Cannabis, a potential treatment option in pediatric IBD? Still a long way to go

ABSTRACT

Introduction: The onset of inflammatory bowel disease (IBD) in children is rising. Current treatment options are based on immunomodulatory therapy. Alternative treatment options are upcoming since they appear to be effective in individual patients. Cannabis might relief IBD symptoms in these cases and improve quality of life. Recent evidence suggests a potential anti-inflammatory effect of cannabis.

Areas covered: This review presents an overview of recent literature on the use of cannabis in IBD focussing on pediatric IBD patients. Background information on the role of the endocannabinoid system within the gastrointestinal tract is presented. Other modalities of cannabis and its purified ingredients will be discussed as well, with attention to its applicability in children with IBD.

Expert opinion: More research is needed on the efficacy and safety of cannabis in pediatric IBD. Studies are well underway, but until then the use of cannabis in pediatric IBD cannot be recommended.

KEYWORDS:

• Adolescents
• cannabis
• cannabidiol
• children
• endocannabinoid system
• inflammatory bowel disease
• medical marijuana
• pediatric

Article highlights

• Incidence of pediatric IBD is rising, while conventional treatment in many patients fails. Alternative treatment options have to be explored.

• The endocannabinoid system is involved in gut homeostasis and can be altered in an inflamed gastrointestinal tract.

• Questionnaires in adolescent and young-adult IBD patients report relieve of IBD symptoms and improved quality of life when using cannabis.

• Cannabis seems to have a potential immunomodulating effect on IBD in murine colitis models.

• Preclinical data suggest a relevant role for endocannabinoid-degrading enzymes, such as FAAH and MAGL. To what extent inhibitors of these enzymes will cause decreased inflammation in humans needs to be further investigated.

• Until there is sufficient data about the efficacy and safety profile of cannabis, cannabis use needs to be actively discouraged in children with IBD.

• Further research needs to focus on clinical response and evaluation of mucosal healing due to cannabis or its purified ingredients.

Declaration of interest

L de Ridder discloses that for the last 3 years they have received consultation fee, research grant, or honorarium from ZonMw (national health institute), Janssen, Pfizer, Mundipharma, Shire and Abbvie. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.