Perspektiven von Cannabinoiden in der Gastroenterologie

Zusammenfassung

Frühere Kulturen verwandten Extrakte der Pflanze Cannabis sativa unter medizinischen Gesichtspunkten, unter anderem zur Behandlung von gastrointestinalen Symptomen wie Übelkeit, Erbrechen, Diarrhö und abdominellen Schmerzen. Bis ca. 1920 war Cannabisextrakt ein häufig verwendetes Therapeutikum, z. B. bei Diarrhöerkrankungen in den Vereinigten Staaten. Die missbräuchliche Verwendung von Cannabinoiden als Sucht- und Rauschmittel führten zu einem weltweiten gesetzlichen Verbot und damit zum vorläufigen Ende von Cannabisextrakten als Heilmittel. Die Charakterisierung eines endogenen Cannabinoidsystems, bestehend aus endogenen Rezeptoren, Agonisten, Antagonisten und degradierenden Enzymen, öffnet die Tür für ein Comeback der Cannabinoide in die Medizin. Insbesondere den klinisch gut belegten Effekten in der Behandlung von Schmerzen verschiedenster Art, Kachexie im Rahmen von HIV oder Tumorerkrankungen sowie Übelkeit und Erbrechen im Rahmen von Chemotherapien ist es zu verdanken, dass Patienten mit Cannabinoiden wirksame Medikamente verabreicht werden können. In dieser Übersicht werden mit Übelkeit und Erbrechen diejenigen Indikationen diskutiert, in denen Cannabinoide zur Behandlung von Funktionsstörungen des Gastrointestinaltraktes aktuell eingesetzt werden. Weiterhin werden diejenigen Indikationen vorgestellt, bei denen tierexperimentelle Daten und Einzelbeobachtungen am Menschen einen zukünftigen Einsatz denkbar erscheinen lassen.

Abstract

In early cultures, extracts of the plant Cannabis sativa were medically used for the treatment of gastrointestinal symptoms like nausea, vomiting, diarrhoea and abdominal pain. In the United States cannabis extracts were frequently used as drugs, e. g., for the treatment of diarrhoea, until around 1920. The possibility of cannabis abuse resulted in a worldwide prohibition and thus the temporary ending of the medical use of cannabinoids. The characterisation of an endogenous cannabinoid system consisting of receptors, endogenous agonists, antagonists and degrading enzymes opens the door for a comeback of cannabinoids in medicine. The clinically proven effects in the treatment of pain, cachexia in conjunction with HIV, or malignant disease and treatment of nausea and vomiting in conjunction with chemotherapy now result in the prescription of cannabinoids as valuable medication. This review will discuss the value of cannabinoids in the treatment of nausea and vomiting, i. e., the indications for which cannabinoids are presently used in gastroenterology. Additionally, this review will discuss potential indications within gastroenterology, where results from basic research or individual observations suggest that a future use of cannabinoids in gastroenterology seems possible.

Schlüsselwörter

Cannabis - Cannabinoide - Gastroenterologie - Behandlung

Key words

Cannabis - gastroenterology - cannabinoids - treatment

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