Ulcerative Colitis and Medical Cannabis

What Causes Ulcerative Colitis?

The causes of ulcerative colitis are not entirely known but it is thought to be a result of complex interactions between a person’s genes and their environment. Having a family member with ulcerative colitis or another autoimmune condition is associated with an increased likelihood of developing ulcerative colitis. Between 10-20% of patients with ulcerative colitis will have a family history of inflammatory bowel disease.

Symptoms of Ulcerative Colitis

Symptoms can vary depending on the amount of the gut affected and severity. The most common symptoms include:

• Diarrhoea
• Blood mixed in with bowel motions
• Tummy pain
• Pain on passing a bowel motion
• Periods of constipation
• Loss of weight
• Fatigue
• Pale skin

Some patients may develop symptoms due to complications of their ulcerative colitis including bowel dilation, bowel obstruction, bowel leak, or severe bleeding. Some patients may also develop symptoms in other parts of the body including skin rashes (erythema nodosum or pyoderma gangrenosum), joint pain, back pain, eye inflammation, fragile bones and bile duct problems (primary sclerosing cholangitis).

Patients with ulcerative colitis are also at a higher risk of developing bowel cancer. As such patients should undergo regular colonoscopy according to their particular risk of developing cancer.

How is Ulcerative Colitis Diagnosed

Ulcerative colitis is most commonly diagnosed via blood tests, stool samples and scans which can all help towards making a diagnosis.

The gold standard for diagnosis is to insert a flexible telescope into the anus and around the colon (colonoscopy) or into the final section of the large bowel (flexible sigmoidoscopy) to collect a sample of tissue (biopsy) to be examined under a microscope.

Ulcerative Colitis Treatment

Treatment for ulcerative colitis is separated into two components:

• To treat active symptoms (flare-up) and then once a flare-up is settled to maintain remission. Treatment for ulcerative colitis is managed in specialist settings. Flare-ups are treated with a short course of immunosuppressant with an aminosalicylate (e.g. mesalazine, sulfasalazine) and/or corticosteroids.
• Remission is maintained using a stepwise approach starting with an aminosalicylate and adding in second-line therapies (e.g. azathioprine, 6-mercaptopurine) as required. Some patients may require treatment with special medications made from antibodies or surgery.
• Many patients with moderate-to-severe disease may also require newer medications that affect the immune system called biological agents or biologics.

Medicinal cannabis can be considered for associated symptoms of ulcerative colitis when first and second-line therapies have not achieved adequate benefit.

Medical Cannabis for Ulcerative Colitis

Medical cannabis may be appropriate for some individuals with ulcerative colitis, but only when traditional therapies have not been effective in improving symptoms.