NORML: 胃腸道疾病

胃腸道（GI）疾病，包括功能性腸道疾病如腸躁症（IBS）及炎症性腸道疾病如克羅恩病（CD）與結腸炎，影響了超過五分之一的美國人，尤其是女性。儘管某些胃腸道疾病可通過飲食和藥物進行控制，但其他疾病則無法通過傳統治療得到有效調節。胃腸道疾病的症狀通常包括痙攣、腹痛、大腸及/或小腸內壁炎症、慢性腹瀉、直腸出血及體重減輕。

患有胃腸道特定疾病的患者經常報告使用大麻來治療各種症狀，包括腹痛、腹部痙攣和腹瀉。[1-9] 根據2011年《歐洲胃腸病學與肝臟病學雜誌》發表的調查數據，「大麻使用在炎症性腸病（IBD）患者中較為常見，尤其是那些有腹部手術歷史、慢性腹痛和/或低生活質量指數的患者。」[10] 來自IBD患者的最新調查進一步證實：「許多IBD患者目前使用大麻，大多數患者認為它對症狀控制非常有效。」[11]

前期研究表明，CB1和CB2大麻素受體的激活對胃腸道具有生物學作用。[12] 在動物實驗中，這些受體的激活包括抑制胃腸蠕動、[13] 抑制腸道分泌、[14] 減少胃酸反流、[15] 及保護免受炎症，[16] 以及促進人類組織的上皮傷口癒合。[17] 專家建議，內源性大麻素系統在炎症性腸病（IBD）的發病機制中扮演著「關鍵角色」，[18] 並且「因此，大麻素可能對如結腸炎及其他消化系統疾病等炎症性疾病具有益處。」[19]

多項人體研究顯示，無論是使用大麻素或是全植物大麻，都能有效改善多種與腸胃相關的症狀。例如，2021年的一項多發性硬化症患者研究報告指出，“過去三個月內的使用大麻與尿頻、尿急、膀胱漏尿和濕疹、衛生巾使用及膀胱排空等症狀的改善有兩倍的機率相關。”[20]來自義大利的數據顯示，在重度腸胃疾病患者中，納比酮能有效減少腹瀉症狀。[21]來自紐西蘭的一項研究發表在《婦女健康雜誌》，同樣記錄了大麻使用與內膜異位症患者腸胃症狀的改善相關。研究中的受試者常報告，在開始使用大麻治療後，減少了處方藥物的攝入量。[22]

2019年發表的一項觀察性研究記錄了草藥大麻在治療難治性胃輕癱患者中的影響。研究的作者總結道：“大麻素顯著改善了難治性胃輕癱的症狀，包括腹痛。大麻可能優於德羅納比諾（dronabinol）改善這些症狀，儘管兩種大麻素似乎都是胃輕癱的新型治療選擇。……在疼痛管理方面的突破，代表著在目前對於胃輕癱相關腹痛尚無有效療法的情況下，這一領域的重大突破。”[23]另一項2019年發表的觀察性研究則報告，大麻使用與住院的潰瘍性結腸炎患者的治療效果改善相關。[24]2020年一篇病例報告記錄了口服THC（德羅納比諾）在一名患有慢性腸道假阻塞（CIPO）青少年患者中的成功使用。報告指出，德羅納比諾的使用顯著緩解了腸胃不適症狀。[25]

在患有腸躁症（IBS）的患者中，使用大麻的歷史與較低的內視鏡檢查機率、較短的住院時間以及較低的住院費用相關聯。[26]

多項人體研究也證實了大麻在克羅恩病患者中的安全性和療效。縱向數據顯示，長期使用全植物大麻與克羅恩病患者的症狀改善及處方藥物使用減少有關。[27]另一項研究發現，大麻治療與克羅恩病活動度的減少及疾病相關住院的減少相關聯。梅爾醫療中心胃腸科與肝病學研究所的研究人員評估了30名克羅恩病患者在使用大麻前後的“疾病活動度、藥物使用、手術需求和住院情況”。作者報告指出，“所有患者表示，使用大麻對他們的疾病活動度有積極影響”，並記錄到“21名患者顯著改善”。[28]最近的另一項研究報告了相似的結果，發現使用大麻的克羅恩病住院患者比對照組的患者經歷了較少的疾病相關併發症。[29]

在一項隨機安慰劑對照試驗中，吸入大麻已被證實能減輕患有治療抗藥性克羅恩病的患者的症狀。近一半參與試驗的患者在使用草本大麻後達到了疾病緩解。[30]相比之下，在對照試驗中，口服CBD未能在克羅恩病患者中提供類似的有益效果。[31]

根據目前的證據，一些專家認為，調節內源性大麻素系統（ECS）代表了治療多種胃腸疾病的新型療法，包括炎症性腸病、功能性腸道疾病、胃食道逆流病、分泌性腹瀉、胃潰瘍和結腸癌。[32-34]

參考文獻

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[3] Baron et al. 1990. Ulcerative colitis and marijuana. Annals of Internal Medicine 112: 471.

[4] Jeff Hergenrather. 2005. Cannabis alleviates symptoms of Crohn’s Disease. O’Shaughnessy’s 2: 3.

[5] Bruce et al. 2017. Preferences for medical marijuana over prescription medications among persons living with chronic conditions: Alternative, complementary, and tapering uses. Journal of Complementary Medicine [online ahead of print].

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[8] Weiss and Friedenberg. 2015. Patterns of cannabis use in patients with Inflammatory Bowel Disease: A population based analysis. Drug and Alcohol Dependence 156: 84-89.

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[11] Ravikoff et al. 2013. Marijuana use patterns among patients with inflammatory bowel disease. Inflammatory Bowel Diseases 19: 2809-2814.

[12] Massa and Monory. 2006. Endocannabinoids and the gastrointestinal tract. Journal of Endocrinological Investigation 29 (Suppl): 47-57.

[13] Roger Pertwee. 2001. Cannabinoids and the gastrointestinal tract. Gut 48: 859-867.

[14] DiCarlo and Izzo. 2003. Cannabinoids for gastrointestinal diseases: potential therapeutic applications. Expert Opinion on Investigational Drugs 12: 39-49.

[15] Lehmann et al. 2002. Cannabinoid receptor agonism inhibits transient lower esophageal sphincter relaxations and reflux in dogs. Gastroenterology 123: 1129-1134.

[16] Massa et al. 2005. The endocannabinoid system in the physiology and pathophysiology of the gastrointestinal tract. Journal of Molecular Medicine 12: 944-954.

[17] Wright et al. 2005. Differential expression of cannabinoid receptors in the human colon: cannabinoids promote epithelial wound healing. Gastroenterology 129: 437-453.

[18] Ahmed and Katz. 2016. Therapeutic use of cannabis in Inflammatory Bowel Disease. Gastroenterology & Hepatology 12: 668-679.

[19] Natfali et al. 2014. Cannabis for inflammatory bowel disease. Digestive Diseases 32: 468-474.

[20] Kim-Fine et al. 2021. Cannabinoids and bladder symptoms in multiple sclerosis. Multiple Sclerosis and Related Disorders [online ahead of print].

[21] Pellessi et al. 2019. Nabilone administration in refractory chronic diarrhea: A case series. BMC Gastroenterology 19 [open access publication].

[22] Armour et al. 2020. Illicit cannabis use as a management strategy in New Zealand women with endometriosis: An online survey. Journal of Women’s Health [online ahead of print].

[23] Barbash et al. 2019. Impact of cannabinoids on symptoms of refractory gastroparesis: A single-center experience. Cureus [online access publication].

[24] Mbachi et al. 2019. Association between cannabis use and complications related to ulcerative colitis in hospitalized patients: A propensity matched retrospective cohort study. Medicine 98 [open access journal].

[25] Zemrani et al. 2020. Cannabinoids improve gastrointestinal symptoms in a parenteral nutrition–dependent patient with chronic intestinal pseudo-obstruction. Journal of Parenteral and Eternal Nutrition [online ahead of print].

[26] Desai et al. 2020. Association between cannabis use and healthcare utilization in patients with irritable bowel syndrome: A retrospective cohort study. Cureus 12 [open access journal].

[27] Naftali et al. 2019. Medical cannabis for inflammatory bowel disease: Real-life experience of mode of consumption and assessment of side effects. European Journal of Gastroenterology & Hepatology 31: 1376-1381.

[28] Naftali et al. 2011. Treatment of Crohn’s disease with cannabis: an observational study. Journal of the Israeli Medical Association 13: 455-458.

[29] Mbachi et al. 2019. Association between cannabis use and complications related to Crohn’s disease: A retrospective cohort study. Digestive Diseases and Sciences 64: 2939-2944.

[30] Naftali et al. 2013. Cannabis induces a clinical response in patients with Crohn’s disease: a prospective placebo-controlled study. Clinical Gastroenterology and Hepatology 11: 1276-1280.

[31] Natfali et al. 2017. Low-dose cannabidiol is safe but not effective in the treatment for Crohn’s disease, a randomized controlled trial. Digestive Diseases 62: 1615-1620.

[32] Massa and Monory. 2006. op. cit.

[33] Izzo and Coutts. 2005. Cannabinoids and the digestive tract. Handbook of Experimental Pharmacology 168: 573-598.

[34] Izzo et al. 2009. Non-psychotropic plant cannabinoids: new therapeutic opportunities from an ancient herb. Trends in Pharmacological Sciences 30: 515-527.

原文標題：《Gastrointestinal Disorder》

原文作者：NORML

原始網站：https://norml.org

翻譯者：大麻101

翻譯日期：2025年4月

翻譯聲明：本文章由原文翻譯而來，原文發表於NORML。如需閱讀原文，請訪問 https://norml.org/marijuana/library/recent-medical-marijuana-research/gastrointestinal-disorders/