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Review: The Role of Cannabinoids on Esophageal Function—What We Know Thus Far 1 Department of Gastroenterology, Temple University Hospital, Philadelphia, Pennsylvania. 2 Lewis Katz School of Does CBD help with GERD and acid reflux? Those suffering from frequent heartburn often seek natural remedies to their problems, and CBD shows promise in the treatment and prevention of acid reflux. CBD for Acid Reflux has been found to be effective as per recent research. Using CBD oil for acid reflux helps alleviate symptoms like pain and inflammation.

Review: The Role of Cannabinoids on Esophageal Function—What We Know Thus Far

1 Department of Gastroenterology, Temple University Hospital, Philadelphia, Pennsylvania.

2 Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania.

Rahul Kataria

1 Department of Gastroenterology, Temple University Hospital, Philadelphia, Pennsylvania.

2 Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania.

Ron Schey

1 Department of Gastroenterology, Temple University Hospital, Philadelphia, Pennsylvania.

2 Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania.

* Address correspondence to: Ron Schey, MD, FACG, Department of Gastroenterology, Temple University Hospital, Philadelphia, PA 19140, E-mail: [email protected]

This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The endocannabinoid system (ECS) primarily consists of cannabinoid receptors (CBRs), endogenous ligands, and enzymes for endocannabinoid biosynthesis and inactivation. Although the presence of CBRs, both CB1 and CB2, as well as a third receptor (G-protein receptor 55 [GPR55]), has been established in the gastrointestinal (GI) tract, few studies have focused on the role of cannabinoids on esophageal function. To date, studies have shown their effect on GI motility, inflammation and immunity, intestinal and gastric acid secretion, nociception and emesis pathways, and appetite control. Given the varying and sometimes limited efficacy of current medical therapies for diseases of the esophagus, further understanding and investigation into the interplay of the ECS on esophageal health and disease may present new therapeutic modalities that may help advance current treatment options. In this brief review, the current understanding of the ECS role in various esophageal functions and disorders is presented.

Overview of Endocannabinoid System

The endocannabinoid system (ECS) primarily consists of cannabinoid receptors (CBRs), endogenous ligands, and enzymes for endocannabinoid biosynthesis and inactivation. 1 The ECS plays an important role in regulation of synaptic transmission in the central and enteric nervous systems (ENS) through both excitatory and inhibitory effects, mediating a variety of physiological processes including pain sensation and modulation, motor function, inflammation, and immunity. 2

CBRs belong to the superfamily of G-protein-coupled receptors and are expressed in two main forms, CB1 and CB2. 3 CB1 is mainly expressed in central and peripheral neurons, including the ENS, whereas CB2 is mostly expressed by inflammatory/immune cells. 4–6 The ubiquitous distribution of CBRs in the ENS and gastrointestinal (GI) tract highlights its role in GI health and disease including motility, inflammation and immunity, intestinal and gastric acid secretion, nociception and emesis pathways, and appetite control 7–9 ( Table 1 ).

Table 1.

Known Functions of the Endocannabinoid System Along the Upper Alimentary Tract

Function Brief summary Related studies
Appetite regulation 1. Stimulates appetite, especially high energy, fatty foods Argueta and DiPatrizio 18
2. Induces hyperphagia, potential target for obesity therapy, generates hunger signal DiPatrizio et al. 17
DiPatrizio et al. 16
Nociception/emesis 1. Stimulation of CB1 receptor in CNS leads to nausea, therapeutic target for antiemetic effect of exogenous cannabinoid therapy Van Sickle et al. 19
Rock and Parker 71
Motility 1. Multiple receptors (CB1 and CB2) thought to influence contractile and relaxant forces in stomach Hornby and Prouty 10
2. Modulates intestinal propulsion, GPR55 inhibits whole gut transit time, modulation of cholinergical and vagal stimulation of upper GI tract Yuece et al. 12
Storr et al. 21
3. Enhances gut motility in setting of inflammation Izzo et al. 24
Yang et al. 26
Li et al. 27
Gastric acid and intestinal secretions 1. Exhibits antisecretory effects on gastric acid Adami et al. 15
2. Implicated in mitigating inflammation and mucosal damage in GERD Calabrese et al. 25
3. Effect on transient lower esophageal relaxation Lehmann et al. 33
Inflammation and immunity 1. Anti-inflammatory effects in esophageal reflux disease Calabrese et al. 25
2. CB2 receptor downregulates inflammation and associated hypermotility in disease state Izzo 23
Analgesia 1. Increases pain threshold Clapper et al. 65
Malik et al. 66

CNS, central nervous system; GERD, gastroesophageal reflux disease; GI, gastrointestinal; GPR55, G-protein receptor 55.

The CB1 receptor plays a role in intestinal motility by attenuating both large and small bowel muscle tone when activated. 10–13 Within the upper GI tract, activation of CB1 decreases intragastric pressure and delays gastric emptying through inhibition of excitatory neurons. 14,15 As demonstrated in rodent models, CB1 receptors play a role in energy regulation by driving consumption of food high in dietary fat. 16 After sham feeding in rats with high-fat foods, upregulation of CB1 receptors was found in rat small intestine, leading to inhibition of neural signaling events of satiety to suppress feeding. These findings suggest that CB1 acts through a positive feedback loop after dietary fat exposure to stimulate further consumption of higher energy foods. In another study, pharmacological inhibition of CB1 led to decreased amount of refeeding in rats after food deprivation, highlighting CB1 receptor’s role in appetite regulation. 17 In addition, CB1 was found to be upregulated in rats fed a high fat, high caloric Western diet (WD). It was also suggested to play a role in hyperphagia after antagonism of CB1 with an inhibitor led to decreased food intake in rats fed a WD for 60 days. 18

CB2 receptors located in the central nervous system (CNS) have been shown to play a role in the emetic pathway; however, the receptor has also been found in inflammatory tissue and immune cells (plasma cells and macrophages) throughout the GI tract. 19–22 CB2 is expressed in the GI tract but less extensively than CB1 receptors. 23 Evidence that upregulation of CB2 receptors occurs in patients with inflammatory bowel disease suggests that these receptors play a critical role in colonic inflammation. 7 Distinct from CB1 receptors effect on motility, CB2 receptors may further regulate motility in pathophysiological states with its expression being upregulated in inflammatory disease states. 5,24

Presence of CBRs in human esophageal epithelium was first demonstrated in a study comparing patients with nonerosive esophageal reflux disease (NERD) and erosive esophageal reflux disease (ERD) to normal controls. 25 The authors found increased expression of CB1 mRNA in NERD patients compared with erosive esophagitis, but overall less expression compared with normal controls. Interestingly, CB1 protein expression was similar to patients with ERD, whereas NERD patients showed increased CB1 receptor levels when compared with healthy controls ( Fig. 1 ). Although other GI inflammatory conditions have increased CB1 activity, there may be contribution of the inflammatory microenvironment that alters CB1 gene expression. 24

Immunostaining of CB1 receptor in histological sections of esophageal mucosa. Healthy subjects (a) show a weak positive staining localized in mature squamous cells (black arrow) and in connectival papillae (red arrows). NERD patients (b) show CB1 receptor expression in mature squamous cells (black arrow), in squamous cells (blue arrow), and in connectival papillae (red arrow). ERD patients (c) show CB1 positivity only in mature squamous cells (black arrow) and in squamous cells (blue arrows), whereas connectival papillae appear negative (red arrow). CB1 staining disappeared in esophageal mucosa (d) when CB1 blocking peptide was incubated with CB1 antibody. ERD, erosive esophageal reflux disease; NERD, nonerosive esophageal reflux disease. Reprinted with permission from Calabrese et al. 25

Recently, a potential third CBR has been identified with implications in the GI tract. G-protein receptor 55 (GPR55) shares 13–15% sequence homology with the CB1 and CB2 receptors and responds to a multitude of endogenous and exogenous cannabinoid ligands as well as several lipids. 26 A recent study found activation of GPR55 after administration of a synthetic agonist slowed down whole-gut transit in mice in vivo, suggesting GPR55 may be involved in the regulation of gut motility. 27

Endocannabinoids are endogenously produced ligands that exert effects on CBRs. The major ligands, anandamide (AEA) and 2-arachidonylglycerol (2-AG), play a role in maintaining GI homeostasis and have been found at increased levels in GI disease states, including celiac disease, diverticulosis, and colorectal cancer. 28–30 Exogenous cannabinoids, both plant-derived phytocannabinoids (cannabis sativa) and synthetic cannabinoids, also directly activate CBRs. They have been shown to play a role in both GI pathophysiology (e.g., cannabinoid hyperemesis syndrome) and therapies (e.g., antiemetics and appetite stimulant). 31

Although both CB1 and CB2 receptors have been found in the esophagus, few studies have focused on the role of cannabinoids on esophageal function. 21 Thus far, the role of GPR55 in esophageal motility has not been established. Given the varying and sometimes limited efficacy of current medical therapies for diseases of the esophagus, further understanding and investigation into the interplay of the ECS on esophageal health and disease may present new therapeutic modalities that may help advance current treatment options. In this review, the current understanding of the role of ECS in various esophageal functions and disorders is presented.

Swallowing Mechanism

The swallowing reflex is an important mechanism in controlling acid exposure in the esophagus, whereby increased swallowing decreases stasis and reduces acidic and nonacidic reflux. The role of the swallowing reflex in reducing reflux has been demonstrated after observation that supine sleeping patients experienced a decreased spontaneous swallowing reflex during 24-h pH monitoring, leading to increased acid and nonacid exposure. 32 CB1 receptor activation has been shown to decrease spontaneous swallows in human and animal studies. One study on dogs found administration of CB1 agonist suppressed spontaneous swallowing in a dose-dependent manner with an >80% decrease in spontaneous swallows at high doses (57 nmol/kg). 33 The authors noted that although administration of CB1 agonist decreased transient lower esophageal sphincter relaxations (TLESRs) thereby decreasing reflux events, the concomitant decrease in spontaneous swallows and clearance of refluxate potentially limit the benefits of decreasing TLESRs. The mechanism of action of CBRs on swallowing mechanism is likely centrally located through endogenous cannabinoid action, modifying synaptic neurotransmitter release. 34 The swallowing reflex, evoked by repetitive electrical stimulation of the superior laryngeal nerve in rats, was analyzed with and without combinations of both CB1 and CB2 agonists and antagonists. CB1 receptor antagonist injected directly into the nuclear tractus solitarius blocked the action of intravenous-administered CB1 agonist. The only study in humans to date found administration of the combination CB1/CB2 agonist Δ9-THC resulted in a significant reduction in the number of swallows wherein high doses (20 mg) led to a reduction in spontaneous swallows by 50%. 35

Esophageal Motility

CBRs, specifically CB1, play a role in GI motility and have mainly been studied in the small intestine and colon. 8,10 Only two studies have evaluated the effect of ECS on esophageal motility in humans. 35,36 Administration of Δ9-THC decreased basal lower esophageal sphincter (LES) pressure in a nondose-dependent manner, with onset occurring 45 min after meal ingestion, maximal effect around 100 min, followed by slow recovery. 35 This was confirmed in another human study that administration of rimonabant, a CB1 receptor antagonist, increased postprandial LES pressures in the first and second postprandial hours. 36

Previous studies in animal models did not demonstrate CBR action influenced esophageal motility. Lehman et al. demonstrated that CBR agonism did not influence the extent of LES relaxation. Similarly, CBR antagonists had no influence on esophageal peristalsis. 33 A recent case report suggested that exogenous phytocannabinoid use improved symptoms of dysphagia in a patient with manometric findings, consistent with type 3 achalasia. 37 Others have suggested that exogenous cannabinoid use, like chronic opiate use, may produce motor findings similar to type 3 achalasia. 38 The conflicting data support the need for further study of endo- and exogenous cannabinoids on esophageal motility. 39

Gastroesophageal Reflux Disease and TLESRs

TLESRs are the predominant mechanism seen in gastroesophageal reflux disease (GERD). TLESRs occur after gastric stimuli, mainly distension, to relieve counteracting gastric pressure on the LES. 40,41 The LES response to gastric distension is vagally mediated through communication of the LES and crural diaphragm with afferent gastric pathways, brainstem integrative centers (nucleas tractus solitarus and dorsal motor nucleus), and efferent inhibitory pathways. 41 The action of CBRs on TLESRs and GERD was first demonstrated in animal models after the observation that administration of a CB1 agonist (WIN55,212-2) reduced the rate of TLESRs without altering the TLESRs latency or esophageal peristalsis. 33 The authors concluded that the action of the CBRs on TLESRs most likely occured via central pathways because no effect on the extent of LES relaxation was seen. 33,42,43 Absence of CB1 receptors in preganglionic vagal motor neurons projecting to the gastric fundus or LES further supports the assumption that CB1 does not directly participate in vagal motor output modulation and rather relies on central activation. 42

Interestingly, the use of a CB1 receptor antagonist (rimonabant) in healthy human subjects enhanced postprandial LES pressure but unexpectedly decreased TLESRs. 36 This contradicts earlier data in an animal model with dogs that showed rimonabant enhanced the rate of TLESRs and reflux events that received acidified meal and intragastric air insufflation. 36 The authors attributed this discrepancy to different dosage, bioavailability, or interspecies differences of rimonabant. A possible explanation for the similar results from administrating CBR antagonist and agonists may be a result of rimonabant exerting potent CB1 receptor-independent pharmacological effects. 44

Gastric accommodation may affect TLESRs and play an important role in development of GERD. 45 Previous studies evaluated the effect of CB1 receptors on pain sensation during intragastric balloon distension, however, they did not find modulation of CB1 receptors with rimonabant-influenced mechanosensitivity of the proximal stomach. 46 It should be noted that baclofen has been shown to decrease TLESRs rate and increase basal LES pressure while not affecting meal-induced fundic accommodation, suggesting that the mechanism may not be as simple as binary, an observation previously suggested by Lehmann et al. 33 Other studies have suggested that using Δ9-THC inhibits gastric insufflation-induced LES relaxations in the decerebrate ferret, highlighting the need for further clarification of the relationship between gastric stimulation and TLESRs. 10

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The effect of CBRs on gastric emptying has been studied in humans although the data are limited and conflicting. 48–51 Although there may be some influence of CBRs, gastric emptying itself does not necessarily correlate with fundus accommodation and activation of TLESRs.

The presence of CBRs in the esophagus, specifically those affecting TLESRs, offers a potential therapeutic target for treating GERD. Using Δ9-THC, Beaumont et al. demonstrated decreased rate of TLESRs in healthy volunteers who received 10 and 20 mg of Δ9-THC on three occasions a week apart. 35 Delta(9)-THC significantly reduced the number of TLESRs and caused a nonsignificant reduction of acid reflux episodes in the first postprandial hour. In addition, lower esophageal sphincter pressure and swallowing were significantly reduced by Δ(9)-THC. 35 However, in the high dose of Δ9-THC (20 mg) group, central activity led to increased nausea and vomiting. Centrally acting CB1 receptor agonists produce the psychotropic effects and, therefore, selective targeting of peripheral CB1 receptors is necessary for effective therapy, with recent efforts to develop higher potency and effective CB1 agonists. 52,53 Previous studies have looked at using CB1 antagonists; however, their therapeutic use is also limited by its side effect of major depression. 54

Newer methodologies for understanding the pharmacodynamics and pharmacokinetics of medication effects on TLESRs have been developed that may provide more accurate modeling of drug concentrations and their effects. 55

Bronchoconstriction

In patients with a chronic cough where lung disease, environmental exposure, and medications have been excluded, GERD is often a major cause. 56 The two main mechanisms implicated in reflux-related cough are microaspiration of refluxate and stimulation of vagal innervation of the esophagus, leading to esophagobronchial reflex arc. The CB2 receptor has been shown to play a role in inhibiting bronchoconstriction and microvascular leakage in reflux models using guinea pigs. After infusion of intraesophageal HCl, the inhibitory effect of bronchoconstriction by a CB1 agonist (WIN55,212-2) was blocked after administration of a CB2 antagonist (SR 144528) but not after CB1 receptor antagonist, demonstrating CB2 receptor’s role as a downregulatory mechanism of sensory nerve activation. 57 CB2 receptor activation in models of direct airway damage has been shown to play an active role in reducing inflammation, potentially supporting protective role of CB2 in microaspiration of refluxate. 58

Visceral Hypersensitivity and Pain

Functional esophageal disorders are defined as the presence of esophageal symptoms in the absence of structural, inflammatory, or motor abnormalities. 59 Proposed pathophysiological mechanisms include alterations in neural processing between peripheral triggers and central perception of esophageal symptoms. 60 CBRs likely play a role in pain sensation and modulation through visceral antinociceptive action. 61 Previous studies have demonstrated an analgesic effect of cannabinoids in animal models through both CB1 and CB2 activation. 62–64 In one important study, upregulation of the endocannabinoid AEA through inhibition of its degrading enzyme led to an attenuated behavioral response to noxious stimuli in rodents. 65 This suggests a central role of CB1 receptors in mitigating pain-related inputs to the CNS.

There are few studies of visceral sensitivity in the esophagus and the effects of CBR modulation. In a randomized, placebo controlled trial, administration of dronabinol for 1 month increased the threshold for first sensation, pain frequency, and intensity of pain during an esophageal balloon distention test. 66 Notably, anxiety and depression indices were unchanged after dronabinol administration. The mainstay of functional esophageal disorders relies on tricyclic antidepressants, selective serotonin reuptake inhibitors, and serotonin norepinephrine reuptake inhibitors, all of which have been found to influence psychiatric parameters, highlighting a possible difference in mechanism of action. 60

Role in Esophageal Neoplasm

Cannabinoids inhibit tumor cell growth and induce apoptosis by modulating cell signaling pathways. 67 Decreased frequency of CNR-1 gene, the gene encoding CB1 receptor, expression was found in tissue of esophageal cancer patients (10.8%) compared with controls (60.0%), and its presence is considered an independent predictor of survival. 68 However, recently a multivariate analysis revealed that CB1 receptor overexpression was independently associated with poor prognosis (p=0.019). Biological analysis of CB1 receptor overexpression using esophageal squamous carcinoma cell lines revealed that CB1 receptor activation appeared to promote cell proliferation and invasion. 69 Thus, the role of CB1 receptor expression in tumorogenesis needs to be further evaluated.

Conclusion

A more thorough understanding of the ECS in esophageal function and disease is needed. Recently, there has been a push to legalize cannabis for both medicinal and recreational use. There have also been reports of increasing use of both plant-derived cannabis and synthetic cannabinoids in the United States. 70 This may allow additional studies to be added to the few human studies to date on the effect of cannabinoid use in humans. Further study in this area is imperative for the development of future therapeutic potential of utilizing the ECS.

Authors’ Contributions

J.G. was involved in literature review and is the primary author. R.K. was involved in literature review. R.S. was involved in study conceptualization and reviewed the article.

Abbreviations Used

CBRs cannabinoid receptors
CNS central nervous system
ECS endocannabinoid system
ENS enteric nervous system
ERD erosive esophageal reflux disease
GERD gastroesophageal reflux disease
GI gastrointestinal
GPR55 G-protein receptor 55
NERD nonerosive esophageal reflux disease
THC tetrahydrocannabinol
TLESRs transient lower esophageal sphincter relaxations
WD Western diet

Author Disclosure Statement

No competing financial interests exist.

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Cite this article as: Gotfried J, Kataria R, Schey R (2017) Review: the role of cannabinoids on esophageal function: what we know thus far, Cannabis and Cannabinoid Research 2:1, 252–258, DOI: 10.1089/can.2017.0031.

CBD for GERD and Acid Reflux: Can Cannabis Oil Help?

Experiencing heartburn after eating a hearty meal — especially a spicy one — isn’t uncommon. In fact, 1 in 10 Americans experiences Gastroesophageal Reflux Disease (GERD), which is closely related to acid reflux. Most people use over-the-counter medications for short-term relief from GERD, but these medications fail to provide long-term benefits. They also have side effects upon prolonged use, including headache, nausea, vomiting, nausea, and vitamin deficiencies.

CBD oil can be an effective alternative for GERD, but most importantly, it also seems safer than conventional treatments. In this article, we explain the mechanism behind CBD’s benefits for GERD and acid reflux on top of providing a buyer’s guide for beginners in this booming and unregulated market.

CBD for GERD and Acid Reflux: Highlights

  • GERD is the abbreviation for gastroesophageal reflux disorder. It is caused by esophageal dysfunction and dysregulation of gastric acid secretion.
  • In a study published by Current Neuropharmacology, cannabinoid receptor activities in the endocannabinoid system were mentioned to provide modulatory effects on gastric acid secretion, gastrointestinal inflammation, and esophageal function (1).
  • A 2016 review posted in the Asian Pacific Journal of Medicine highlighted CBD and THC as potential inhibitors of gastric acid secretions through their interaction with cannabinoid receptors (2).
  • According to the British Pharmacological Society, cannabinoid receptors are engaged in modulating esophageal function (3).
  • Studies confirmed that the gastric protective and anti-inflammatory effects of CBD might be useful in treating GERD.

What is GERD and Acid Reflux?

Acid reflux occurs when stomach acid flows back into the esophagus due to the movements of transient lower esophageal sphincter (LES) muscle. The sphincter muscle opens when you swallow food. Dysfunctional LES muscles cause the sphincter to open even when a person is not swallowing. The continuous flow of gastric acid in the esophagus may trigger inflammation known as esophagitis. This, in turn, causes heartburn, which is a burning sensation causing discomfort in sufferers.

GERD is a more severe form of acid reflux. On top of heartburn, it can cause coughing, wheezing, sore throat, and voice hoarseness; untreated GERD may also lead to esophageal mucosal damage and hiatal hernia resulting from prolonged exposure to gastric acid on the lining of the esophagus. Individuals with GERD are also more prone to developing esophageal cancer.

Risk Factors for GERD

Acid reflux and GERD may be caused by some lifestyle factors that cause irritation to the esophagus. The risk factors and causes of GERD include:

  • Not swallowing food properly
  • Eating large meals
  • Consuming spicy foods
  • Smoking
  • Drinking alcohol
  • Drinking coffee
  • Taking aspirin
  • Pregnancy
  • Obesity
  • Hereditary factors
  • Hiatal hernia (bulging of the stomach)

Can CBD Oil Help with GERD and Acid Reflux?

CBD oil isn’t the first-choice treatment for GERD. Doctors usually recommend over-the-counter antacids (stomach neutralizers) and proton pump inhibitors (PPI) such as nizatidine and cimetidine. The PPI medications reduce the number of stomach acids.

However, the said medications might have adverse effects, such as constipation, stomach pain, nausea, vomiting, and neurotoxicity. These side effects, as well as the low cost-efficacy of such treatments, tend to occur in elderly patients, which is why some individuals are seeking natural alternatives.

Although there’s a lack of direct studies on CBD’s efficacy for GERD, existing research indicates that CBD’s activity on the endocannabinoid system (ECS) — specifically on its receptors — might produce several modulatory effects that can regulate gastric acid production, reduce pain, and inflammation in the gut, and promote healthy esophageal function.

The ECS is a widespread regulatory network that helps the body maintain a balance between all biological processes between its systems and organs. It is found in all vertebrates and mammals.

According to a 2016 review published in the Asian Pacific Journal of Medicine, cannabinoid receptor activities prompted by CBD and THC might reduce stomach acid production. The authors of the review cited studies pointing to cannabis extracts as a means to protect animal subjects from mucosal damage and gastric lesions.

Cannabis contains both CBD and THC; depending on the species, they occur in different ratios. Hemp plants contain higher levels of CBD and only trace amounts of THC (no more than 0.3%), while marijuana comes with significant concentrations of THC and low-to-moderate CBD content.

The research team concluded that the gastric protective and anti-inflammatory effects of cannabinoids on the gut may be useful in treating GERD and its symptoms.

An animal study published by the British Pharmacological Society mentioned that cannabinoids could improve gastrointestinal motility by reducing LES relaxation. Some researchers believe that disruptions in gastric motility may also be involved in the faster onset of GERD.

GERD is often associated with inflammation and oxidative stress caused by inflammatory cytokines. These compounds are known to cause early inflammation in individuals with GERD. In a study using animal and human biopsies, the researchers have found that CBD produces remarkable anti-inflammatory and antioxidant effects. The authors of the study added that these benefits hold promise for treating inflammation conditions.

According to researchers, GERD could be a significant cause of anxiety and depression. A study published by Cureus concluded that 41% of GERD patients suffered from depression, 34% suffered from anxiety, and 27% had both (4).

A study from Frontiers in Immunology acknowledged that CBD may be an effective treatment for mental health problems due to its anxiolytic and antidepressant effects.

How Does CBD Work for GERD?

The endocannabinoid system (ECS) plays an important role in the regulation of biological processes in the body, including gastrointestinal function. As mentioned, cannabinoid receptor activities have been linked to modulatory effects on gastroesophageal activity and the production of stomach acids.

Cannabinoid receptors are found in the immune system, central nervous system, and gastrointestinal system. The immunomodulatory effects of CBD derived from its interaction with CB2 receptors. CBD also reduces the production of pro-inflammatory cytokines, curbing inflammation and allowing the body to regenerate faster (5).

The presence of cannabinoid receptors in the gastrointestinal system is another possible explanation for the benefits of CBD for GERD.

Long story short, CBD’s interaction with the ECS and its receptors may regulate GI tract motility, reduce gastric acid secretion, and lower inflammation in the gut.

Is CBD Oil the Same as Medical Marijuana?

CBD oil can be extracted from two types of cannabis plants: hemp and marijuana. It is made using CO2, steam, or solvents — resulting in a concentrated oil chock-full of cannabinoids and terpenes. This oil can be further added to carrier oils, edibles, capsules, topicals, and vape liquids.

If a CBD oil is derived from hemp, it will contain only 0.3% of THC per volume. These are insufficient concentrations to produce a high. Instead, the user will experience the benefits of CBD enhanced by the presence of other cannabinoids and terpenes.

On the other hand, CBD oil sourced from medical marijuana strains will provide higher concentrations of THC, ranging between 5–35% depending on the strain. Selectively bred marijuana plants also come with higher ratios of CBD. They may come in a 1:1, 2:1, 5:1, 10:1, or even 20:1 ratio. Depending on the THC content in such CBD oils, the intoxicating effects may range from nearly nonexistent to mild euphoria on the verge of high. However, these effects are nowhere near the signature intoxication from high-THC strains.

If you’re looking for a product that is legal in all 50 states and won’t get you high, hemp-derived CBD oil is a more available option for GERD. This may change, though, as more states are on the way to legalizing the entire spectrum of cannabis.

How to Choose CBD Products for Acid Reflux?

Here are a few tips to consider before buying CBD for GERD and acid reflux:

  • Do your research about any company selling CBD. The market is unregulated, so there’s a risk of buying a mislabeled or dangerous product. You can find more information about the CBD product and the company behind it by checking customer reviews, testimonials, and by reading expert blogs.
  • People with GERD should first consult with a gastroenterologist and discuss different treatment options. Holistic physicians should be knowledgeable about CBD and its benefits for inflammation and gastrointestinal problems.
  • Be sure to check for Certificates of Analysis (CoA) from an independent laboratory to confirm that the potency on the label reflects the actual chemical profile of your CBD oil. Outside laboratories also look for common contaminants, such as pesticides, solvents, heavy metals, and residual solvents.

Another important thing to consider when buying CBD oil for GERD is the cannabinoid spectrum it offers.

Full Spectrum or Isolate: Which Is Better for GERD?

CBD is available in three basic formats: full-spectrum CBD, broad-spectrum CBD, and CBD isolate.

Full-spectrum CBD contains all the cannabinoids in hemp, including CBD, CBC, CBG, CBN, and traces of THC (up to 0.3%). Together, these compounds enter a synergy known as the entourage effect. According to a review published in Frontiers in Plant Science, the entourage effect increases the primary activity of the endocannabinoid system. The author of the study noted that the whole-plant synergy would explain why botanical extracts are more efficient compared to isolated compounds (6).

The entourage effect was demonstrated by a controlled trial on patients with chronic pain. In the study, opioid treatment supported with isolated THC failed to provide significant relief compared to placebo. However, a whole-plant extract containing both THC and CBD produced much better results (7).

The second type — broad-spectrum CBD — includes CBD, CBG, CBC, CBN, all the minor cannabinoids, and terpenes — but without any THC. The intoxicating cannabinoid is removed after initial extraction. Although not as potent as full-spectrum CBD, broad-spectrum extracts still evoke some of the entourage effects.

Finally, individuals who are allergic to other compounds from hemp, or those afraid of failing a drug test for THC, may opt for CBD isolate. This product contains 99% pure CBD and carries the highest dose in a single serving. However, CBD isolate doesn’t produce the entourage effect and is less predictable when it comes to dosing.

Safety: Can CBD Oil Make Acid Reflux Worse?

There is no evidence that CBD oil could make acid reflux or GERD worse. Unlike conventional anti-acid reflux medications, CBD doesn’t have dangerous side effects and is well tolerated in humans in doses of up to 1,500 mg daily. Numerous health agencies, including the World Health Organization (WHO), have concluded that CBD is a safe and effective compound.

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Of course, this doesn’t mean CBD oil is free from side effects. They do exist, but they are very mild and typically include the following symptoms:

  • Dry mouth
  • A temporary drop in blood pressure
  • Dizziness
  • Fatigue
  • Changes in appetite
  • Diarrhea

There’s also a chance of CBD-induced drug interactions, so if you take any medications, consult your doctor to avoid them. Doing so may also help you find the right dosage for yourself.

CBD Dosage for Acid Reflux

The FDA has yet to regulate CBD products, so until that happens, there are no officially established dosage guidelines when it comes to using CBD for specific conditions. The best CBD dosage range for GERD and acid reflux depends on several individual factors, such as your age, weight, metabolism, the severity of symptoms, and previous experience with CBD. The potency of your product, its cannabinoid spectrum, and the route of administration also affect the onset, type, and duration of effects.

It’s recommended to start with a low dose to evaluate your body’s response to CBD. The optimal initial dosage is between 2–5 mg of CBD for every 10 pounds of the body weight. After one week, you can reassess the effects and adjust the dose if needed. Once you’ve found your effective dose, you can stick to it; there’s no risk of building tolerance to CBD.

Final Verdict: Does CBD Help with GERD?

Acid reflux is a gastrointestinal condition that can cause discomfort in the stomach, leading to backflow or “reflux” of gastric acid to the esophageal tract. Poor diet and bad lifestyle choices (e.g. high-sugar diet, spicy food, and smoking cigarettes), can cause acute acid reflux to turn into a chronic disease known as GERD.

CBD interacts with the endocannabinoid system, whose receptors are present in the gastrointestinal tract. Through this interaction, CBD modulates the activity of the immune system, reducing inflammation. It also slows down the production of stomach acid and improves gastrointestinal motility, preventing fluid backflow to the esophagus.

CBD is a promising anti-acid reflux agent; however, more direct clinical trials are needed to confirm its efficacy on a relevant sample. If you’re considering taking CBD oil for acid reflux, you should seek advice from a holistic gastroenterologist.

Do you take CBD oil for GERD? Or do you know anyone who has managed to overcome acid reflux using CBD products? Let us know in the comments section!

References:

  1. Gyires, Klára, and Zoltán S Zádori. “Role of Cannabinoids in Gastrointestinal Mucosal Defense and Inflammation.” Current neuropharmacology vol. 14,8 (2016): 935-951. doi:10.2174/1570159×14666160303110150
  2. Abdel-Salam, Omar. “Gastric acid inhibitory and gastric protective effects of Cannabis and cannabinoids.” Asian Pacific journal of tropical medicine vol. 9,5 (2016): 413-9. doi:10.1016/j.apjtm.2016.04.021
  3. Wright, K L et al. “Cannabinoid CB2 receptors in the gastrointestinal tract: a regulatory system in states of inflammation.” British journal of pharmacology vol. 153,2 (2008): 263-70. doi:10.1038/sj.bjp.0707486
  4. Mohammad, Saleh et al. “Depression and Anxiety in Patients with Gastroesophageal Reflux Disorder With and Without Chest Pain.” Cureus vol. 11,11 e6103. 8 Nov. 2019, doi:10.7759/cureus.6103
  5. Nagarkatti, Prakash et al. “Cannabinoids as novel anti-inflammatory drugs.” Future medicinal chemistry vol. 1,7 (2009): 1333-49. doi:10.4155/fmc.09.93
  6. Russo, Ethan B. “The Case for the Entourage Effect and Conventional Breeding of Clinical Cannabis: No “Strain,” No Gain.” Frontiers in plant science vol. 9 1969. 9 Jan. 2019, doi:10.3389/fpls.2018.01969
  7. van de Donk, Tine et al. “An experimental randomized study on the analgesic effects of pharmaceutical-grade cannabis in chronic pain patients with fibromyalgia.” Pain vol. 160,4 (2019): 860-869. doi:10.1097/j.pain.0000000000001464
Livvy Ashton

Livvy is a registered nurse (RN) and board-certified nurse midwife (CNM) in the state of New Jersey. After giving birth to her newborn daughter, Livvy stepped down from her full-time position at the Children’s Hospital of New Jersey. This gave her the opportunity to spend more time writing articles on all topics related to pregnancy and prenatal care.

CBD for Acid Reflux and GERD – Is It Effective?

If you are reading this post, you (or someone you know) likely experience a burning sensation in the chest or throat, especially after eating spicy food.

You have tried the traditional treatments of acid reflux or GERD and have not seen the expected results. It’s also possible you have heard about the benefits of CBD use and are wondering whether it can help with your acid reflux symptoms.

Luckily you have found this post. Here we look at everything you need to know about CBD for acid reflux and GERD. We will also learn how using CBD oil for acid reflux provides relief from its symptoms.

Let’s get started:

Table of Contents

How is Acid Reflux Caused? Is CBD for Acid Reflux Beneficial?

The gastrointestinal system is a sensitive organ in your body. When your digestive network is interfered with, it may lead to acid reflux (the acid stomach backflow).

Acid reflux happens when the stomach acid moves into your esophagus when the lower esophageal sphincter (LES), which is supposed to close when food passes through, fails to close or opens more often.

As such, the acid produced by your stomach moves up into the esophagus leading to unpleasant symptoms, including:

  • Heartburn (burning chest discomfort)
  • Regurgitation
  • Dysphagia
  • Bloating
  • Burping
  • Nausea
  • Hiccups
  • Dry cough, wheezing, or hoarseness

Drinking coffee, taking a hearty meal, or alcohol consumption can cause heartburn in people with acid reflux. Many people commonly experience acid reflux in the morning that causes lots of discomforts.

What’s the Difference Between Acid Reflux and GERD?

Although acid reflux and gastroesophageal disease are related, the terms mean different things.

As earlier stated, acid reflux happens when stomach acid flows back into the esophagus resulting in heartburn. Usually, this occurs after taking spicy meals or drinking coffee or alcohol.

GERD occurs when you have a more severe form of reflux with symptoms of severe acid reflux . Heartburn is the most common symptom of GERD (more than two times a week). Other GERD symptoms include difficulty swallowing, chest pain. Regurgitation of sour liquid, and coughing.

As you can see, acid reflux and GERD exhibit the same symptoms, but the symptoms occur more than twice a week in people with GERD.

CBD Reflux Benefits – Demand in the Global Market

As of 2019, the global cannabis legal market was valued at 17.7 billion U.S. dollars. It is expected that the market will be worth 73.6 billion U.S. dollars by 2027.

Gerd and Marijuana health benefits and the continued legalization in various countries are the major drivers of this vast market.

We have seen the emergence of many CBD brands to cater to the increasing cannabis demand. If you plan to invest in the CBD industry, it is imperative to work with a reputable CBD marketing agency .

The best CBD marketing agency understands the industry trends and will use their expertise to put your business before your target market without being at loggerheads with authorities.

CBD for Acid Reflux and GERD

Before we look at the benefits of CBD for GERD , let’s take a closer look at the Endocannabinoid System (ECS) and its role in our bodies.

The ECS plays a vital role in your wellbeing and regulates many biological functions including, sensations, memory, anti-secretory effects, and pain perception.

Cannabinoids (found in the cannabis plant and those found in the body) play a vital role in gastric and intestinal acid secretion and regulate gastrointestinal motility.

CBD reacts with the endocannabinoid system and may reduce the acid secretion that causes heartburn in GERD patients.

CBD and ECS will prevent or reduce the severity of GERD by reducing inflammation and mucosal damage. Besides, it may help lower esophageal relaxation.

CBD for Pain Management

Pain is a common problem for GERD patients. CBD is known to activate CB1 and CB2 cannabinoid receptors to produce analgesic effects that help relieve pain, including pain from the gastrointestinal tract.

Compared to conventional pain medications, CBD oil for pain relief is a safer alternative for acid reflux patients. Many people suffering from acid reflux are aware of CBD and pain management benefits and are using CBD to derive its positive health benefits.

People with GERD experience pain in the chest, throat, or stomach. Certain pain medications can make GERD worse. They include:

This is where marijuana comes in. CBD can help reduce pain, meaning you do not have to take pain medications that can worsen GERD. Marijuana is better than medicine for acid reflux and will alleviate pain without irritating your stomach and esophagus.

Cannabis for acid reflux Relieves Stomach Acid

Although clinical trials on the effects of cannabis on stomach acid secretion are yet to be conducted, some preclinical studies suggest that cannabinoids may help inhibit gastric acid production.

In a study involving rats, cannabinoids were found to reduce stress-induced ulcers. That being the case, researchers believe that cannabis may help inhibit gastric acid secretion in humans.

Some cannabinoids are known to protect the stomach lining, meaning cannabis may be useful for GERD patients. So CBD can be one of the best acid reflux natural remedies for people chronically suffering from GERD.

Marijuana for GERD Reduces Inflammation

Is CBD good for GERD ? Although more research is required to determine if marijuana is a useful option for treating GERD, available studies suggest that cannabis may help boost endocannabinoid’s ability to reduce inflammation.

In turn, this might help combat GERD symptoms and repair mucosal damage. CBD also binds to cannabinoid receptors in the gastrointestinal system to prevent peristalsis (involuntary muscle movements), thus reducing the chances of the stomach acid going back into the esophagus.

CBD Decreases Stress

Can stress cause acid reflux ? Yes, stress and anxiety are known to trigger GERD symptoms. Luckily, medical cannabis may help you feel less anxious and overwhelmed. In the end, this might reduce stress-related ailments like stomach pain and nausea.

Your mental health is closely related to gastrointestinal health (GI). Conversely, stress and GERD are linked.

Taking medical marijuana may help calm your mind. However, talk to your doctor about the right dosage, as taking a higher THC dose can hurt you.

What’s the Best Way to Take CBD for Acid Reflux?

Having that you have read to this point, it’s likely you want to try CBD for GERD and are wondering how to take it. Here’s how to take CBD for acid reflux :

CBD Oil for Acid Reflux Benefits

To get the best benefits of CBD for acid reflux , you should know about CBD oil for GERD dosage . As the name suggests, CBD oil comes in a liquid form. Taking CBD oil for acid reflux is straightforward – measure an appropriate dose using a glass dropper and place it under the tongue.

Hold it in your mouth for about one minute before swallowing it. You will start feeling the effects of CBD oil within fifteen to thirty minutes of use and last up to six hours.

CBD Vapes – Best Medicine for Acid Reflux

If you are looking for the fastest and effective way of taking CBD for GERD , vaping is the way to go. Vaping has the highest bioavailability than tinctures and oral CBD products, as it gets into the bloodstream within three to five minutes of inhalation.

However, compared to CBD oils, CBD vape effects last for a few hours, meaning it might not be the best option if you need long-lasting effects from GERD symptoms.

CBD Capsules – For Heartburn and Acid Reflux Relief

CBD capsules may be ideal for you if you want to take CBD on the go. CBD capsules offer a discreet way to use CBD in your workplace.

However, taking CBD for acid reflux or GERD in the form of capsules will have a slower onset (between 40 and 90 minutes) than CBD oils and vapes. CBD capsules need to pass through your digestive system to feel the effect.

CBD Edibles and Acid Reflux Benefits

CBD edibles come in different flavors, making it a more enjoyable way to take CBD. However, when taking CBD gummies for GERD, keep in mind that the effects delay as they will have to pass through the liver.

How much CBD to Take for Acid Reflux?

Since the FDA does not control many CBD products, there is no standard recommendation of CBD dosage for acid reflux.

The right CBD dosage for you will depend on various factors, including:

  • Gender
  • Age
  • Weight
  • The severity of the symptoms
  • Unique body chemistry
  • Prior CBD experience

As a rule of thumb, start small (about 1 – 6 mg of CBD for every 10 pounds) and increase slowly until you get your ideal dosage. Keep a record of how each dose affects your GERD symptoms.

If taken in the right dosage, CBD is the best medicine for acid reflux and can relieve your symptoms to a great extent.

CBD for Acid Reflux Side Effects

As with any other medication, cannabis use may have side effects. Talk to your doctor about the best CBD/THC levels for you and the best method of use to reduce the risk of side effects.

Depending on the cannabis strain that you take, dose, and your CBD experience , you may experience any of the following side effects:

  • Dry mouth
  • Insomnia
  • Fatigue
  • Diarrhea
  • Red eyes
  • Paranoia
  • Drowsiness
  • Constipation
  • Dizziness
  • Impaired balance

So, Should You Take CBD for Acid Reflux ?

Although much research is needed, CBD has been shown to help with acid reflux and GERD. Marijuana interacts with the endocannabinoid system to soften the gastrointestinal muscles and protect the lining from damage.

That way, it leads to improved peristalsis, thus preventing stomach content’s backflow in the esophagus .

Talk to your doctor before taking CBD for acid reflux or GERD, especially if you take other medications.

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