Cannabinoids are increasingly being used for medicinal purposes, including neuropathy. The gastroparesis disorder is a neurological disorder and neuropathy is important for its development. Therefore, it is reasonable that cannabinoids may play a beneficial role in the management of gastroparesis. This new study evaluates the effect of cannabinoids on the symptoms of gastroparesis.

Symptoms

Basically ,Gastroparesis is a chronic neuromuscular disorder that results in delayed gastric emptying in the absence of mechanical obstruction. This condition causes many symptoms that are difficult to treat, including nausea, vomiting, early satiety, bloating, anorexia, and abdominal pain. Idiopathic gastroparesis and diabetes mellitus accounts for the majority of gastroparesis cases, although other etiologies are well described, including post-surgical, collagen-vascular, neuromuscular disorders (e.g. Parkinson’s disease, multiple sclerosis), malignancies, hypothyroidism, medications, and end-stage renal disease.

The socio-economic impact and adverse effect on the quality of life resulting from gastroparesis are significant and increasing recent years. More than 10% of patients reported being disabled due to their condition, while many other gastroparesis patients report missing days of work and thus significant loss of income. Hospitalizations for gastroparesis increased by > 150% over 1995-2004 and > 300% over 1997-2013. Although the exact prevalence of gastroparesis in the United States is unknown, it appears to be an under-diagnosed and therefore under-treated disorder.

Pathophysiology leading to symptoms of gastroparesis is not fully understood, although neuropathy probably plays an important role in its pathogenesis.

So ,alternate normal phasic motor activity in the distal stomach produces the clinical manifestations of delayed gastric emptying. The frequency and direction of phasic motor activity are regulated by the gastric slow wave, a rhythmic electrical oscillation, which is generated by the Cajal interstitial cells in the proximal gastric body – this area is therefore known as the “pacemaker” zone of the stomach.

Treatment

Treatments for gastroparesis often focus on improving gastric motility, although data on the correlation between the degree of delayed gastric emptying and symptom manifestations are variable. other gastroparesis therapies seek to control symptoms related to gastroparesis such as antibiotics and neuromodulators.  The latter group of drugs often used to treat abdominal pain specifically, despite a lack of efficacy observed in clinical trials.

Study

In this study, 24 patients with gastroparesis and refractory symptoms selected from a single gastroenterology practice associated with a tertiary care medical center. The effects of cannabinoids on gastroparesis symptoms prospectively evaluated in these 24 patients.

 Patients included in the study first require a definite diagnosis of gastroparesis via a gastric emptying study using scintigraphy: in order to determine how quickly food transported from the stomach to the small intestine. This showed delayed gastric emptying, and by gastroesophageal gastroduodenoscopy (EGD) which ruled out any mechanical obstruction (stoppage of intestinal transit). Only patients with symptoms refractory to standard treatments for gastroparesis included (dietary modification, medications (prokinetics, antiemetics, and neuromodulators), endoscopic therapy (e.g. botulinum toxin injections) and some patients had implantable gastric stimulators and/or surgical pyloroplasty).

Trials

Patients prescribed either dronabinol, medical cannabis, or both, for symptom management. Those receiving both treatments prescribed in sequence (dronabinol followed by marijuana) if dronabinol did not provide adequate symptom relief. Marijuana prescribed on an as-needed basis, at varying THC/CBD levels (at the discretion of the cannabis clinic) and taken by inhalation vaporization or sublingual drops. The dose of dronabinol ranged from 2-10 mg twice daily to four times daily. Patients completed a GCSI form, a validated symptom index for gastroparesis, before and after treatment.

The “Gastroparesis Cardinal Symptom Index” (GCSI) and an analog scale assessing abdominal pain . Applied to prospectively evaluate the effect of cannabinoids, in the form of medical cannabis, on the symptoms of refractory gastroparesis. Patients completed a GCSI form and assessed their abdominal pain before and after treatment. There were at least 60 days of cannabinoid use between reporting intervals. Total composite GCSI symptom scores, GCSI symptom subset scores, and abdominal pain scores calculated before and after treatment.

Cannabinoids, primarily delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD), are increasingly studied for medicinal purposes. Dronabinol, a synthetic analog of THC, used for nausea, vomiting, and anorexia in human immunodeficiency virus (HIV) and cancer, although it has been used for symptom management in other conditions.

Novel and effective gastroparesis therapy methods are emerging while cannabinoids remain a viable alternative.In fact ,the study was to evaluate the effects of cannabinoids on the symptoms of refractory gastroparesis.

Conclusion

In conclusion, a significant improvement in the overall composite GCSI symptom score observed with either cannabinoid treatment (mean score difference 12.8, 95% confidence interval 10.4-15.2; p-value <0.001). All 24 patients experienced statistically significant improvement in each GCSI symptom subgroup. A significant improvement in abdominal pain score was also observed with either cannabinoid treatment (mean score difference 1.6, p-value <0.001).

Cannabinoids significantly improve the symptoms of gastroparesis. Also, an improvement in abdominal pain with cannabinoids represents a breakthrough in the treatment of abdominal pain associated with gastroparesis, for which there is currently no validated treatment.

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