
- The effect of medical cannabis in inflammatory bowel disease: analysis from the UK Medical Cannabis Registry: https://www.tandfonline.com/doi/full/10.1080/17474124.2022.2161046
- A Survey of Cannabis Use among Patients with Inflammatory Bowel Disease (IBD): https://www.mdpi.com/1660-4601/20/6/5129
- Cannabis Induces a Clinical Response in Patients With Crohn’s Disease: A Prospective Placebo-Controlled Study: https://www.cghjournal.org/article/s1542-3565(13)00604-6/fulltext
- Cannabis Use in Patients With Inflammatory Bowel Disease Following Legalization of Cannabis in Canada: https://academic.oup.com/crohnscolitis360/article/6/2/otae031/7667593
- Cannabis in Gastroenterology: Watch Your Head! A Review of Use in Inflammatory Bowel Disease, Functional Gut Disorders, and Gut-Related Adverse Effects: https://link.springer.com/article/10.1007/s11938-020-00323-w
- Therapeutic Use of Cannabis in Inflammatory Bowel Disease: https://pmc.ncbi.nlm.nih.gov/articles/PMC5193087/
- Association Between Cannabis Use and Healthcare Utilization in Patients With Irritable Bowel Syndrome: A Retrospective Cohort Study: https://pmc.ncbi.nlm.nih.gov/articles/PMC72796
- An overview of cannabis based treatment in Crohn’s disease: https://pubmed.ncbi.nlm.nih.gov/32149543/
- Endocannabinoid System as a Promising Therapeutic Target in Inflammatory Bowel Disease – A Systematic Review: https://pmc.ncbi.nlm.nih.gov/articles/PMC8727741/
- The Microbiome and Gut Endocannabinoid System in the Regulation of Stress Responses and Metabolism: https://pmc.ncbi.nlm.nih.gov/articles/PMC9130962/
- Low Dietary Flavonoid Consumption Is Associated to Severe Inflammatory Bowel Disease: https://www.ghadvances.org/article/S2772-5723(23)00137-1/fulltext
- Therapeutic potential of flavonoids in inflammatory bowel disease: A comprehensive review: https://pmc.ncbi.nlm.nih.gov/articles/PMC5537178/
- Intestinal Anti-Inflammatory Activity of Terpenes in Experimental Models (2010–2020): A Review: https://pmc.ncbi.nlm.nih.gov/articles/PMC7699610/
- Terpenes: Modulating anti-inflammatory signaling in inflammatory bowel disease: https://www.sciencedirect.com/science/article/abs/pii/S0163725823001201
- Irritable Bowel Syndrome: Manipulating the Endocannabinoid System as First-Line Treatment: https://pmc.ncbi.nlm.nih.gov/articles/PMC7186328/
- Cannabis use in the United States and its impact on gastrointestinal health: https://aspenjournals.onlinelibrary.wiley.com/doi/full/10.1002/ncp.11111
- Influence of PTPN22 Allotypes on Innate and Adaptive Immune Function in Health and Disease: https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2021.636618/full
- Differential association of two PTPN22 coding variants with Crohn’s disease and ulcerative colitis: https://translational-medicine.biomedcentral.com/articles/10.1186/1479-5876-8-S1-P2
- Endocannabinoids in immune regulation and immunopathologies: https://pmc.ncbi.nlm.nih.gov/articles/PMC8442232/
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