The popularity of cannabis edibles, infused with compounds like delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD), has raised questions about their effects on digestive health. Since these compounds are ingested and processed through the digestive tract, concerns exist about potential irritation or damage to the stomach lining. A peptic ulcer is an open sore that develops on the inner lining of the stomach (gastric ulcer) or the upper small intestine (duodenal ulcer). This condition occurs when the protective mucosal barrier is compromised, allowing corrosive digestive acids to cause tissue damage.
Established Causes of Peptic Ulcers
The vast majority of peptic ulcers are attributable to two distinct, well-documented causes involving a breakdown in the gastrointestinal tract’s mucosal defense. The most common cause is chronic infection with the bacterium Helicobacter pylori. This organism infects the stomach lining, damaging the protective mucus layer and causing inflammation that makes the tissue vulnerable to stomach acid.
The second primary cause involves the chronic use of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), such as ibuprofen and naproxen. NSAIDs interfere with the body’s natural defense mechanisms by inhibiting the enzyme cyclooxygenase-1 (COX-1). COX-1 is responsible for producing prostaglandins, compounds that maintain the stomach lining’s integrity.
These prostaglandins stimulate the production of the mucous layer and bicarbonate, which neutralize acid near the tissue surface. When NSAIDs suppress COX-1, the production of these protective chemicals decreases, leaving the lining exposed to stomach acid and pepsin. Less frequently, other factors like Zollinger-Ellison syndrome, which causes excessive acid production, can also contribute to ulcer formation.
Cannabinoids and Their Interaction with the Gut
Ingested cannabinoids, such as THC and CBD, interact with the Endocannabinoid System (ECS), a signaling network highly active in the gut. The ECS utilizes Cannabinoid Receptor 1 (CB1) and Cannabinoid Receptor 2 (CB2), which are found throughout the digestive tract, influencing motility, inflammation, and pain signaling. In the stomach, activating CB1 receptors can trigger a mechanism that is protective against ulcer formation.
Research shows that direct activation of CB1 receptors can effectively reduce the secretion of gastric acid, a destructive factor in ulcer development. This antisecretory effect is partially mediated by suppressing the vagal nerve drive to the stomach. Cannabinoids may also decrease the formation of gastric mucosal lesions induced by various stressors, including alcohol and NSAIDs, in animal models.
The protective qualities of cannabinoids are multi-faceted, involving antioxidant and anti-inflammatory properties. These compounds help maintain the integrity of the gastrointestinal epithelial barrier, the physical layer separating the body from the gut contents. The collective action of reducing acid, dampening inflammation, and protecting the mucosal layer suggests a generally gastroprotective biology.
Scientific Consensus on Edibles and Ulcer Risk
Despite the gastroprotective mechanisms observed in experimental settings, the clinical consensus regarding edibles and ulcer risk is not settled. There is currently no direct evidence establishing a causal link between occasional consumption of cannabis edibles and the development of new peptic ulcers. However, some large-scale epidemiological studies suggest that chronic, heavy use of cannabis may be associated with an increased risk of hospitalization for Peptic Ulcer Disease (PUD).
One analysis of nationwide inpatient data found that individuals with a cannabis use disorder had higher odds of being hospitalized for PUD, suggesting a correlation with chronic, high-dose exposure. This association may not be directly due to cannabinoids creating the ulcer, but rather to confounding factors frequently seen in chronic cannabis users. For example, chronic substance users may also have higher rates of other ulcer risk factors, such as tobacco use or heavy alcohol consumption, or they may delay seeking medical care.
The potential for misdiagnosis complicates the clinical picture, as ulcer symptoms can be confused with other GI issues related to cannabis use. Cannabinoid Hyperemesis Syndrome (CHS) is a distinct condition marked by cyclical episodes of severe nausea, vomiting, and abdominal pain in long-term, heavy cannabis users. While severe vomiting from CHS can lead to complications, the syndrome is separate from true peptic ulcer disease, which involves a specific mucosal lesion. The only known cure for CHS is the complete cessation of cannabis use, which distinguishes it from peptic ulcer treatment.