ABSTRACT
Herbal cannabis has been used for thousands of years for medical purposes. With elucidation of the chemical structures of tetrahydrocannabinol (THC) and cannabidiol (CBD) and with discovery of the human endocannabinoid system, the medical usefulness of cannabinoids has been more intensively explored. While more randomized clinical trials are needed for some medical conditions, other medical disorders, like chronic cancer and neuropathic pain and certain symptoms of multiple sclerosis, have substantial evidence supporting cannabinoid efficacy. While herbal cannabis has not met rigorous FDA standards for medical approval, specific well-characterized cannabinoids have met those standards. Where medical cannabis is legal, patients typically see a physician who "certifies" that a benefit may result. Physicians must consider important patient selection criteria such as failure of standard medical treatment for a debilitating medical disorder. Medical cannabis patients must be informed about potential adverse effects, such as acute impairment of memory, coordination and judgment, and possible chronic effects, such as cannabis use disorder, cognitive impairment, and chronic bronchitis. In addition, social dysfunction may result at work/school, and there is increased possibility of motor vehicle accidents. Novel ways to manipulate the endocannbinoid system are being explored to maximize benefits of cannabinoid therapy and lessen possible harmful effects.
Subject(s)
Cannabinoids/therapeutic use , Cannabis/chemistry , Endocannabinoids/metabolism , Medical Marijuana/therapeutic use , Pain/drug therapy , Receptors, Cannabinoid/metabolism , Analgesics, Non-Narcotic/therapeutic use , Cannabinoids/adverse effects , Cannabinoids/standards , Drug and Narcotic Control , Humans , Marijuana Abuse/prevention & control , Medical Marijuana/adverse effects , Medical Marijuana/standards , Meta-Analysis as Topic , Practice Guidelines as Topic , Randomized Controlled Trials as Topic , United StatesABSTRACT
Eosinophilic esophagitis is an under-recognized inflammatory disorder of the esophagus. It has been frequently diagnosed in pediatric patients; however, over the last few years, there has been an increase in the number of cases recognized in adults as well. Despite this fact, eosinophilic esophagitis (EE) is often a delayed diagnosis in the primary care setting due to the overlapping symptoms it shares with other esophageal and gastrointestinal disorders such as gastroesophageal reflux disease and gastroenteritis, as well as a lack of awareness among physicians who see adult patients. We performed an exhaustive search of the literature, which revealed over 400 articles on EE; however, most were reported in gastroenterology or autoimmune specialty journals. We report a case of eosinophilic esophagitis in a 39-year-old man who presented with persistent epigastric abdominal pain and who was diagnosed via endoscopy and biopsy.
