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A Rare and Unexpected Side-Effect of Cannabis Use: Abdominal Pain due to Acute Pancreatitis This is an open access article distributed under the Creative Commons Attribution License, which Gallbladder disease (GBD) is a common health concern that affects millions across the world.

A Rare and Unexpected Side-Effect of Cannabis Use: Abdominal Pain due to Acute Pancreatitis

This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Acute pancreatitis is a frequently encountered disorder in patients presenting to emergency units. Biliary system disorders, alcohol consumption, infections, and drugs are among the causes of acute pancreatitis. However, it is sometimes difficult to determine the etiology of this disorder, particularly if the patient does not wish to disclose his consumption of cannabis, the use of which is illegal.

1. Introduction

Acute pancreatitis is an inflammatory disorder of pancreas, caused mainly by biliary system disorders, alcohol consumption, and infections [1, 2]. Acute pancreatitis may also be caused by some drugs such as antibiotics (metronidazole), immunosuppressants (azathioprine), antihypertensives (angiotensin converting enzyme inhibitors, furosemide or thiazide diuretics), aspirin, or valproic acid [1, 3]. Case of acute pancreatitis due to cannabis has been rarely reported in the literature [4]. In this paper, because of its rarity, a case of cannabis-induced acute pancreatitis has been presented.

2. Case

A 44-year-old male patient presented to our Emergency Department with complaints of abdominal pain and nausea. He stated that he had been suffering from abdominal pain for one week. In other medical centers he had formerly visited, he had been told that his pain was due to a stomach disorder and, for therapy, a proton pump inhibitor had been commenced. Upon continuation of his complaints, the patient had presented to our Emergency Unit.

At the time of presentation, the patient had epigastric tenderness, but the other systemic findings were normal. His arterial blood pressure was 130/80 mm Hg, pulse was 86/minute, and body temperature was 37°C. His blood tests were as follows: WBC, 12.800/µL, CRP, 0.60 mg/L, and serum electrolytes, serum calcium, AST, ALT, GGT, and bilirubin within their normal ranges. However, his serum amylase and lipase were 294 IU/L and 935 U/L, respectively (Ranson criteria score: 0). Dual testing with lipase and amylase had a sensitivity of 93% for pancreatitis [5]. The patient gave no history of a chronic disease, regularly medications used, alcohol consumption, or trauma. He had no history of a recent febrile disease, either. However, one of the family members stated that the patient was regularly taking cannabis powder that he had been preparing for a long time and stopped cannabis when his pains began.

On the abdominal computed tomography scan performed to determine the etiology and pancreas damage, there were no abnormalities in the pancreas, no peripancreatic fluid (Balthazar grade A acute pancreatitis), no gall stones, and no dilation in the biliary system. Following a consultation, the patient was hospitalized in the Clinic of Gastroenterology. Endoscopy revealed grade B esophagitis, two ulcers of 5 and 8 mm in the antrum, and a 1 cm ulcer in the duodenum. The computed tomography showed no penetration of the duodenal ulcer to the pancreas.

On the 3rd day of hospitalization, the patient’s amylase and lipase levels were normalized, and, thereupon, the patient, who was thought to have had cannabis-induced pancreatitis, was discharged from the hospital with the necessary recommendations.

3. Discussion

Cannabis is a plant belonging to the Cannabaceae family. The active substances of cannabis are cannabinoids in resin, which are obtained through dried and then powdered leaves of the plant. The major cannabinoid in hashish is tetrahydrocannabinol (THC), which is responsible for the pharmacological effect of hashish. Powder hashish is obtained by drying the high THC-containing parts of female cannabis in the shade and then by grinding and sifting the dried parts.

The mechanism by which THC causes acute pancreatitis has not been fully clarified [4, 6]. There are two cannabinoid receptors in the human body, namely, CBI and CBII; CBI is found in the central nervous system, peripheral endothelial cells, and smooth muscle cells, whereas CBII is found in macrophages. These two receptors are also present in the pancreatic tissue [6]. The receptors affect the gastrointestinal system both positively and negatively [7, 8]. By decreasing gastric acid and intestinal secretions, they delay the gastric emptying [6, 9].

Dembiński et al. [7] have shown that, via CBI receptors, cannabinoids increase the blood supply and DNA synthesis in the gastric mucosa and inhibit the inflammatory mediator interleukin-1β. Studies on mice with cerulein-induced pancreatitis have shown that administration of anandamide, a cannabinoid receptor agonist, to mice increases the severity of pancreatitis, but the reason for this effect is not clearly explained [10, 11]. Some authors think that this increase in severity may be due to the effect of cannabinoids on the pancreatic canal and Oddi’s sphincter [1, 4, 10]. The effect of cannabinoids on gastric secretions and emptying can be the cause of gastric and duodenal ulcers present in our patient.

In our case, Naranjo score was +1; the mean of this score is possible adverse drug reactions [2].

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We achieved this score from the answers of the questions shown below.

The other questions answers were as follows: do not know or not done (0 points).

In conclusion, patients may not give a history of cannabinoid use which is illegal. In order to determine the etiology in patients with acute pancreatitis attacks, the use of hashish should also be questioned. Hashish consumers present to the emergency units with frequently repeated pancreatitis attacks [4].

Conflict of Interests

The authors declare that there is no conflict of interests regarding the publication of this paper.

References

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CBD for Gallbladder: What does the Science Say?

Gallbladder disease (GBD) is a common health concern that affects millions across the world.

According to the NHANES III, “a total of 20.5 million persons in the United States, 6.3 million men and 14.2 million women, aged 20–74 years, were estimated to have GBD”.

CBD addresses the symptoms of gallbladder problems that cause a lot of discomfort in the patients. But does it actually work? Is it even safe to use?

To understand all of this, we have compiled various studies and researches about CBD and its benefits for gallbladder problems. Read on!

What are Gallbladder Problems?

The gallbladder is a pear-shaped organ present under the liver on the upper right section of the abdomen. It stores bile, a digestive fluid produced by the liver. This fluid is released into the small intestine for proper digestion of fats.

Gallstones or cholelithiasis is the most common gallbladder disease. They are hardened deposits of the bile in the gallbladder.

The size may vary from that of sand grain to a golf ball. The patient can develop one-to-many gallstones at the same time.

Gallstones mostly affect women above the age of 40. According to the Mayo Clinic , it may happen due to the following:

High cholesterol in the bile: When the liver produces more cholesterol than the bile can dissolve, the excess cholesterol forms crystals and then gallstones in the gallbladder.

High bilirubin in the bile: Bilirubin is a chemical that breaks down the RBCs in the body. The body produces excess bilirubin in conditions like liver cirrhosis, biliary tract infections. This leads to gallstone formation.

Inability to empty the bladder correctly: When your bladder doesn’t get empty correctly, the bile gets concentrated and eventually forms gallstones.

Types of Gallstones

Cholesterol gallstones: These stones are usually yellow in color. This is a more common type of gallstones that are formed due to undissolved cholesterol.

Pigment gallstones : Due to the excess bilirubin content, these gallstones are brown and black in color.

Other types of gallbladder diseases are:

Cholecystitis, Common bile duct infection, common bile duct stones (choledocholithiasis), gallbladder disease without stones, perforated gallbladder, abscess of the gallbladder, and many more.

Symptoms of Gallbladder Disease

Here are a few common symptoms one may experience:

  • Pain
  • Inflammation
  • Nausea and vomiting
  • Fever
  • Chronic diarrhea

Treatment for gallbladder Problems

Depending upon the type of problem, the treatments may include:

  • over-the-counter pain medications, like ibuprofen
  • prescription pain medications, like hydrocodone and morphine
  • surgery to remove gallstones
  • Cholecystectomy: s urgery to remove the whole gallbladder
  • lithotripsy, a medical procedure where shock waves are used to break stones in the gallbladder and other organs
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Can CBD help with Gallbladder Pain and Inflammation?

Cannabidiol is a non-psychoactive component of the Cannabis Sativa plant. Extracted from the hemp plant, CBD has several therapeutic and health benefits. Pure CBD products don’t contain tetrahydrocannabinol ( THC) intoxicating compound

CBD provides relief in gallbladder problems. It also helps in alleviating gastrointestinal symptoms.

People are resorting to cannabinoids as a natural alternative to usual pain medications. This is because drugs like NSAIDs and prescription medicines can have long-term adverse side effects.

CBD is arising as a potential treatment for gallbladder problems due to its interaction with the endocannabinoid system (ECS).

The ECS is responsible for regulation of pain, sleep, memory, mood, immune response, and other functions in the body.

CBD works to maintain homeostasis (balance) in the body to inhibit the pain sensation, a major symptom of gallbladder diseases.

A 2013 review talked about the role of the endocannabinoid system and the phytocannabinoids in chronic pain management.

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How does CBD help with Gallbladder problems?

According to a 2017 study, “CBD is mostly devoid of adverse psychoactive effects and possesses anticonvulsant, analgesic, anti-anxiety, antiemetic, immune-modulating, anti-inflammatory, neuroprotectant, and anti-tumorigenic properties”.

As mentioned above, CBD not only aids in gallbladder problems but also takes care of the gastrointestinal issues. It also supports gut health and relieves digestive issues.

It works to protect the intestinal cells and gallbladder from chemical or inflammatory damage and inhibits the development of harmful diseases.

Based on the studies and researches available, here’s how CBD can help the patients with Gallbladder and GI issues:

Reduces Inflammation and Pain

Inflammation is the body’s natural response to infection or injury. Chronic inflammation is a common symptom in people suffering from the gallbladder and gastrointestinal issues.

CBD has anti-inflammatory properties, and it works through various receptors, fatty acids, hormones, and cell-signaling proteins to reduce the discomfort in the patient.

Pain is another major symptom of gallbladder disease. The pain can be dull, achy, sharp, or sudden depending on the cause. It affects the abdomen to the lower back.

CBD has analgesic (pain-relieving) properties that can decrease discomfort in the patients

A 2004 study revealed that CBD interacts with the vanilloid TRPV1 receptor to produce its anti-hyperalgesic effect . It was used to treat acute inflammation in a rat model.

CBD has antinociceptive effects t hrough which it can prevent the detection of painful signals by the sensory neurons. That’s why its effects last longer than the usual painkillers .

Heals Leaky Gut

Leaky gut or intestinal permeability is a digestive condition that affects the lining of the intestines. Here the bacteria and toxins leak from the intestinal walls into the bloodstream.

The common symptoms of leaky gut are inflammation, abdominal pain, gas, bloating, etc. It can further lead to gallstones and gastrointestinal diseases.

CBD may help in relieving this condition. A 2017 study concluded that CBD can “ restore the intestinal barrier integrity, through the involvement of the CB1 receptor”.

A 2012 study showed that “phytocannabinoids have therapeutic potential for reversing the disordered intestinal permeability associated with inflammation”.

In another 2019 study , it was revealed that CBD when taken with palmitoylethanolamide (PEA) can reduce intestinal hyper-permeability (leaky gut) induced by inflammation. This is also beneficial for people with Irritable bowel syndrome.

Improves Metabolism

The endocannabinoid system also regulates the metabolic function in the body. It is made up of metabolic enzymes that help in energy storage, transportation of nutrients, and insulin sensitivity.

A 2012 study i nvestigated the association between metabolic syndrome and the development of gallstone disease (GSD). It concluded that more the components of metabolic syndrome are there in the body, higher is the prevalence of GSD.

The use of CBD has shown significant development in treating metabolic disorders like diabetes . However, we require specific studies to prove their use for gallstones.

CBD turns the white fat cells into brown to prevent the risk of obesity. This further leads to increased lipolysis, thermogenesis, and reduction of lipogenesis. It, therefore, improves the user’s metabolic health.

Promotes Brain Health

The discomfort in your gut also affects brain function. A 2019 study talks about this gut-brain connection.

The inflammation in the gut usually causes brain fog, lack of concentration, and even anxiety. It also leads to inflammation in the brain which could develop into neurodegenerative disease.

A 2018 review revealed that CBD can attenuate acute autonomic responses induced by stress by activating the 5HT1A (serotonin) receptors.

Also, it concluded that CBD can show neuroprotective effects by activating the adenosine receptors. It can enhance the signaling of adenosine to mediate immunosuppressive and anti-inflammatory effects in the body.

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Pros and Cons of using CBD to Treat Your Gallbladder Problems

Before using CBD for your gallbladder condition, let’s understand its pros and cons:

Pros

  • CBD helps alleviate pain and inflammation in the gallbladder.
  • Helps heal leaky gut and promotes overall health by taking care of metabolism and the brain.
  • According to the World Health Organization (WHO) , “CBD is

generally well-tolerated with a good safety profile”.

  • The patient cannot develop tolerance or get addicted to CBD. It delivers therapeutic benefits without making them ‘high’.
  • Has relatively milder side effects than medication drugs.

Cons

  • There are limited studies related to CBD’s efficacy for gallbladder problems.
  • There’s no standard CBD dosage prescribed for its usage for gallbladder.
  • The Food and Drug Administration (FDA) doesn’t regulate CBD except in the case of epilepsy .
  • Due to the lack of regulation and standardization, low quality, mislabelled CBD products are being sold in the market that can be harmful.

CBD and Alternative Treatments for Gallbladder Problems

Many patients go for complementary and alternative therapies (CAM) to relieve gallbladder pain. They can also prevent the further development of gallbladder diseases. This should be done in supervision of a healthcare practitioner. Here’s what all it includes:

Maintain a healthy weight: Being obese puts you at risk for various gallbladder problems. It is important to maintain a healthy weight, reducing your calorie intake, and indulging regular exercise.

CBD also helps in improving your metabolism and reduces the risk of gallbladder diseases related to metabolic syndrome.

Dietary changes: To lower the plasma insulin levels, it is important to make significant changes in your diet. Eliminate fatty foods and refined carbohydrates from your diet.

Try having unrefined carbs like whole grains, legumes, and starchy vegetables.

Like CBD, these foods will help in reducing inflammation as they get digested slowly and ensure a steady dosage of sugar in your body.

Herbal medicine: You can also rely on turmeric, bupleurum, Oregon grape, and coin grass to reduce the painful inflammation caused by the gallbladder diseases. It may also relieve liver congestion.

CBD is also a herbal compound that comes from plants and treats the health ailments naturally. You can easily add it to your wellness routine.

How to take CBD for Gallbladder?

CBD is available in many forms in the market for you to choose from. Take a look:

CBD Oil

The most common way to take Cannabidiol is in the form of oil tincture. As oils are molecular carriers, they hold more cannabinoids than other CBD products. They easily get absorbed into the bloodstream to show desired effects.

How to use : The best way to take CBD oil is sublingually. You need to put it under the tongue and let it sit for 90 seconds and then swallow it. The effects will appear in 15 to 45 minutes.

You can also have CBD oil in the form of capsules, edibles like gummies, baked goods.

CBD Topicals

Another way to use CBD is through CBD topicals. This includes ointments, lotions, and salves. These topicals get absorbed in the skin to provide relief in the affected areas.

How to use: Apply the cream generously on the upper abdomen or back area at the site of the pain. You can reapply it after 30-60 minutes until the pain reduces.

Pro tip: Always check the ingredients of the topical to check if you are not allergic to any of them.

CBD Dosage for Gallbladder Problems

Unfortunately, there is no recommended dosage of CBD for gallbladder diseases. It may depend on your weight, metabolism, cause of the pain, and its severity.

Finding the right dosage is a process of trials and experimentation.

You can either follow the instructions on the package or start with the lowest dosage.

Increase the dosage as required. Once you get the desired effects, stick to that dosage.

For further assistance, consult your doctor.

Side Effects of CBD

Although you cannot develop a tolerance or addiction towards CBD, it is important you do not overindulge in it.

It may cause some mild side-effects, like:

  • Dry mouth
  • Nausea
  • Tiredness
  • Headache

If the side effects become too severe, we advise you to discontinue the use.

Conclusion: Should you try?

Although there is a long way to go for CBD as a potential gallbladder treatment, the present researches spark a promising light of hope. It may become a natural alternative to the drugs currently being used.

As CBD can be procured without any proper prescription, the risk of its side effects also increases. It may even interact with your over the counter (OTC) medications.

Therefore, we recommend you to consult your healthcare provider before taking CBD for any gallbladder problem. They shall let you know if it is safe for you to use given your medical state.

We hope we helped you understand the efficacy of CBD for gallbladder problems. Stay healthy, stay fit!

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