Chimezie Mbachi, MD1, Yuchen Wang, MD2, Jodie A. Barkin, MD3, Melchor V. Demetria, MD2, Jamie S. Barkin, MD, MACG3, Paul T. Kroner, MD, MSc4, Roberto Simons-Linares, MD, MS5
1John H. Stroger, Jr. Hospital of Cook County, Chicago, IL; 2Cook County Health and Hospital Systems, Chicago, IL; 3University of Miami Miller School of Medicine, Miami, FL; 4Mayo Clinic, Jacksonville, FL; 5Cleveland Clinic Foundation, Cleveland, OH
Introduction: Chronic pancreatitis (CP) does not currently have a cure and it leads to multiple complications (pain, exocrine pancreatic insufficiency, steatorrhea, bone disease), its management is still a challenge. There is evidence that stimulating the endocannabinoid system may reduce inflammation and fibrosis in pancreatic stellate cells. Cannabis is the most frequently used recreational drug in the US and in recent years its legalization has increased. There are currently multiple States in the US that have approved medical cannabis for CP. We investigate the prevalence and outcomes of CP-related complications amongst cannabis-exposed (CE) and non-cannabis-exposed (non-CE) CP patients.
Methods: The National Inpatient Sample (NIS) database from 2005 to 2014 was queried for all patients with a primary or secondary discharge diagnosis of chronic pancreatitis as per the International Classification of Diseases 9th revision (ICD-9) code 577.1 and a complication related to chronic pancreatitis. Active exposure to cannabis was ascertained based on ICD-9 code 304.3X and 305.2X. We compared CE vs. non-CE patients. Outcomes included pancreatic cancer diagnosis, biliary stricture, pancreatic duct stricture, cholangitis, endoscopic retrograde cholangiopancreatography (ERCP) use for either diagnostic or therapeutic purpose. Propensity match analysis for age, gender, race, median income quartile, hospital characteristics and Elixhauser comorbidity index and multivariable logistic regression models were performed using SAS software (STATA 14).
Results: 109,326 patients with CP were analyzed [Figure 1]. Prevalence of CE was 2.2% (2360 patients). The mean age of CP patients was 49. When comparing CE vs. non-CE, the CP-related complications amongst matched cohorts were as follows chronic abdominal pain 5.2% vs 0.3% (p< 0.001), steatorrhea/diarrhea 1.2% vs 13.5% (p< 0.001), biliary stricture 0.3% vs. 7.1% (p< 0.001), pancreatic cancer 0.4% vs. 11.8% (p< 0.001), cholangitis (0.1% vs 2.6%; p< 0.001), pancreatic cancer (0.4 vs 11.8; p< 0.001). Cannabis users also required less diagnostic ERCP (1.4% vs 5.5%; p< 0.001) and therapeutic ERCP (3.5% vs 9.3%; p< 0.001). (Figure 2)
Discussion: In CP patients admitted to the hospital, CE patients had lower rates of CP-related complications and importantly pancreatic cancer. These effects could possibly be through the effect of cannabis in the endocannabinoid system as previously shown in mice studies in Germany. More studies are needed to corroborate our findings.
Citation: Chimezie Mbachi, MD; Yuchen Wang, MD; Jodie A. Barkin, MD; Melchor V. Demetria, MD; Jamie S. Barkin, MD, MACG; Paul T. Kroner, MD, MSc; Roberto Simons-Linares, MD, MS. P0031 - DOES CANNABIS CONSUMPTION IMPACT CHRONIC PANCREATITIS RELATED COMPLICATIONS?. Program No. P0031. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.