For IBS Patients, Cannabis Linked to Fewer Rehospitalizations, Shorter Stays
— 30-day readmission rate and overall costs were lower in cannabis users
by Diana Swift, Contributing Writer, MedPage Today May 5, 2020
This article is a collaboration between MedPage Today and:
Cannabis use may help ease symptoms of irritable bowel syndrome (IBS) that are strong enough to send patients to the hospital, an analysis of the Agency for Healthcare Research and Quality’s 2016 Nationwide Readmissions Database suggested.
In their cohort study of hospitalized IBS sufferers, Catherine Choi, MD, of Rutgers New Jersey Medical School in Newark, New Jersey, and colleagues found that all-cause 30-day readmission rates were 12.7% in non-cannabis users and 8.1% in cannabis users. After adjustment for age, sex, median income by zip code, insurance status, Charlson Comorbidity Index, hospital bed size, teaching status, and location, the adjusted odds ratio in cannabis users was 0.53 (95% CI 0.28-0.99).
The study was presented in an online press program organized by Digestive Disease Week, which was to have started on May 2 but was cancelled because of the COVID-19 pandemic.
In addition, cannabis use appeared to correlate with shorter hospital stays, for an adjusted mean difference of -0.44 days (95% CI -0.85 to -0.03, P=0.036), as well as with lower total hospitalization charges, for an adjusted mean difference of -$3,473 (95% CI -$46,773 to -$174, P=0.04). Cannabis use was also associated with a slightly higher survival rate compared with non-use.
The researchers identified 6,798 adult patients with IBS of whom 357 were cannabis users. The inclusion criterion was a principal diagnosis of IBS using ICD-10 CM codes, the exposure of interest was cannabis, and the primary outcome was 30-day readmission to hospital. For patients with and without cannabis use, the mean age differed substantially at 36.7 (range 34.5-38.9) years and 53.3 (52.6-54.1) years, respectively. Women accounted for 62% and 81% of the two groups, respectively.
The most common three reasons for readmission in non-users were enterocolitis due to Clostridium difficile, IBS without diarrhea, and sepsis. In users, the indications for rehospitalization were cyclical vomiting, IBS-diarrhea, and endometriosis. Among non-users, independent factors predicting readmission were mean age (0.99, 95% CI 0.98-1.33, P=0.04), having private insurance (0.56, 95% CI 0.41-0.77, P<0.01), and home healthcare (1.98, 95% CI 1.40-2.82, P<0.01). None of the factors analyzed predicted readmission in cannabis users, the researchers noted.
Adding medical marijuana to standard analgesics is under discussion for easing pain or increasing pain tolerance in such conditions as fibromyalgia-related back pain.
Asked for his perspective, Anthony J. Lembo, MD, of Beth Israel Deaconess Medical Center in Boston, who was not involved with the research, noted that to date no studies have evaluated the effect of cannabis on IBS symptoms. “While the authors hypothesize that cannabis use is associated with better control of irritable IBS compared to no cannabis use, the current study does not provide information to support or disprove this hypothesis,” he told MedPage Today.
Lembo pointed out that cannabis users in the study who were hospitalized with a principal diagnosis of IBS were significantly different from those who did not use cannabis: “Specifically, they differed in age and sex, both of which are likely to contribute to reasons for readmissions,” he said. “And cyclic vomiting was one of the most common reasons for readmission in the cannabis group, which is a known complication of cannabis use.”
He said that such intergroup differences and the small number of cannabis users in the study preclude drawing conclusions about factors affecting survival, adding: “And it’s worth noting that use of ICD-10 codes likely under-represents the true number of patients with these disorders. I don’t think there is more you can interpret from these data.”
Diana Swift is a freelance medical journalist based in Toronto.
One study co-author reported relationships with Allergan, Bayer, BeiGene, Bristol-Myers Squibb, Confirm, Conatus, Intercept, Mallinckrodt, Novartis, Resusix, Saro, Valeant, Gilead, Exelixis, Hologic, Shire, Genfit, and Prometheus outside of the submitted work. All other authors reported no conflicts of interest.
Lembo reported having no conflicts of interest in regard to his comments.
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