Inflammatory Bowel Diseases (IBDs)

The two main forms of inflammatory bowel disease (IBD) are Crohn’s disease and ulcerative colitis, which are autoimmune disorders. An estimated 2.39 million Americans are diagnosed with an IBD as of 2020.

IBD also reduces life expectancy by 6.6 to 8.1 years in females and 5.0 to 6.1 years in males. However, some do posit a link between IBS and IBD as both are immune-mediated conditions, and those with IBS are more likely to receive an IBD diagnosis.

There are several types of IBD resulting from a variety of genetic and other factors. The primary problems arise from the body’s immune system attacking its digestive system (as an autoimmune disorder, like in Crohn’s disease); a lack of biodiversity in the microbiome, or intestinal flora, which can make for a “leaky gut” (abnormal intestinal permeability) and provoke a harmful immune response; and disturbances of mood, like stress and anxiety. As IBD progresses, bleeding problems can occur, leading to extreme fatigue and vitamin deficiencies.

IBD is often grouped together with irritable bowel syndrome (IBS), as the two share many similar symptoms, such as abdominal pain, cramps, gastrointestinal tract upset, fatigue, swollen or inflamed joints, and problems with bowel movements. However, the conditions are different in many regards, with IBS being a functional gut disorder and not a disease. IBD is also often accompanied by anemia, bleeding, weight loss, and fever –  symptoms that do not typically occur in IBS episodes.

Due to cannabis’ and cannabinoids’ anti-inflammatory and immunomodulatory effects, medical cannabis may be useful for reducing pain, swelling, and inflammation associated with different types of IBD, including Crohn’s, ulcerative colitis, and coeliac disease.

IBD Causes

It is not known precisely what causes IBD, but it is thought that they develop as a result of genetic and environmental factors. Those with a family history of IBD or any other autoimmune disorder (e.g. lupus, rheumatoid arthritis, type-1 diabetes) may have an increased risk of developing an IBD, as mutations in the PTPN2 gene may be implicated in immune system dysregulation and the development of autoimmune diseases.

Certain environmental factors can trigger an IBD episode or flare-up. A person may have an irregular response to bacteria, viruses, or foodstuffs such as gluten in the case of coeliac disease. These triggers can cause the body’s immune system to attack its own tissues. In the case of IBD, the immune system attacks the gut.

The most common triggers for IBD include:

• Certain types of antibiotics
• Non-steroidal anti-inflammatory drugs (NSAIDs)
• Stress
• Smoking tobacco
• Alcohol
• Caffeinated drinks
• Greasy food
• Gluten (coeliacs disease)

IBD can also increase the likelihood of developing colon cancer or liver diseases, or undergoing a medical emergency, such as a toxic megacolon or a perforated bowel. Other complications include kidney stones, skin rashes, swollen joints, malabsorption & malnutrition, blood clots, and osteoporosis.

IBD Diagnosis

The most common and reliable way to diagnose an IBD is by an endoscopic procedure, such as a colonoscopy, upper endoscopy, sigmoidoscopy, or capsule endoscopy, carried out by a specialist such as a gastroenterologist. Such procedures provide clear and detailed views of the gastrointestinal tract that can help diagnose IBD and differentiate between Crohn’s disease and ulcerative colitis. An endoscopy can also help determine whether the problem is another health concern with similar symptoms, diverticulitis.

For coeliac disease, the most common first test is a tissue transglutaminase IgA (tTG-IgA) test. This test determines whether or not your body produces the enzyme that breaks down gluten, transglutaminase.

In Crohn’s disease, any part of the intestinal tract can become inflamed, from the mouth to the anus. Crohn’s disease also has more patchy areas of inflammation in large sections of the bowel. In ulcerative colitis, inflammation and ulceration is focused in the large intestine (colon and rectum), with inflamed areas in the bowel being more continuous and less patchy.

Both conditions may include blood in stools, but this is more common in ulcerative colitis. After diagnosis, blood tests are common to check for vitamin and mineral deficiencies (e.g. iron) that may cause other complications.

IBD Prognosis

There is no cure for IBD, and it is a chronic condition that lasts the entirety of one’s life. IBD can have a severely negative impact on one’s quality of life, leading to other health problems that can compound IBD further, such as pain, swelling, inflammation, anxiety, insomnia, GI issues, nausea, and food intolerances. Those with an IBD also have an increased risk of developing cancers such as colorectal cancer, small bowel cancer, intestinal lymphoma, and cholangiocarcinoma. Other complications include liver disease, kidney disease, kidney stones, toxic megacolon, or a perforated bowel.

IBD can reduce life expectancy by 6.6 to 8.1 years in females and 5.0 to 6.1 years in males. Immune-mediated diseases like IBD tend to be more prevalent among females. With all autoimmune diseases combined, 8 out of 10 patients are female.

IBD Treatments

There is no cure for IBD of any type, but it is possible to slow down the progression of the disease and cause it to go through remission. Treatments ffor inflammatory bowel disease usually include lifestyle and dietary changes, medications to manage pain and inflammation (especially immunosuppressants, steroid-based anti-inflammatories, anxiolytics, and both opioid and non-opioid-based analgesics), and surgery.

First Line Treatments

Lifestyle modifications and various medications can reduce the symptoms of certain types of IBS and IBD but, unfortunately, do not address its root cause. Changes in diet and proper exercise can help, and vitamin supplementation can sometimes provide a measure of relief. Loperamide (Imodium) may also be prescribed.

Doctors may also prescribe anti-inflammatory steroid drugs, whereas common consumer drugs such as ibuprofen are specifically not recommended as they may trigger flare-ups in those with one or more autoimmune diseases. Other remedies may include anti-diarrheal medications (e.g., loperamide), antibiotics, and immune system suppressants. Acetaminophen (Tylenol) can be used to control moderate pain; Interestingly, acetaminophen has been shown to work as an endogenous cannabinoid, binding to the same receptor as THC (CB1).

Those with IBD may be prescribed immunosuppressants (e.g., steroids or azathioprine), aminosalicylates or mesalazines, antibiotics, and other antibody-based treatments. These medications reduce inflammation and dampen an overactive immune system. Those with IBS are more likely to be prescribed or recommended medications like lubiprostone (Amitiza), linaclotide (Linzess), or bismuth subsalicylate (Kaopectate, Pepto-Bismol).

Unfortunately, some medications can cause complications and increase the risk of some types of cancer and negatively impact other areas of life. Medication side-effects are therefore another concern when it comes to managing IBD effectively.

Other Treatments

Many of those with ulcerative colitis or Crohn’s will need surgery to repair and remove damaged and inflamed parts of the intestine. The surgery can severely impact the quality of life, causing pain and reducing GI function significantly, and may result in the need for a colostomy bag (stoma).

Although numbers can differ slightly between countries, in the US, Canada, and the UK, around about  21% of people with Crohn’s will have resection surgery within five years of diagnosis and 26% within 10 years. 7 out of 100 patients will need surgery within 5 years. In Canada, 80% of those with Crohn’s and 20% of those with ulcerative colitis will need surgery in their lifetimes. Similar rates are found in the US, with 50% to 80% Crohn’s disease (CD) and 10% to 30% ulcerative colitis (UC) patients requiring surgery over their lifetime.

Adjunctive Therapy & Alternative Treatments

Although evidence for herbal remedies in managing IBD is limited, patients may utilize them to manage symptoms and triggers such as pain, inflammation, anxiety, and GI issues. Some encouraging results for alternative treatments to IBD include wheat grass juice, curcumin (found in turmeric), and aloe vera. However, more clinical studies are needed to confirm efficacy and to determine therapeutic value for different forms of IBD.

Other treatments can be focused on managing triggers like stress and anxiety, where exercise, Yoga, meditation, and techniques such as mindfulness can help reduce the chance of flare-ups. Probiotics to improve gut health and fish oils to ensure appropriate omega-3 intake may also help reduce pain and inflammation.

Cannabis for Inflammatory Bowel Disease (IBD)

Even if IBS and IBD are different in many ways, their similarities (i.e., inflammation and dysregulation of the gut) may mean there could be common treatments for both. Medical cannabis may be one such treatment.

People who take medicinal cannabis to relieve inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) typically experience health benefits. The most studied medical effects of cannabis involve the endocannabinoid system (ECS). It is responsible for receiving the various molecular substances contained in cannabis (e.g., phytocannabinoids like CBD and THC) and triggering natural healing responses within our bodies.

The phytocannabinoids that interact with ECS receptors in the gut are present in great numbers. This activity directs digestive tract functions, particularly the modulation of intestinal inflammation.

In addition to the familiar phytocannabinoids CBD and THC, various other bioactive substances present in cannabis may contribute to its beneficial effects on IBD and IBS. Other cannabinoids – as well as additional healing molecules known as terpenes (e.g., beta-caryophyllene, myrcene, limonene, geraniol) and flavonoids (e.g., quercetin and cannflavins) – demonstrate significant anti-inflammatory activity, and so may provide relief from IBD, IBS, and any associated stress and anxiety experienced by people living with these conditions.

Several scientists even suggest that phytocannabinoids overcome an “endocannabinoid deficiency,” meaning that our bodies need these compounds like certain nutrients and vitamins. It has been proposed that some immune system dysfunctions, like those seen in autoimmune conditions, result from a weakened or “underfed” endocannabinoid system. In this sense, phytocannabinoids may work by restoring balance to the ECS, reducing the pathological inflammation associated with IBD and IBS.

Another study showed:

“Anandamide (AEA) and oleoylethanolamide (OEA) were increased in plasma of ulcerative colitis (UC) and Crohn’s disease (CD) patients, while 2-arachidonoylglycerol (2-AG) was elevated in patients with CD, but not UC. 2-AG, but not AEA, PEA and OEA, was elevated in CRC [colorectal cancer] patients.”

Several cannabinoids, terpenes, and flavonoids found in cannabis may have therapeutic effects for various IBD types due to their anti-inflammatory, antioxidative, anxiolytic (anti-anxiety), antispasmodic, and antiemetic properties.

Flavonoids like quercetin, cannflavin, and catechins (and many other polyphenols) “possess numerous anti-inflammatory and antioxidant effects, which help to improve the IBS symptoms and the QOL scores in the IBS patients.” THC, THCV, CBD, CBG, CBC, and CBN may be useful for IBD and IBS. Terpenes such as myrcene, beta-caryophyllene, limonene, and gingerol may be helpful for their anti-inflammatory and stress-busting effects.

Additional Information for Patients

Various types of IBD have severe impacts on a patient’s QoL and can reduce life expectancy. Moreover, little is known about how different types of IBD are caused and how flare-ups can be triggered. As such, charitable organizations such as the Crohn’s & Colitis Foundation and the National Organization for Rare Disorders (NORD) work to educate affected individuals, physicians, and the public about these disorders.

In the UK, Charities such as CICRA (a UK-based charity focused on children with Crohn’s & Colitis) and the Catherine McEwan Foundation also fund research into IBD. In the US, organizations such as The Helmsley Trust fund research efforts to find a cure for diseases such as Crohn’s.

For those from the US, it is possible to contact the Crohn’s and Colitis Foundation for further help and advice on:

• PHONE: 1-888-MY-GUT-PAIN (888-694-8872, OPTION 8)
• EMAIL: INFO@CROHNSCOLITISFOUNDATION.ORG
• VISIT TO SPEAK TO A LIVE AGENT: https://www.crohnscolitisfoundation.org/patientsandcaregivers/community-support/the-ibd-help-center

IBD FAQs

What does inflammation of the bowel feel like?

Symptoms of IBD can range from mild to severe, causing significant impacts on a patient’s quality of life. Typical symptoms include diarrhea, rectal bleeding, abdominal pain, fatigue, and weight loss. Joint pain (arthralgia) is also common in those with IBD.

What causes inflammatory bowel disease (IBD)?

There is no known specific cause of IBD.  Mutations in the PTPN2 gene are associated with the development of many autoimmune diseases, including Crohn’s, colitis, rheumatoid arthritis, Evans syndrome, lupus, and type-1 diabetes. People who have a parent or sibling with Crohn’s disease are more likely to develop it themselves. In some instances, a person who is susceptible to it may develop an IBD as a result of the use/overuse of nonsteroidal anti-inflammatory drugs (NSAIDs), hormonal therapies, birth control, and antibiotics.

What foods should I avoid with inflammatory bowel disease?

Different people may find varying types of food trigger a flare-up of their IBD symptoms. Although triggers may differ, common ones include gluten, dairy, alcohol, popcorn, raw vegetables, legumes, nuts, seeds, deep-fried food, and processed meats. Those needing advice and the development of an appropriate diet are advised to speak with a dietitian and specialist gastroenterologist.

Related Articles

How Does Cannabis Work with My Gut Bacteria?

Cannabis, Stress, and Inflammation: Targeting the ECS for a Range of Health Problems

Can Weed Cause Stomach Ulcers?

Please note that the information in this article does not constitute medical advice.

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