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      Insights into the role of cannabis in the management of inflammatory bowel disease

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          Abstract

          Over the last decade, interest in the therapeutic potential of cannabis and its constituents (e.g. cannabidiol) in the management of inflammatory bowel diseases (IBD) has escalated. Cannabis has been increasingly approved for a variety of medical conditions in several jurisdictions around the world. In animal models, cannabinoids have been shown to improve intestinal inflammation in experimental models of IBD through their interaction with the endocannabinoid system. However, the few randomized controlled trials of cannabis or cannabidiol in patients with IBD have not demonstrated efficacy in modulating inflammatory disease activity. Cannabis may be effective in the symptomatic management of IBD. Given the increasing utilization and cultural acceptance of cannabis, physicians need to be aware of its safety and efficacy in order to better counsel patients. The aim of this review is to provide an overview of the role of cannabis in the management of patients with IBD.

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          Human cannabinoid pharmacokinetics.

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            Cannabinoid receptor localization in brain.

            [3H]CP 55,940, a radiolabeled synthetic cannabinoid, which is 10-100 times more potent in vivo than delta 9-tetrahydrocannabinol, was used to characterize and localize a specific cannabinoid receptor in brain sections. The potencies of a series of natural and synthetic cannabinoids as competitors of [3H]CP 55,940 binding correlated closely with their relative potencies in several biological assays, suggesting that the receptor characterized in our in vitro assay is the same receptor that mediates behavioral and pharmacological effects of cannabinoids, including human subjective experience. Autoradiography of cannabinoid receptors in brain sections from several mammalian species, including human, reveals a unique and conserved distribution; binding is most dense in outflow nuclei of the basal ganglia--the substantia nigra pars reticulata and globus pallidus--and in the hippocampus and cerebellum. Generally high densities in forebrain and cerebellum implicate roles for cannabinoids in cognition and movement. Sparse densities in lower brainstem areas controlling cardiovascular and respiratory functions may explain why high doses of delta 9-tetrahydrocannabinol are not lethal.
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              Review article: loss of response to anti-TNF treatments in Crohn's disease.

              Loss of response to anti-TNF agents in Crohn's disease is an emerging clinical problem.
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                Author and article information

                Contributors
                Journal
                Therap Adv Gastroenterol
                Therap Adv Gastroenterol
                TAG
                sptag
                Therapeutic Advances in Gastroenterology
                SAGE Publications (Sage UK: London, England )
                1756-283X
                1756-2848
                03 September 2019
                2019
                : 12
                : 1756284819870977
                Affiliations
                [1-1756284819870977]Inflammatory Bowel Disease Unit, Department of Gastroenterology, Cumming School of Medicine, University of Calgary, AB, Canada
                [2-1756284819870977]Inflammatory Bowel Disease Unit, Department of Gastroenterology, Cumming School of Medicine, University of Calgary, AB, Canada
                [3-1756284819870977]Department of Community Health Sciences, University of Calgary, AB, Canada
                [4-1756284819870977]Hotchkiss Brain Institute and Snyder Institute for Chronic Diseases, Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, AB, Canada
                [5-1756284819870977]Inflammatory Bowel Disease Unit, Department of Gastroenterology, Cumming School of Medicine, University of Calgary, AB, Canada
                [6-1756284819870977]Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, TRW building, Room 6D18, Calgary, AB T2N 4Z6, Canada
                Author notes
                Author information
                https://orcid.org/0000-0002-1551-9054
                Article
                10.1177_1756284819870977
                10.1177/1756284819870977
                6727090
                0c190e9c-0bd7-409f-9e28-e01ca0872e1f
                © The Author(s), 2019

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                : 20 June 2019
                : 26 July 2019
                Categories
                Review Research
                Custom metadata
                January-December 2019

                cannabis,cannabidiol,crohn’s,inflammatory bowel disease,ulcerative colitis

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