Gastrointestinal Disorders: Heartburn and reflux disease

Symptoms: Food gets stuck in throat

Pain Scale Before Cannabis Use: 6

Pain Scale After Cannabis Use: 1

This 31-year-old computer security specialist developed heartburn around age 15, which did not respond to usual antacid treatment. Six years later he developed severe dysphagia and was diagnosed with eosinophilic esophagitis upon esophagoscopy and biopsy. Cannabidiol-rich concentrates relieve his difficulty swallowing, without the need for additional medication.

Previous and current conventional therapies (Protonix, Nexium) did not relieve heartburn. He undergoes annual esophagoscopy and esophageal biopsy and recently required esophageal dilatation for stricture. He is currently in remission, for which he credits cannabidiol.

Clinical response to Cannabis: Relief of heartburn and dysphagia.

Additional Comments: Esophageal eosinophilia is increasingly recognized as a separate disease, with an incidence of one in 10,000 per year. Unlike GERD, it does not respond to antacids. It manifests with progressive dysphagia and may progress to esophageal stricture. It is usually associated with food allergies, however it may occur in antibody deficient patients. It is treated with dietary restrictions and topical corticosteroids, such as Flonase. The role of medical marijuana has not been investigated.

Usual method of Cannabis administration: Vaporized

Usage pattern (as described by patient): “I do not use medical marijuana throughout the day, just at night, usually sometime just before dinner, to before bed, but almost never more than once in a day. I have used it twice after food has become lodged (and subsequently dislodged) to try to limit the additional swelling that usually occurs after such an event. With the use of medical marijuana, I have been able to return to, and finish my meal. My tolerance is quite low, so I have tried both vaporized plant and concentrate, and smoked plant, and low-dose lozenges and sprays. I cannot day for certain that one is any better than the other; all seem to help.”

Reported by Stefan Arnon, MD