Abstract
Marijuana derived from the plant Cannabis sativa has been used for the treatment of many gastrointestinal (GI) disorders, including anorexia, emesis, abdominal pain, diarrhea, and others. However, its psychotropic side effects have often limited its use. Several cannabinoid receptors, which include the cannabinoid receptor 1 (CB1), CB2, and possibly GPR55, have been identified throughout the GI tract. These receptors may play a role in the regulation of food intake, nausea and emesis, gastric secretion and gastroprotection, GI motility, ion transport, visceral sensation, intestinal inflammation, and cell proliferation in the gut. However, the regulation of nausea and vomiting by cannabinoids and the endocannabinoid system has shed new knowledge in this field. Thus far, despite evidence of visceral sensitivity inhibition in animal models, data in irritable bowel syndrome (IBS) patients is scarce and not supportive. Furthermore, many compounds that either act directly at the receptor or increase (or reduce) ligand availability have the potential to affect other brain functions and cause side effects. Novel drug targets such as FAAH and monoacylglycerol lipase (MAGL) inhibitors appear to be promising in animal models, but more studies are necessary to prove their efficiency. The promise of emerging drugs that are more selective and peripherally acting suggest that, in the near future, cannabinoids will play a major role in managing an array of GI diseases.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: • Of importance
United States Department of Health and Human Services. Substance Abuse and Mental Health Services Administration. Office of Applied, Studies.
Pacher P, Batkai S, Kunos G. The endocannabinoid system as an emerging target of pharmacotherapy. Pharmacol Rev. 2006;58(3):389–462.
Matsuda LA, Lolait SJ, Brownstein MJ, Young AC, Bonner TI. Structure of a cannabinoid receptor and functional expression of the cloned cDNA. Nature. 1990;346(6284):561–4. doi:10.1038/346561a0.
Munro S, Thomas KL, Abu-Shaar M. Molecular characterization of a peripheral receptor for cannabinoids. Nature. 1993;365(6441):61–5. doi:10.1038/365061a0.
Di Marzo V, Fontana A. Anandamide, an endogenous cannabinomimetic eicosanoid: ‘killing two birds with one stone’. Prostaglandins Leukot Essent Fat Acids. 1995;53(1):1–11.
Wright K, Rooney N, Feeney M, et al. Differential expression of cannabinoid receptors in the human colon: cannabinoids promote epithelial wound healing. Gastroenterology. 2005;129(2):437–53.
Brusberg M, Arvidsson S, Kang D, Larsson H, Lindstrom E, Martinez V. CB1 receptors mediate the analgesic effects of cannabinoids on colorectal distension-induced visceral pain in rodents. J Neurosci. 2009;29(5):1554–64. doi:10.1523/JNEUROSCI. 5166-08.2009.
Kulkarni-Narla A, Brown DR. Localization of CB1-cannabinoid receptor immunoreactivity in the porcine enteric nervous system. Cell Tissue Res. 2000;302(1):73–80.
Izzo AA, Sharkey KA. Cannabinoids and the gut: new developments and emerging concepts. Pharmacol Ther. 2010;126(1):21–38. doi:10.1016/j.pharmthera.2009.12.005.
Gruber SA, Rogowska J, Yurgelun-Todd DA. Altered affective response in marijuana smokers: an FMRI study. Drug Alcohol Depend. 2009;105(1–2):139–53. doi:10.1016/j.drugalcdep.2009.06.019.
Moreno-Sanz G, Sasso O, Guijarro A, et al. Pharmacological characterization of the peripheral FAAH inhibitor URB937 in female rodents: interaction with the Abcg2 transporter in the blood-placenta barrier. Br J Pharmacol. 2012;167(8):1620–8. doi:10.1111/j.1476-5381.2012.02098.x.
Wright KL, Duncan M, Sharkey KA. Cannabinoid CB2 receptors in the gastrointestinal tract: a regulatory system in states of inflammation. Br J Pharmacol. 2008;153(2):263–70.
Izzo AA. The cannabinoid CB(2) receptor: a good friend in the gut. Neurogastroenterol Motil. 2007;19(9):704–8.
Ross GR, Lichtman A, Dewey WL, Akbarali HI. Evidence for the putative cannabinoid receptor (GPR55)-mediated inhibitory effects on intestinal contractility in mice. Pharmacology. 2012;90(1–2):55–65. doi:10.1159/000339076.
Fioramonti J, Bueno L. Role of cannabinoid receptors in the control of gastrointestinal motility and perception. Expert Rev Gastroenterol Hepatol. 2008;2(3):385–97. doi:10.1586/17474124.2.3.385.
Farquhar-Smith WP, Jaggar SI, Rice AS. Attenuation of nerve growth factor-induced visceral hyperalgesia via cannabinoid CB(1) and CB(2)-like receptors. Pain. 2002;97(1–2):11–21.
Kinsey SG, Cole EC. Acute delta(9)-tetrahydrocannabinol blocks gastric hemorrhages induced by the nonsteroidal anti-inflammatory drug diclofenac sodium in mice. Eur J Pharmacol. 2013;715(1–3):111–6. doi:10.1016/j.ejphar.2013.06.001.
Beltramo M. Cannabinoid type 2 receptor as a target for chronic pain. Mini-Rev Med Chem. 2009;9(1):11–25.
Govaerts SJ, Hermans E, Lambert DM. Comparison of cannabinoid ligands affinities and efficacies in murine tissues and in transfected cells expressing human recombinant cannabinoid receptors. Eur J Pharm Sci. 2004;23(3):233–43.
Pertwee RG. Receptors and channels targeted by synthetic cannabinoid receptor agonists and antagonists. Curr Med Chem. 2010;17(14):1360–81.
Di Marzo V, Piscitelli F. Gut feelings about the endocannabinoid system. Neurogastroenterol Motil. 2011;23(5):391–8. doi:10.1111/j.1365-2982.2011.01689.x.
Booker L, Naidu PS, Razdan RK, Mahadevan A, Lichtman AH. Evaluation of prevalent phytocannabinoids in the acetic acid model of visceral nociception. Drug Alcohol Depend. 2009;105(1–2):42–7. doi:10.1016/j.drugalcdep.2009.06.009.
Saez-Cassanelli JL, Fontanella GH, Delgado-Garcia JM, Carrion AM. Functional blockage of the cannabinoid receptor type 1 evokes a kappa-opiate-dependent analgesia. J Neurochem. 2007;103(6):2629–39. doi:10.1111/j.1471-4159.2007.05000.x.
Gregg JM, Small EW, Moore R, Raft D, Toomey TC. Emotional response to intravenous delta9tetrahydrocannabinol during oral surgery. J Oral Surg. 1976;34(4):301–13.
Bisogno T, Ligresti A, Di Marzo V. The endocannabinoid signalling system: biochemical aspects. Pharmacol Biochem Behav. 2005;81(2):224–38.
Battista N, Di Tommaso M, Bari M, Maccarrone M. The endocannabinoid system: an overview. Front Behav Neurosci. 2012;6:9. doi:10.3389/fnbeh.2012.00009.
Sugiura T, Kishimoto S, Oka S, Gokoh M. Biochemistry, pharmacology and physiology of 2-arachidonoylglycerol, an endogenous cannabinoid receptor ligand. Prog Lipid Res. 2006;45(5):405–46.
Aviello G, Romano B, Izzo AA. Cannabinoids and gastrointestinal motility: animal and human studies. Eur Rev Med Pharmacol Sci. 2008;12 Suppl 1:81–93.
Anthony JC, Warner L, Kessler R. Comparative epidemiology of dependence on tobacco, alcohol, controlled substances, and inhalants: basic findings from the national comorbidity survey. Exp Clin Psychopharmacol. 1994;2:224–68.
Wang T, Collet JP, Shapiro S, Ware MA. Adverse effects of medical cannabinoids: a systematic review. CMAJ. 2008;178(13):1669–78. doi:10.1503/cmaj.071178.
Camilleri M. Management of the irritable bowel syndrome. Gastroenterology. 2001;120(3):652–68.
Mertz H, Naliboff B, Munakata J, Niazi N, Mayer EA. Altered rectal perception is a biological marker of patients with irritable bowel syndrome. Gastroenterology. 1995;109(1):40–52.
Posserud I, Syrous A, Lindstrom L, Tack J, Abrahamsson H, Simren M. Altered rectal perception in irritable bowel syndrome is associated with symptom severity. Gastroenterology. 2007;133(4):1113–23.
Talley NJ. Functional gastrointestinal disorders as a public health problem. Neurogastroenterol Motil. 2008;20 Suppl 1:121–9. doi:10.1111/j.1365-2982.2008.01097.x.
Cash B, Sullivan S, Barghout V. Total costs of IBS: employer and managed care perspective. Am J Manage Care. 2005;11(1 Suppl):S7–S16.
Rice AS, Farquhar-Smith WP, Nagy I. Endocannabinoids and pain: spinal and peripheral analgesia in inflammation and neuropathy. Prostaglandins Leukot Essent Fat Acids. 2002;66(2–3):243–56. doi:10.1054/plef.2001.0362.
Farquhar-Smith WP, Rice AS. Administration of endocannabinoids prevents a referred hyperalgesia associated with inflammation of the urinary bladder. Anesthesiology. 2001;94(3):507–13. discussion 6A.
Jaggar SI, Hasnie FS, Sellaturay S, Rice AS. The anti-hyperalgesic actions of the cannabinoid anandamide and the putative CB2 receptor agonist palmitoylethanolamide in visceral and somatic inflammatory pain. Pain. 1998;76(1–2):189–99. The first study to demonstrate anti-nociceptive effect of a CB2 receptor agonist.
Sanson M, Bueno L, Fioramonti J. Involvement of cannabinoid receptors in inflammatory hypersensitivity to colonic distension in rats. Neurogastroenterol Motil. 2006;18(10):949–56.
Mahmud A, Santha P, Paule CC, Nagy I. Cannabinoid 1 receptor activation inhibits transient receptor potential vanilloid type 1 receptor-mediated cationic influx into rat cultured primary sensory neurons. Neuroscience. 2009;162(4):1202–11. doi:10.1016/j.neuroscience.2009.05.024. Demonstrated that potential vanilloid type 1 receptor (TRPV1), which plays a pivotal role in the development of inflammatory heat hyperalgesia and visceral hyper-reflexia, can be activated by cannabinoids.
Kikuchi A, Ohashi K, Sugie Y, Sugimoto H, Omura H. Pharmacological evaluation of a novel cannabinoid 2 (CB2) ligand, PF-03550096, in vitro and in vivo by using a rat model of visceral hypersensitivity. J Pharmacol Sci. 2008;106(2):219–24.
Bingham B, Jones PG, Uveges AJ, et al. Species-specific in vitro pharmacological effects of the cannabinoid receptor 2 (CB2) selective ligand AM1241 and its resolved enantiomers. Br J Pharmacol. 2007;151(7):1061–70.
Esfandyari T, Camilleri M, Busciglio I, Burton D, Baxter K, Zinsmeister AR. Effects of a cannabinoid receptor agonist on colonic motor and sensory functions in humans: a randomized, placebo-controlled study. Am J Physiol Gastrointest Liver Physiol. 2007;293(1):G137–45.
Klooker TK, Leliefeld KE, Van Den Wijngaard RM, Boeckxstaens GE. The cannabinoid receptor agonist delta-9-tetrahydrocannabinol does not affect visceral sensitivity to rectal distension in healthy volunteers and IBS patients. Neurogastroenterol Motil. 2011;23(1):30–5, e2. doi: 10.1111/j.1365-2982.2010.01587.x. This study concluded that the CB agonists are not a useful drug for treatment of visceral hypersensitivity in IBS patients.
Wong BS, Camilleri M, Busciglio I, et al. Pharmacogenetic trial of a cannabinoid agonist shows reduced fasting colonic motility in patients with nonconstipated irritable bowel syndrome. Gastroenterology. 2011;141(5):1638–47.e1-7. doi:10.1053/j.gastro.2011.07.036.
Malik Z, Bayman L, Valestin J, Schey R. Dronabinol increases pain threshold in non-cardiac chest pain: A double blind placebo controlled trial. 2014. First study to demonstrate that dronabinol increases NCCP pain threshold using an objective parameter (EBDT).
Fichna J, Salaga M, Stuart J, et al. Selective inhibition of FAAH produces antidiarrheal and antinociceptive effect mediated by endocannabinoids and cannabinoid-like fatty acid amides. Neurogastroenterol Motil. 2014;26(4):470–81. doi:10.1111/nmo.12272. One of the first studies evaluating the effect of selective FAAH inhibitor on mouse colonic motility and pain.
Sharkey KA, Darmani NA, Parker LA. Regulation of nausea and vomiting by cannabinoids and the endocannabinoid system. Eur J Pharmacol. 2014;722:134–46. doi:10.1016/j.ejphar.2013.09.068.
Patil CL, Abrams ET, Steinmetz AR, Young SL. Appetite sensations and nausea and vomiting in pregnancy: an overview of the explanations. Ecol Food Nutr. 2012;51(5):394–417. doi:10.1080/03670244.2012.696010.
Brainard A, Gresham C. Prevention and treatment of motion sickness. Am Fam Physician. 2014;90(1):41–6.
Rutkowska M, Gliniak H. The influence of ACEA—a selective cannabinoid CB1 receptor agonist on whole blood and platelet-poor plasma serotonin concentrations. Pharmazie. 2009;64(9):598–601.
Napadow V, Lee J, Kim J, et al. Brain correlates of phasic autonomic response to acupuncture stimulation: an event-related fMRI study. Hum Brain Mapp. 2013;34(10):2592–606. doi:10.1002/hbm.22091.
Sharkey KA, Cristino L, Oland LD, et al. Arvanil, anandamide and N-arachidonoyl-dopamine (NADA) inhibit emesis through cannabinoid CB1 and vanilloid TRPV1 receptors in the ferret. Eur J Neurosci. 2007;25(9):2773–82.
Mackie K. Distribution of cannabinoid receptors in the central and peripheral nervous system. Handb Exp Pharmacol. 2005;(168):299–325.
Kano M, Ohno-Shosaku T, Hashimotodani Y, Uchigashima M, Watanabe M. Endocannabinoid-mediated control of synaptic transmission. Physiol Rev. 2009;89(1):309–80. doi:10.1152/physrev.00019.2008.
Mechoulam R. Plant cannabinoids: a neglected pharmacological treasure trove. Br J Pharmacol. 2005;146(7):913–5.
Nevalainen T. Recent development of CB2 selective and peripheral CB1/CB2 cannabinoid receptor ligands. Curr Med Chem. 2014;21(2):187–203.
Darmani NA. Delta(9)-tetrahydrocannabinol and synthetic cannabinoids prevent emesis produced by the cannabinoid CB(1) receptor antagonist/inverse agonist SR 141716A. Neuropsychopharmacology. 2001;24(2):198–203.
Darmani NA. Delta-9-tetrahydrocannabinol differentially suppresses cisplatin-induced emesis and indices of motor function via cannabinoid CB(1) receptors in the least shrew. Pharmacol Biochem Behav. 2001;69(1–2):239–49.
Ray AP, Chebolu S, Darmani NA. Receptor-selective agonists induce emesis and fos expression in the brain and enteric nervous system of the least shrew (Cryptotis parva). Pharmacol Biochem Behav. 2009;94(1):211–8. doi:10.1016/j.pbb.2009.08.010.
Van Sickle MD, Duncan M, Kingsley PJ, et al. Identification and functional characterization of brainstem cannabinoid CB2 receptors. Science. 2005;310(5746):329–32.
Despres JP, Ross R, Boka G, Almeras N, Lemieux I, ADAGIO-Lipids Investigators. Effect of rimonabant on the high-triglyceride/ low-HDL-cholesterol dyslipidemia, intraabdominal adiposity, and liver fat: the ADAGIO-lipids trial. Arterioscler Thromb Vasc Biol. 2009;29(3):416–23. doi:10.1161/ATVBAHA.108.176362.
Kipnes MS, Hollander P, Fujioka K, et al. A one-year study to assess the safety and efficacy of the CB1R inverse agonist taranabant in overweight and obese patients with type 2 diabetes. Diabetes Obes Metab. 2010;12(6):517–31. doi:10.1111/j.1463-1326.2009.01188.x.
Pi-Sunyer FX, Aronne LJ, Heshmati HM, Devin J, Rosenstock J, RIO-North America Study Group. Effect of rimonabant, a cannabinoid-1 receptor blocker, on weight and cardiometabolic risk factors in overweight or obese patients: RIO-north america: a randomized controlled trial. JAMA. 2006;295(7):761–75.
Chouker A, Kaufmann I, Kreth S, et al. Motion sickness, stress and the endocannabinoid system. PLoS One. 2010;5(5):e10752. doi:10.1371/journal.pone.0010752.
Mo FF, Qin HH, Wang XL, et al. Acute hyperglycemia is related to gastrointestinal symptoms in motion sickness: an experimental study. Physiol Behav. 2012;105(2):394–401. doi:10.1016/j.physbeh.2011.08.024.
Callen L, Moreno E, Barroso-Chinea P, et al. Cannabinoid receptors CB1 and CB2 form functional heteromers in brain. J Biol Chem. 2012;287(25):20851–65. doi:10.1074/jbc.M111.335273.
Gulyas AI, Cravatt BF, Bracey MH, et al. Segregation of two endocannabinoid-hydrolyzing enzymes into pre- and postsynaptic compartments in the rat hippocampus, cerebellum and amygdala. Eur J Neurosci. 2004;20(2):441–58. doi:10.1111/j.1460-9568.2004.03428.x.
Dalzell AM, Bartlett H, Lilleyman JS. Nabilone: an alternative antiemetic for cancer chemotherapy. Arch Dis Child. 1986;61(5):502–5.
Lane M, Vogel CL, Ferguson J, et al. Dronabinol and prochlorperazine in combination for treatment of cancer chemotherapy-induced nausea and vomiting. J Pain Symptom Manag. 1991;6(6):352–9.
Klumpers LE, Beumer TL, van Hasselt JG, et al. Novel delta(9)-tetrahydrocannabinol formulation Namisol(R) has beneficial pharmacokinetics and promising pharmacodynamic effects. Br J Clin Pharmacol. 2012;74(1):42–53. doi:10.1111/j.1365-2125.2012.04164.x.
Ahmed AI, van den Elsen GA, Colbers A, et al. Safety and pharmacokinetics of oral delta-9-tetrahydrocannabinol in healthy older subjects: a randomized controlled trial. Eur Neuropsychopharmacol. 2014.
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(3):533–43. doi:10.1185/030079907X167525.
Abalo R, Cabezos PA, Vera G, Lopez-Perez AE, Martin MI. Cannabinoids may worsen gastric dysmotility induced by chronic cisplatin in the rat. Neurogastroenterol Motil. 2013;25(5):373. doi:10.1111/nmo.12073. –82, e292.
Bolognini D, Rock EM, Cluny NL, et al. Cannabidiolic acid prevents vomiting in Suncus murinus and nausea-induced behaviour in rats by enhancing 5-HT1A receptor activation. Br J Pharmacol. 2013;168(6):1456–70. doi:10.1111/bph.12043.
Duran M, Perez E, Abanades S, et al. Preliminary efficacy and safety of an oromucosal standardized cannabis extract in chemotherapy-induced nausea and vomiting. Br J Clin Pharmacol. 2010;70(5):656–63. doi:10.1111/j.1365-2125.2010.03743.x.
Galli JA, Sawaya RA, Friedenberg FK. Cannabinoid hyperemesis syndrome. Curr Drug Abus Rev. 2011;4(4):241–9.
Allen JH, de Moore GM, Heddle R, Twartz JC. Cannabinoid hyperemesis: cyclical hyperemesis in association with chronic cannabis abuse. Gut. 2004;53(11):1566–70.
Nicolson SE, Denysenko L, Mulcare JL, Vito JP, Chabon B. Cannabinoid hyperemesis syndrome: a case series and review of previous reports. Psychosomatics. 2012;53(3):212–9. doi:10.1016/j.psym.2012.01.003.
Simonetto DA, Oxentenko AS, Herman ML, Szostek JH. Cannabinoid hyperemesis: a case series of 98 patients. Mayo Clin Proc. 2012;87(2):114–9. doi:10.1016/j.mayocp.2011.10.005.
Compliance with Ethics Guidelines
Conflict of Interest
Zubair Malik, Daniel Baik, and Ron Schey declare no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with animal subjects performed by any of the authors. With regard to the authors’ research cited in this paper, all procedures were followed in accordance with the ethical standards of the responsible committee on human experimentation and with the Helsinki Declaration of 1975, as revised in 2000 and 2008.
Author information
Authors and Affiliations
Corresponding author
Additional information
This article is part of the Topical Collection on Neurogastroenterology and Motility Disorders of the Gastrointestinal Tract
Rights and permissions
About this article
Cite this article
Malik, Z., Baik, D. & Schey, R. The Role of Cannabinoids in Regulation of Nausea and Vomiting, and Visceral Pain. Curr Gastroenterol Rep 17, 9 (2015). https://doi.org/10.1007/s11894-015-0429-1
Published:
DOI: https://doi.org/10.1007/s11894-015-0429-1