October 30, 2026
3 min read
Key takeaways:
- Cannabis use is associated with relief from pain and nausea/vomiting among patients with GI disorders.
- These benefits are tempered by potential side effects, including cannabis hyperemesis syndrome.
NASHVILLE, Tenn. — As cannabis is increasingly used to address pain, nausea and vomiting among patients with gastrointestinal disorders in the U.S., discussion of its role in practice intensifies.
Two experts debated the issue at ACG Annual Scientific Meeting.
“Cannabis is here and it’s not going anywhere — and our patients are using [cannabinoids],” David J. Levinthal, MD, PhD, FACG, director of the Neurogastroenterology & Motility Center at University of Pittsburgh Medical Center, told attendees. “The [number] of patients using cannabis grows year on year.
“It’s across all age groups,” he added. “Even older individuals are using cannabis much more frequently than they were even 10 years ago.”
‘Friend’
Levinthal, whose stance is that cannabis is a “friend” to patients with GI conditions, emphasized the positive biological effects cannabis use can have on the endocannabinoid system.
“There are [cannabis type 1] and [type 2] receptors on almost every target along the brain-gut axis, so it’s not surprising that taking in extra doses of a cannabinoid has a broad range of effects biologically,” he said. “[Cannabis use] can decrease colonic tone and motility, so it is particularly helpful for someone with intestinal spasms.”
Cannabinoids can also decrease gastric tone and contractility while stimulating appetite, according to Levinthal.
“Most importantly, I want to draw everyone’s attention to the idea that [cannabis] really reduces nausea and visceral pain perception, because these receptors are widely expressed in neural circuits that are important for nausea and emesis,” he said.
Patients have told Levinthal that cannabis has been “more effective than the other medications that [gastroenterologists] have to offer them” in providing symptom relief.
“Cannabinoids already sit in our neuromodulator toolkits,” he said.
Levinthal highlighted the prescription cannabinoid medication dronabinol, noting that he has seen it benefit patients who have not responded to other medications.
“I see a very affected patient population, but when I think about patient care for nausea symptoms or pain, for example, in functional dyspepsia, gastroparesis, overlap syndrome or even outside of other [disorders of gut-brain interaction] illnesses, these are some of the agents we have at our disposal,” Levinthal said.
He acknowledged the risk for cannabinoid hyperemesis syndrome (CHS), a condition characterized by cyclic periods of vomiting and abdominal pain, associated with long-term, frequent cannabis use.
However, he emphasized that CHS is treatable with standard interventions for cyclic vomiting syndrome and cessation of cannabis use.
“Millions and millions of people use cannabis,” Levinthal said. “It’s only a small percentage of people that [develop] CHS illness, so I don’t think we should be scared away from using cannabis just because CHS exists.
“Cannabis is not a panacea, but if we dismiss it outright, we lose a major tool to help patients,” he told attendees.
‘Foe’
Thangam Venkatesan, MD, professor of clinical medicine at The Ohio State University, countered that cannabis is a “foe,” but acknowledged that its role in the care of patients with GI disorders is “nuanced.”
She emphasized that while cannabis’s impact on the endocannabinoid system can benefit patients by easing pain and nausea, chronic daily use can have negative biological effects.
Thangam Venkatesan, MD, speaks at the podium during ACG Annual Scientific Meeting. Photo: Octavia Feliciano.
“We all produce marijuana-like substances in our body, so we’re happy and healthy, but when you throw cannabis on top, it actually causes downregulation of these [cannabis type 1] receptors,” Venkatesan told attendees. “They do recover after 4 weeks of abstinence, but as you can see, [studies] looking at multiple brain areas with PET scans indicate the hippocampal deregulation might persist.”
Venkatesan also described CHS as “debilitating,” and noted its association with abdominal pain, nausea, sweating, diarrhea, photosensitivity, headache and vomiting.
Given that there is an ICD-10 code for CHS as of October 2025, Venkatesan anticipates better data and documentation of CHS will be available in the near future.
In addition to CHS, Venkatesan highlighted a bevy of side effects associated with cannabis use, including anxiety, psychosis, sleep disorders, delirium, cannabis withdrawal and cannabis use disorder.
“Whenever you’re seeing a patient with a problem with cannabis, I think one of the most effective recommendations is abstinence, but it’s important to at least tell them to reduce [usage],” she said.
Venkatesan also suggested advising patients to select low-potency products with limited THC and CBD concentrations. However, she acknowledged that patients will likely have difficulty finding these products.
“Grandma’s cannabis had about 4% THC,” she said. “But now, even in medical dispensaries, the proportion of THC is about 25%, and the amount of CBD has gone down.”
The “best” harm-reduction strategies for potential side effects of cannabinoid use include “abstinence and avoiding early initiation, high potency THC and daily use,” Venkatesan told attendees.
Sources/Disclosures
Source:
Levinthal DJ. Cannabis: Friend or foe? Presented at: ACG Annual Scientific Meeting; Oct 12-14; Nashville, Tenn. (hybrid meeting).
Reference:
Disclosures:
Healio could not confirm relevant financial disclosures at time of publication.
Ask a clinical question and tap into Healio AI’s knowledge base.
- PubMed, enrolling/recruiting trials, guidelines
- Clinical Guidance, Healio CME, FDA news
- Healio’s exclusive daily news coverage of clinical data
