A Rare and Unexpected Side-Effect of Cannabis Use: Abdominal Pain due to Acute Pancreatitis This is an open access article distributed under the Creative Commons Attribution License, which CBD has been shown to help treat symptoms linked to gallbladder issues by addressing gastrointestinal symptoms, supporting metabolism, & promoting brain health.
A Rare and Unexpected Side-Effect of Cannabis Use: Abdominal Pain due to Acute Pancreatitis
This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Acute pancreatitis is a frequently encountered disorder in patients presenting to emergency units. Biliary system disorders, alcohol consumption, infections, and drugs are among the causes of acute pancreatitis. However, it is sometimes difficult to determine the etiology of this disorder, particularly if the patient does not wish to disclose his consumption of cannabis, the use of which is illegal.
Acute pancreatitis is an inflammatory disorder of pancreas, caused mainly by biliary system disorders, alcohol consumption, and infections [1, 2]. Acute pancreatitis may also be caused by some drugs such as antibiotics (metronidazole), immunosuppressants (azathioprine), antihypertensives (angiotensin converting enzyme inhibitors, furosemide or thiazide diuretics), aspirin, or valproic acid [1, 3]. Case of acute pancreatitis due to cannabis has been rarely reported in the literature . In this paper, because of its rarity, a case of cannabis-induced acute pancreatitis has been presented.
A 44-year-old male patient presented to our Emergency Department with complaints of abdominal pain and nausea. He stated that he had been suffering from abdominal pain for one week. In other medical centers he had formerly visited, he had been told that his pain was due to a stomach disorder and, for therapy, a proton pump inhibitor had been commenced. Upon continuation of his complaints, the patient had presented to our Emergency Unit.
At the time of presentation, the patient had epigastric tenderness, but the other systemic findings were normal. His arterial blood pressure was 130/80 mm Hg, pulse was 86/minute, and body temperature was 37°C. His blood tests were as follows: WBC, 12.800/µL, CRP, 0.60 mg/L, and serum electrolytes, serum calcium, AST, ALT, GGT, and bilirubin within their normal ranges. However, his serum amylase and lipase were 294 IU/L and 935 U/L, respectively (Ranson criteria score: 0). Dual testing with lipase and amylase had a sensitivity of 93% for pancreatitis . The patient gave no history of a chronic disease, regularly medications used, alcohol consumption, or trauma. He had no history of a recent febrile disease, either. However, one of the family members stated that the patient was regularly taking cannabis powder that he had been preparing for a long time and stopped cannabis when his pains began.
On the abdominal computed tomography scan performed to determine the etiology and pancreas damage, there were no abnormalities in the pancreas, no peripancreatic fluid (Balthazar grade A acute pancreatitis), no gall stones, and no dilation in the biliary system. Following a consultation, the patient was hospitalized in the Clinic of Gastroenterology. Endoscopy revealed grade B esophagitis, two ulcers of 5 and 8 mm in the antrum, and a 1 cm ulcer in the duodenum. The computed tomography showed no penetration of the duodenal ulcer to the pancreas.
On the 3rd day of hospitalization, the patient’s amylase and lipase levels were normalized, and, thereupon, the patient, who was thought to have had cannabis-induced pancreatitis, was discharged from the hospital with the necessary recommendations.
Cannabis is a plant belonging to the Cannabaceae family. The active substances of cannabis are cannabinoids in resin, which are obtained through dried and then powdered leaves of the plant. The major cannabinoid in hashish is tetrahydrocannabinol (THC), which is responsible for the pharmacological effect of hashish. Powder hashish is obtained by drying the high THC-containing parts of female cannabis in the shade and then by grinding and sifting the dried parts.
The mechanism by which THC causes acute pancreatitis has not been fully clarified [4, 6]. There are two cannabinoid receptors in the human body, namely, CBI and CBII; CBI is found in the central nervous system, peripheral endothelial cells, and smooth muscle cells, whereas CBII is found in macrophages. These two receptors are also present in the pancreatic tissue . The receptors affect the gastrointestinal system both positively and negatively [7, 8]. By decreasing gastric acid and intestinal secretions, they delay the gastric emptying [6, 9].
Dembiński et al.  have shown that, via CBI receptors, cannabinoids increase the blood supply and DNA synthesis in the gastric mucosa and inhibit the inflammatory mediator interleukin-1β. Studies on mice with cerulein-induced pancreatitis have shown that administration of anandamide, a cannabinoid receptor agonist, to mice increases the severity of pancreatitis, but the reason for this effect is not clearly explained [10, 11]. Some authors think that this increase in severity may be due to the effect of cannabinoids on the pancreatic canal and Oddi’s sphincter [1, 4, 10]. The effect of cannabinoids on gastric secretions and emptying can be the cause of gastric and duodenal ulcers present in our patient.
In our case, Naranjo score was +1; the mean of this score is possible adverse drug reactions .
We achieved this score from the answers of the questions shown below.
The other questions answers were as follows: do not know or not done (0 points).
In conclusion, patients may not give a history of cannabinoid use which is illegal. In order to determine the etiology in patients with acute pancreatitis attacks, the use of hashish should also be questioned. Hashish consumers present to the emergency units with frequently repeated pancreatitis attacks .
Conflict of Interests
The authors declare that there is no conflict of interests regarding the publication of this paper.
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CBD Oil for Gallbladder – August 2022
How CBD May Affect the Gallbladder: Can CBD Help With Gallbladder Problems?
CBD has been shown to help relieve pain (9) , alleviate the effects of metabolic syndrome (10) , and restore the integrity of the intestinal wall (11) . These properties may help symptoms of gallbladder disorder.
CBD’s interaction with the body’s ECS (endocannabinoid system) may explain how the compound induces its purported therapeutic effects, working with the ECS as the system regulates bodily functions (12) .
The ECS comprises cannabinoid receptors like CB1 and CB2, enzymes, and cannabinoids ( 13) .
Pain perception, mood, sleep, hunger, memory, and motor control are all influenced by CB1 (cannabinoid receptors 1). Meanwhile, activated CB2 receptors on immune system cells provide an anti-inflammatory response to lessen pain and tissue damage .
According to a study, the activation of cannabinoid receptors suggests several beneficial approaches linked to metabolic syndrome (14) .
The researchers believe that endogenous cannabinoids and phytocannabinoids lessen the impact of metabolic disorders (15) .
CBD for Leaky Gut
A study showed that cannabinoids may help restore the integrity of the intestinal wall (16) .
Bloating, inflammation, gas, stomach discomfort, and fatigue are symptoms of a leaky gut (17) . T hese symptoms may also lead to common bile duct stones ( CBD stones) , GI disorders (18) , and jaundice ( 19) .
No pain-relieving medicine may quickly fix a leaky gut. However, reducing stress (20) and avoiding things that may cause allergic reactions ( 21) may help alleviate symptoms.
Supplements like crucial minerals (calcium, potassium, magnesium) may help the lining of the body heal and promote blood flow (22) .
Studies suggest that CBD may protect enterocytes (intestinal lining cells) against inflammatory damage, restoring intestinal mucosa integrity (23) .
The researchers also believe that natural and synthetic cannabinoids may help with GI function and intestinal barrier disorders (24) .
Intestinal barrier dysfunction is linked to the formation of gallstones ( 25) , solidified deposits of the digestive fluid in the gallbladder.
CBD for Metabolic Syndrome
Heart disease, including diabetes and stroke, are increased risks in those with metabolic syndrome (26) .
In 2012, the World Journal of Gastroenterology and Hepatology study showed that metabolic syndrome is linked to gallstone disease (27) .
In addition, researchers’ findings noted how CBD may aid in metabolic syndrome induced by lifestyle changes (28) .
Key targets for tissue damage involved in metabolic syndrome include the cardiovascular system, pancreas, and liver (29) .
The liver makes bile, a digestive juice. The bile then passes the concentrates to the gallbladder, storing the digestive juice for later use (30) .
CBD for Inflammation and Pain
CBD, the non-psychoactive component of Cannabis sativa L ., has been studied for its analgesic properties. CBD reduces pain and improves the quality of life in epilepsy patients (31) .
The most common gallbladder symptom is biliary colic (32) . The condition may induce intermittent abdominal pain and upper back pain (33) .
A natural chemical in Cannabis sativa, cannabidiol (34) is derived from Cannabaceae plants (hemp family) . There is less than 0.3% THC in the hemp plant.
THC is found in high concentrations in marijuana plants. High-THC marijuana is known to cause hallucinations and euphoria when smoked or drunk, and acute changes in blood flow and pressure (35) .
The ECS has cannabinoid receptors that interact with CBD (36) . CB1 receptors govern pain perception, whereas CB2 receptors control anti-inflammatory responses.
A study published in the European Journal of Pain showed that cannabidiol may alleviate pain and inflammation without side effects (37) .
Another study suggested that CBD may relieve pain and inflammation with its anti-inflammatory properties (38) .
Through its antioxidant and anti-inflammatory effects, CBD may alleviate the symptoms of leaky gut, pain sensation , and inflammation-related gastrointestinal syndrome (39) .
However, the FDA (Food and Drug Administration) currently only approves cannabis use to treat patients with epilepsy caused by two rare forms of seizure (40) .
Benefits of Using CBD to Help With Gallbladder Problems
The gut microbiome affects overall health. It regulates bacterial growth and development in the body (41) .
Studies show that CBD may help reduce pain ( 42) , regulate metabolic disorders ( 43) , and restore the integrity of the intestinal barrier (44) . CBD may also help reduce inflammation (45) , easing gallbladder pain-related symptoms.
Note that orally administered CBD products allow the compound to pass through the intestinal wall. Active compounds like CBD travel to the liver before being transported to their target site via the bloodstream.
Consult a healthcare expert before using CBD products like CBD oil to treat medical conditions like gallbladder discomfort.
How to Take CBD for Gallbladder Problems
One way to take CBD oil for gallbladder-related issues is under the tongue, immediately absorbed into the bloodstream.
Due to the absence of published clinical guidelines for CBD dosage, dosing will be done progressively titrating until pain relie f is achieved.
On the other hand, CBD topicals frequently include other helpful substances to boost their effectiveness in delivering pain relief (46) to target areas of the body.
CBD Dosage for Gallbladder Problems
There is no standard CBD dosage to ease gallbladder discomfort. Weight, pain intensity, metabolism, and genetics may affect dosing.
Still, research suggests that 1,500mg of CBD per day may be well tolerated in people (47) .
A CBD dose for gallbladder disease is not FDA-authorized. It is suggested to begin with low dosages of the best CBD oil and gradually raise the dose to get the desired impact.
Side Effects of Using CBD for Gallbladder Problems
There is no direct study of particular side effects of CBD for gallbladder issues. However, moderate side effects from CBD include dry mouth, nausea, lethargy, and headache (48) .
Cannabinoids may have a dose-dependent effect on body temperature, which may cause hypothermia or hyperthermia ( 49) . Nevertheless, CBD has not been linked to fatalities, and most people may use it without life-threatening side effects.
Can CBD Oil Help People Without Gallbladders?
Data from clinical investigations show that up to 20% of patients who undergo cholecystectomy (gallbladder removal) may develop diarrhea ( 50) .
Bloating or diarrhea after surgery usually improves within a few weeks (51) . However, blood clots may also occur after a gallbladder removal surgery.
Meanwhile, CBD may cause side effects, like diarrhea and reduced appetite, although these are often well tolerated (52) . CBD may also interact with other medications, like blood thinners.
To avoid increased risks of side effects, it is important to ask your doctor before using CBD, especially after a medical procedure like having your gallbladder removed.
What Is a Gallbladder?
The gallbladder is a pear-shaped organ located on the right side of the abdomen, beneath the liver. The bile ducts are a drainage system for the liver (53) .
The bile duct stores and moves bile from the gallbladder to the small intestine (54) . The gallbladder releases bile in response to neurohormonal signals (55) .
After eating, the gallbladder contracts, releasing bile into the duodenum, the first part of the small intestine.
Common Causes of Gallbladder Pain
Many conditions may cause pain in the gallbladder. One of the most common causes is blockage of the gallbladder ducts (56) .
Gallstones may form if the gallbladder is not emptying properly. Obesity and specific diets are risk factors for common bile duct stones (57) .
What Are Gallbladder Problems?
A common gallbladder condition is the formation of gallstones or cholelithiasis (58) . Gallstones are bile deposits that have solidified in the gallbladder .
The size may range from a grain of sand (sludge) to a golf ball. The patient may develop multiple gallstones concurrently (59) .
Gallstones have a higher incidence in women over 40 (60) . Women produce estrogen and progesterone more readily than men. Estrogen raises the level of cholesterol in bile, leading to the formation of gallstones.
Types of Gallstones
Cholesterol and pigment stones are two gallstones classified according to their risk factors and epidemiology (61) .
Around 80% of gallstones are cholesterol stones, commonly associated with blockage and inflammation. They account for almost 80% of gallstones and are related to obstruction and inflammatory gallstones or intrahepatic bile duct stone prevalence (62)
Common Symptoms of Gallbladder Problems
The patient may feel chronic pain radiating to the upper back ( 63) . This condition is known as acute cholecystitis (64) .
Symptoms of stones in the common bile include nausea, vomiting, bloody urine, stomach discomfort, and low blood pressure (65) .
Sludge forms in the gallbladder as cholesterol, calcium, bilirubin and other chemicals accumulate. No treatment is needed if the gallbladder sludge causes no symptoms (66) .
Often, the sludge is gone when the root cause is solved, like managing the symptoms of gallbladder problems.
Gallbladder Problem Treatments
Gallbladder discomfort causes severe abdominal pain that lasts for about five hours. If it worsens, doctors may consider other issues ( 67) .
Nonsteroidal anti-inflammatory drugs or narcotic pain medications may be used to control the pain of acute biliary colic (68) .
Oral probiotics are also available. Dietary probiotics are bacteria that are similar to gut bacteria (69) . Studies show that oral probiotics may reduce the amount of cholesterol in the body (70) .
Doctors may suggest ursodiol or chenodiol dissolve gallstones (71) . However, individuals should consult a doctor about the best treatment for gallbladder problems.
Physicians may also recommend surgery to remove the gallbladder (72) . After surgery, bile passes straight from the liver into the small intestine (73) .
If patients have small stones in the gallbladder (choledocholithiasis) (74) , these stones may block the cystic duct and result in severe pain and inflammation of the gallbladder (75) .
A scending cholangitis (bile duct inflammation) may spread through the duct. Doctors may suggest another gallbladder stone therapy or cholecystectomy if needed (76) . Nonsurgical options may include endoscopic (77) and interventional radiology ( 78) .
Clinical practice to diagnose gallbladder problems includes CT scan (79) , X-ray (80) , endoscopy (81) , laparoscopic cholecystectomy (82) , lithotripsy (83) , and ultrasonography (84) .
Through e ndoscopic r etrograde c holangiopancreatography (ERCP ) (85) , m agnetic resonance cholangiopancreatography (MRCP) (86) , endoscopic sphincterotomy, or intraoperative cholangiography (IOC) (87) , doctors may make a systematic review of diagnoses to help with follow-up care of patients with various conditions (88) .