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Marijuana Use in Patients with Symptoms of Gastroparesis: Prevalence, Patient Characteristics, and Perceived Benefit

Abstract

Background

Marijuana may be used by some patients with gastroparesis (Gp) for its potential antiemetic, orexigenic, and pain-relieving effects.

Aims

The aim of this study was to describe the use of marijuana by patients for symptoms of Gp, assessing prevalence of use, patient characteristics, and patients’ perceived benefit on their symptoms of Gp.

Methods

Patients with symptoms of Gp underwent history and physical examination, gastric emptying scintigraphy, and questionnaires assessing symptoms. Patients were asked about the current use of medications and alternative medications including marijuana.

Results

Fifty-nine of 506 (11.7%) patients with symptoms of Gp reported current marijuana use, being similar among patients with delayed and normal gastric emptying and similar in idiopathic and diabetic patients. Patients using marijuana were younger, more often current tobacco smokers, less likely to be a college graduate, married or have income > $50,000. Patients using marijuana had higher nausea/vomiting subscore (2.7 vs 2.1; p = 0.002), higher upper abdominal pain subscore (3.5 vs 2.9; p = 0.003), more likely to be using promethazine (37 vs 25%; p = 0.05) and dronabinol (17 vs 3%; p < 0.0001). Of patients using marijuana, 51% had been using it for more than 2 years, 47% were using this once or more per day, and 81% of marijuana users rated their benefit from marijuana as better or much better.

Conclusions

A subset of patients (12%) with symptoms of Gp use marijuana. Patients with severe nausea and abdominal pain were more likely to use marijuana and perceive it to be beneficial for their symptoms.

Trial Registration

ClinicalTrials.gov Identifier: NCT01696747.

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References

  1. Parkman HP, Hasler WL, Fisher RS. American Gastroenterological Association technical review on the diagnosis and treatment of gastroparesis. Gastroenterology. 2004;127:1592–1622.

    Article  Google Scholar 

  2. Camilleri M, Parkman HP, Shafi MA, Abell TL, Gerson L, American College of Gastroenterology. Clinical guideline: management of gastroparesis. Am J Gastroenterol. 2013;108:18–37.

    CAS  Article  Google Scholar 

  3. Lee LA, Chen J, Yin J. Complementary and alternative medicine for gastroparesis. Gastroenterol Clin N Am. 2015;44:137–150.

    Article  Google Scholar 

  4. Jehangir A, Parkman HP. Cannabinoid use in patients with gastroparesis and related disorders. Am J Gastroenterol.. 2019;114:945–953.

    Article  Google Scholar 

  5. Sharkey KA, Wiley JW. The Role of the endocannabinoid system in the brain-gut axis. Gastroenterology. 2016;151:252–266.

    CAS  Article  Google Scholar 

  6. Malik Z, Baik D, Schey R. The role of cannabinoids in the regulation of nausea and vomiting, and visceral pain. Curr Gastroenterol Rep. 2015;17:429–435.

    Article  Google Scholar 

  7. Parkman HP, Hallinan EK, Hasler WL, Farrugia G, Koch KL, Nguyen L, Snape WJ, Abell TL, McCallum RW, Sarosiek I, Pasricha PJ, Clarke J, Miriel L, Tonascia J, Hamilton F; NIDDK Gastroparesis Clinical Research Consortium (GpCRC). Early satiety and postprandial fullness in gastroparesis correlate with gastroparesis severity, gastric emptying, and water load testing. Neurogastroenterol Motil 2017;29

  8. Abell TL, Bernstein VK, Cutts T, et al. Treatment of gastroparesis: a multidisciplinary clinical review. Neurogastroenterol Motil. 2006;18:263–283.

    CAS  Article  Google Scholar 

  9. Rentz AM, Kahrilas P, Stanghellini V, et al. Development and psychometric evaluation of the patient assessment of upper gastrointestinal symptom severity index (PAGI-SYM) in patients with upper gastrointestinal disorders. Qual Life Res. 2004;13:1737–1749.

    CAS  Article  Google Scholar 

  10. Revicki DA, Rentz AM, Dubois D, et al. Development and validation of a patient-assessed gastroparesis symptom severity measure: the Gastroparesis Cardinal Symptom Index. Aliment Pharmacol Ther. 2003;18:141–150.

    CAS  Article  Google Scholar 

  11. De la Loge C, Trudeau E, Marquis P, et al. Cross-cultural development and validation of a patient self-administered questionnaire to assess quality of life in upper gastrointestinal disorders: the PAGI-QOL. Qual Life Res. 2004;13:1751–1762.

    Article  Google Scholar 

  12. Ware JE, Kosinski M, Dewey JE. How to Score Version 2 of the SF-36®Health Survey. Lincoln, RI: QualityMetric Incorporated; 2000.

    Google Scholar 

  13. Beck AT, Steer RA, Ball R, Ranieri W. Comparison of Beck Depression Inventories -IA and -II in psychiatric outpatients. J Pers Assess. 1996;67:588–597.

    CAS  Article  Google Scholar 

  14. Spielberger C, Gorsuch R, Lushene R. Manual for the state-trait anxiety inventory. Palo Alto, CA: Consulting Psychologists Press; 1970.

    Google Scholar 

  15. Kocalevent RD, Hinz A, Brähler E. Standardization of a screening instrument (PHQ-15) for somatization syndromes in the general population. BMC Psychiatry. 2013;13:91.

    Article  Google Scholar 

  16. Spiller RC, Humes DJ, Campbell E, et al. The Patient Health Questionnaire 12 Somatic Symptom scale as a predictor of symptom severity and consulting behaviour in patients with irritable bowel syndrome and symptomatic diverticular disease. Aliment Pharmacol Ther. 2010;32:811–820.

    CAS  Article  Google Scholar 

  17. Tougas G, Eaker EY, Abell TL, et al. Assessment of gastric emptying using a low fat meal: establishment of international control values. Am J Gastroenterol. 2000;95:1456–1462.

    CAS  Article  Google Scholar 

  18. Abell TL, Camilleri M, Donohoe K, et al. Consensus recommendations for gastric emptying scintigraphy. Am J Gastro. 2008;103:753–763.

    Article  Google Scholar 

  19. Agresti A. Categorical data analysis. New York: John Wiley & Sons, Inc.; 1990.

    Google Scholar 

  20. Akaike H. A new look at the statistical model identification. IEEE Trans Autom Control. 1974;19:716–723.

    Article  Google Scholar 

  21. SAS Institute, Inc. SAS software, version 9.3 of the SAS system for Windows. Cary, NC, 2002-2010. StataCorp. 2011. Stata statistical software: release 12. College Station, TX: StataCorp LP.

  22. National Survey on Drug Use and Health. https://nsduhweb.rti.org/respweb/homepage.cfm Visited site 3/2/2019

  23. Bhandari A, Wagner T. Self-reported utilization of health care services: improving measurement and accuracy. Med Care Res Rev. 2006;63:217–235.

    Article  Google Scholar 

  24. Choung RS, Locke GR 3rd, Lee RM, et al. Cyclic vomiting syndrome and functional vomiting in adults: association with cannabinoid use in males. Neurogastroenterol Motil. 2012;24:20-6, e1.

    PubMed  Google Scholar 

  25. Parkman HP, Yates K, Hasler WL, et al. Clinical features of idiopathic gastroparesis vary with sex, body mass, symptom onset, delay in gastric emptying, and gastroparesis severity. Gastroenterology. 2011;140:101–115.

    Article  Google Scholar 

  26. Pasricha PJ, Colvin R, Yates K, et al. Characteristics of patients with chronic unexplained nausea and vomiting and normal gastric emptying. Clin Gastroenterol Hepatol. 2011;9:567–576.

    Article  Google Scholar 

  27. Stanghellini V, Chan FK, Hasler WL, et al. Gastroduodenal Disorders. Gastroenterology. 2016;150:1380–1392.

    Article  Google Scholar 

  28. Allen JH, de Moore GM, Heddle R, Twartz JC. Cannabinoid hyperemesis: cyclical hyperemesis in association with chronic cannabis abuse. Gut. 2004;53:1566–1570.

    CAS  Article  Google Scholar 

  29. Pattathan MB, Hejazi RA, McCallum RW. Association of marijuana use and cyclic vomiting syndrome. Pharmaceuticals. 2012;29:719–726.

    Article  Google Scholar 

  30. Hejazi RA, Lavenbarg TH, McCallum RW. Spectrum of gastric emptying patterns in adult patients with cyclic vomiting syndrome. Neurogastroenterol Motil. 2010;22:1298-302 e338.

    Article  Google Scholar 

  31. Camilleri M. Cannabinoids and gastrointestinal motility: Pharmacology, clinical effects, and potential therapeutics in humans. Neurogastro Motility. 2018;30:e13370.

    CAS  Article  Google Scholar 

  32. Bateman DN. Delta-9-tetrahydrocannabinol and gastric emptying. Br J Clin Pharmacol. 1983;15:749–751.

    CAS  Article  Google Scholar 

  33. McCallum RW, Soykan I, Sridhar KR, Ricci DA, Lange RC, Plankey MW. Delta-9-tetrahydrocannabinol delays the gastric emptying of solid food in humans: a double-blind, randomized study. Aliment Pharmacol Ther. 1999;13:77–80.

    CAS  Article  Google Scholar 

  34. Esfandyari T, Camilleri M, Ferber I, et al. Effect of a cannabinoid agonist of gastrointestinal transit and postprandial satiation in healthy human subjects: a randomized, placebo-controlled study. Neurogastroenterol Motil. 2006;18:831–838.

    CAS  Article  Google Scholar 

  35. Meiri E, Jhangiani H, Vredenburgh JJ, et al. Efficacy of dronabinol alone and in combination with ondansetron versus ondansetron alone for delayed chemotherapy-induced nausea and vomiting. Curr Med Res Opin. 2007;23:533–543.

    CAS  Article  Google Scholar 

  36. Peters J, Chien J. Contemporary routes of cannabis consumption: a primer for clinicians. J Am Osteopath Assoc. 2018;118:67–70.

    Article  Google Scholar 

  37. Cohen K, Weizman A, Weinstein A. Positive and negative effects of cannabis and cannabinoids on health. Clin Pharmacol Ther. 2019;105:1139–1147.

    Article  Google Scholar 

  38. Turna J, Simpson W, Patterson B, Lucas P, van Ameringen M. Cannabis use behaviors and prevalence of anxiety and depressive symptoms in a cohort of Canadian medicinal cannabis users. J Psychiartr Res. 2019;111:134–139.

    Article  Google Scholar 

  39. Di Forti M, Quattrone D, Freeman TP, et al. The contribution of cannabis use to variation in the incidence of psychotic disorder across Europe (EU-GEI): a multicentre case-control study. Lancet Psychiatry. 2019;6:427–436.

    Article  Google Scholar 

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Funding

The NIH/NIDDK Gastroparesis Clinical Research Consortium (GpCRC) is supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) (grants U01DK073975 [Parkman], U01DK073983 [Pasricha], U01DK074007 [Abell], U01DK073974 [Koch], U01DK074035 [McCallum], U01DK112193 [Kuo], and U01DK074008 [Tonascia]).

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Authors and Affiliations

Authors

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Contributions

HPP was involved in the study conceptualization, patient recruitment, data interpretation, and writing of the manuscript; EPS contributed to the statistical analysis, data interpretation, and writing of the manuscript; LN was involved in the study conceptualization, patient recruitment, and revision of the manuscript; KY was involved in the statistical analysis, data interpretation, writing of the manuscript; TLA was involved in the study conceptualization, patient recruitment, and revision of the manuscript; WLH contributed to the study conceptualization, patient recruitment, and revision of the manuscript; WJS was involved in the study conceptualization, patient recruitment, revision of the manuscript; JC was involved in the patient recruitment and revision of the manuscript; RS contributed to the study conceptualization and revision of the manuscript; KLK was involved in the study conceptualization, patient recruitment, and revision of the manuscript; BK was involved in the patient recruitment and revision of the manuscript; RWM was involved in the study conceptualization, patient recruitment, and revision of the manuscript; IS was involved in the study conceptualization, patient recruitment, and revision of the manuscript; MG was involved in the study conceptualization and revision of the manuscript; GF was involved in the study conceptualization, revision of the manuscript; JT contributed to the study conceptualization, statistical analysis, data interpretation, and revision of the manuscript; PJP was involved in the study conceptualization, patient recruitment, and revision of the manuscript; FH contributed to the study conceptualization and revision of the manuscript.

Corresponding author

Correspondence to Henry P. Parkman.

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Parkman, H.P., Sharkey, E.P., Nguyen, L.A. et al. Marijuana Use in Patients with Symptoms of Gastroparesis: Prevalence, Patient Characteristics, and Perceived Benefit. Dig Dis Sci 65, 2311–2320 (2020). https://doi.org/10.1007/s10620-019-05963-2

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  • DOI: https://doi.org/10.1007/s10620-019-05963-2

Keywords

  • Marijuana
  • Cannabis
  • Cannabinoids
  • Dronabinol
  • Gastroparesis