Nabilone administration in refractory chronic diarrhea: a case series. Lanfranco Pellesi et al. BMC Gastroenterology. 2019. Article

Kelly Hughes

The problem: Chronic diarrhea, can be difficult to diagnose and manage, so patients often take non-specific antidiarrheal therapies, often without relief. Cannabis has been used as a treatment for nausea and other GI conditions, but its usefulness for diarrhea is unknown.

 

Why do this study? The GI tract is rich in endocannabinoid receptors, which suggests that cannabis could be a promising therapy for the treatment of chronic diarrhea and other GI conditions.

 

The study: This study reports 6 cases of chronic diarrhea that were treated with nabilone, a synthetic cannabinoid that binds to the CB1 receptor. The patients suffered from a variety of GI disorders but all had the common symptom of chronic diarrhea, and had been unsuccessfully treated with antibiotics and steroids.  Patients were treated daily with oral nabilone for 3 months and improvement was measured by a decrease in the number of daily bowel movements and an increase patient body weight. The health of almost every patient was improved after 3 months: daily bowel movements decreased by over 50%, patient body weight increased and many were able to reduce the number of anti-diarrheal medications they were taking. These results were still maintained at a follow up 3 months later. Nabilone was generally well tolerated.

 

Conclusions: This retrospective case series suggests that cannabinoids might be an effective option for the treatment chronic diarrhea.

 

What does this study add? This is the first study showing successful use of an agonist specifically targeting the CB1 cannabinoid receptor for the treatment of GI disorders. Nabilone may be effective in long-term use.

 

Funder: No funding was used for this research

 

Author conflicts: None

 

Commentary: This study is intriguing, despite its small size. Granted, it only included a small group of patients and lacked a placebo group for comparison. And the results aren’t entirely positive.  In fact, one patient did discontinue nabilone use due to transient symptoms of fatigue and mental confusion. So there isn’t enough information here to recommend nabilone—or other cannabinoids—for chronic, intractable diarrhea. However, there probably is enough evidence here to do a controlled trials, with rigorous outcomes, in a larger population.