From the Guidelines
THC may worsen GERD symptoms for many people due to its potential to relax the lower esophageal sphincter and irritate the esophagus, especially when smoked. The active component in cannabis, THC, can relax the lower esophageal sphincter (LES), which is the muscle that prevents stomach acid from flowing back into the esophagus. When this sphincter relaxes inappropriately, acid reflux occurs, potentially aggravating GERD symptoms. Additionally, smoking cannabis, regardless of THC content, can irritate the esophagus and trigger reflux. Some users report that THC increases appetite and leads to consumption of trigger foods that worsen GERD, such as fatty, spicy, or acidic foods. However, individual responses vary, and some people report temporary symptom relief due to THC's pain-modulating and anti-inflammatory properties.
Management of GERD
If you have GERD and use cannabis, monitor your symptoms carefully and consider alternative consumption methods like edibles rather than smoking. The best approach for managing GERD typically includes lifestyle modifications, such as:
- Elevating the head of your bed
- Avoiding trigger foods
- Not eating before bedtime
- Weight management, as noted in a study published in Gut in 2016 1, which found that weight loss and bed elevation are effective lifestyle interventions for GORD
- Medications like proton pump inhibitors or H2 blockers as recommended by your healthcare provider, as suggested by the American Gastroenterological Association medical position statement on the management of gastroesophageal reflux disease in 2008 1.
Personalized Approach to GERD Management
A personalized approach to the evaluation and management of GERD symptoms is recommended, as outlined in the Clinical Practice Update published in Clinical Gastroenterology and Hepatology in 2022 1. This approach takes into account the individual patient's symptoms, medical history, and response to treatment, and may involve a combination of lifestyle modifications, medications, and other interventions.
Considerations for Cannabis Use
While there is limited research on the specific effects of THC on GERD, it is essential to consider the potential risks and benefits of cannabis use in patients with GERD. As noted in the Asia-Pacific consensus on the management of gastro-oesophageal reflux disease in 2016 1, patients with persistent extra-oesophageal symptoms despite PPI therapy should be investigated for non-GORD causes before proceeding to endoscopy or function testing. This highlights the importance of a comprehensive approach to managing GERD symptoms, including consideration of potential triggers and underlying causes.
From the Research
THC and GERD
There is no direct evidence in the provided studies to suggest that THC affects GERD.
Current Treatments for GERD
- Proton pump inhibitors (PPIs) remain the first-choice therapy in the treatment of GERD, as stated in 2 and 3.
- The management of patients with non-erosive reflux disease (NERD) can be challenging, and new drugs have been introduced to increase the defensive properties of the mucosa, with promising results in randomized clinical trials 2.
- Combination therapy with PPIs and histamine(2) receptor antagonists has been evaluated, but no studies have shown that the addition of histamine(2) receptor antagonists to twice-daily PPI therapy provides any further benefit above that derived from PPIs alone 4.
Pharmacology of PPIs
- PPIs suppress gastric acid secretion by blocking the gastric acid pump, H(+)/K(+)-adenosine triphosphatase (ATPase) 5.
- Different PPIs have varying degrees of acid suppression and speed of onset of acid inhibition, which may impact clinical performance 5.
- Newer PPIs, such as rabeprazole and esomeprazole, offer advantages over older PPIs, including a faster onset of acid suppression and reduced potential for inter-individual pharmacokinetic variation and drug interactions 5.