Fabiana Benjaminov

Cannabis Induces a Clinical Response in Patients With Crohn's Disease: A Prospective Placebo-Controlled Study

BACKGROUND & AIMS The marijuana plant Cannabis sativa has been reported to produce beneficial effects for patients with inflammatory bowel diseases, but this has not been investigated in controlled trials. We performed a prospective trial to determine whether cannabis can induce remission in patients with Crohns disease. METHODS We studied 21 patients (mean age, 40 ± 14 y; 13 men) with Crohns Disease Activity Index (CDAI) scores greater than 200 who did not respond to therapy with steroids, immunomodulators, or anti-tumor necrosis factor-α agents. Patients were assigned randomly to groups given cannabis, twice daily, in the form of cigarettes containing 115 mg of Δ9-tetrahydrocannabinol (THC) or placebo containing cannabis flowers from which the THC had been extracted. Disease activity and laboratory tests were assessed during 8 weeks of treatment and 2 weeks thereafter. RESULTS Complete remission (CDAI score, <150) was achieved by 5 of 11 subjects in the cannabis group (45%) and 1 of 10 in the placebo group (10%; P = .43). A clinical response (decrease in CDAI score of >100) was observed in 10 of 11 subjects in the cannabis group (90%; from 330 ± 105 to 152 ± 109) and 4 of 10 in the placebo group (40%; from 373 ± 94 to 306 ± 143; P = .028). Three patients in the cannabis group were weaned from steroid dependency. Subjects receiving cannabis reported improved appetite and sleep, with no significant side effects. CONCLUSIONS Although the primary end point of the study (induction of remission) was not achieved, a short course (8 weeks) of THC-rich cannabis produced significant clinical, steroid-free benefits to 10 of 11 patients with active Crohns disease, compared with placebo, without side effects. Further studies, with larger patient groups and a nonsmoking mode of intake, are warranted. ClinicalTrials.gov, NCT01040910.

Liver disease in pregnancy

Liver dysfunction during pregnancy can be caused by conditions that are specific to pregnancy or by liver diseases that are not related to pregnancy itself. This review attempts to summarize the epidemiology, pathophysiology, and management of the different pregnancy-related liver diseases, and to review different liver diseases not related to pregnancy and how they may affect or be effected by pregnancy. Some of the liver diseases specific to pregnancy can cause significant morbidity and mortality both to the mother and to the fetus, while most of the liver diseases not specific to pregnancy do not have a deleterious effect on the pregnancy itself.

S2038 The Yield of Routine Small Bowel Biopsies in Investigating Iron Deficiency Anemia in the Elderly

explained the presence of IELs: 6 patients with Celiac disease (4.1%), 9 with IBD (6.1%), 17 with gastritis/duodenitis (11.5%), 5 with HIV (3.4%), 3 with small intestinal bacterial overgrowth, 2 with lymphocytic enterocolitis, and 1 patient each with cyclospora infection, aeromonas infection, B cell lymphoma, Behcets disease, radiation enteritis, sarcoidosis, ischemia and collagenous enterocolitis. 98 patients had no explanation for the presence of IELs but only 41 (42%) were investigated for celiac disease with serology. Conclusions: Celiac disease is prevalent in ethnic minorities and small bowel biopsies may only demonstrate IELs in an otherwise normal biopsy. In a single tertiary-care referral center, 4.1% of ethnic minority patients with IELs and normal villous architecture were diagnosed with CD over a ten-year period. Surprisingly, 58% of patients with IELs of unknown etiology did not have sufficient workup for CD.