High THC Oil in Ulcerative Colitis: A Case Report

1. Abstract Here we presented the case of a 48-year-old patient affected by lumbosacral pain treated with high concentrated THC cannabis oil. He suffered also from ulcerative colitis (UC), whose symptoms were poorly controlled by non-steroidal anti-inflammatory drugs (NSAIDs). During the cannabis oil treatment, the patient reported a significant relief from irritable bowel syndrome (IBS) related symptoms, assessed by the Mayo score, the short inflammatory bowel disease questionnaire (SIBDQ), and the bowel function index (BFI). This case report suggested that THC could be the most effective cannabinoid for the treatment of IBS-related symptoms and the oromucosal route the better way of administration. 2. Introduction In the last years, cannabis has been used for the treatment of different gastro-intestinal disorders, like emesis, dysmotility, and to manage symptoms of many clinical conditions such as inflammatory bowel disease (IBD) and cancer [1-4]. Recently, many authors focused their attention on the potential role of cannabis and its derivatives to alleviate symptoms of IBD, but the effective type and dose of cannabis have not been so far determined. Naftali et al used cannabis cigarettes with high percentage of delta-9-tetrahydrocannabinol (THC), while Irving et al used cannabidiol (CBD) capsules for ulcerative colitis (UC) treatment [5-6]; in three different studies, Naftali et al used high concentrated THC cigarettes or oil with high percentage of CBD to treat Crohn’s disease [7-8]. Cannabis and its derivatives did not show so far a significant improvement of IBD symptoms. Here we reported a case of a patient treated with high concentration THC oil for neuropathic pain syndrome, who experienced considerable relief from IBD related symptoms. 3. Case report In October 2018, a 48-years-old patient came to our attention for lumbosacral pain and bilateral gonalgia (NRS=7). He suffered from acromegaly, UC, benign prostatic hyperplasia (BPH), and HCV infection. Non-steroidal anti-inflammatory drug (NSAID) did not effectively control pain; he took mesalazine for UC treatment and macrogol to control stipsis. Before starting our treatment, we assessed patient’s condition trough the Short Inflammatory Bowel Disease Questionnaire (SIBDQ), a health-related quality of life tool measuring physical, social, and emotional status, scoring from 10 to 70 (a higher score corresponds to a better condition) [9]. We also administrated the patient the Mayo score, which is the most commonly used questionnaire specific for UC, composed of four parts: rectal bleeding, stool frequency, physician assessment, and endoscopy appearance and each part is rated from 0 to 3. A score from 3 to 5 points indicates a mild active disease, a score from 6 to 10 points corresponds to a moderate active disease, and a score from 11 to 12 points reflects a severe active disease [10].