DIGESTIVE HEALTH INSTITUTE
DIGESTIVE HEALTH INSTITUTE
SOMETHING OLD, SOMETHING NEW
CONSIDERING CANNABIS
BREAKING BARRIERS TO CARE WITH A PIECE OF STRING
WHAT MARIJUANA MIGHT DO FOR TEENS WITH
INFLAMMATORY BOWEL DISEASE
It’s a burden for patients, and Dr.
Furuta’s team has made it a priority
to find better ways to perform the
endoscopy. Children’s Colorado’s
Joel Friedlander, D.O., pioneered
a way to do endoscopies through
the nose, avoiding the need for
anesthesia. Dr. Furuta came up
with a way, in many cases, not to
do them at all.
GLENN T. FURUTA, M.D.
As far as diseases go, eosinophilic
esophagitis (EoE) is pretty new —
two decades ago, doctors didn’t
even know it existed — and much
mystery remains. But doctors do
know what causes it: white blood
cells called eosinophils, which, when
concentrated in the esophagus, can
cause chronic inflammation.
“These cells are the hallmark of
the disease,” says
Children’s Hospital Colorado’s Glenn T. Furuta,
M.D., whose research helped define EoE as a
condition unique from acid reflux 20 years ago
and who continues to lead the field.
“The only way to assess whether
eosinophils are there is
by endoscopy and biopsy: an
invasive and expensive test.”
Because some patients respond
better to some treatments than
others, gauging the relative
presence of eosinophils is crucial
not only to diagnose the disease,
but also to measure the progress
of treatment.
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“There was an old test developed
in the 70s,” Dr. Furuta says. “You
had a capsule filled with string,
and you would tape one end of the
string to your cheek and swallow
the capsule, and the string would
go all the way down to the small
intestine.” Doctors would then
pull the string out and check for
intestinal parasites. “We wondered
if you could do a similar thing and
check the portion of string from the
esophagus for the unique proteins
of eosinophils.”
Measured against endoscopy,
the results of the string test were
“remarkably consistent” — enough
so that Dr. Furuta’s team, with his
collaborator Steven Ackerman,
M.D., at the University of Illinois at
Chicago, knew they’d produced a new
treatment standard. With help from a
grant and seed capital from Children’s
Colorado, the team is developing a
commercial version of the test, now
undergoing trials, that it hopes to
introduce to the market soon.
“We always try to identify the
barriers to care for our patients,”
says Dr. Furuta. “Can we use old
approaches? Do we need to develop
new ways to treat? The string test
was kind of a combination of both.”
immune system. “When you activate
immune cells, they spit out chemical
signals to other cells: do this, grow
this way, become this,” says Dr.
Collins. “We’re looking at how the
compounds in marijuana change
those signals.
ED HOFFENBERG, M.D., COLM COLLINS, Ph.D.
For his patients at Children’s
Hospital Colorado, teens and
preteens with Inflammatory Bowel
Disease (IBD), Ed Hoffenberg, M.D.,
is not “prescribing, condoning,
managing, or encouraging
marijuana in any way,” he says.
“Because that would be illegal,”
adds Children’s Colorado’s
Colm Collins, Ph.D.
“But if they do use it for their IBD
symptoms,” says Dr. Hoffenberg, “I
want them to tell us how they use it
and what benefits they get.”
About 30 to 40 percent of
Dr. Hoffenberg’s teenaged patients
admit to using marijuana. That’s
not surprising: the rate is consistent
for teenagers in Colorado, where
marijuana is regulated and sold in
stores, albeit not to anyone under
21. What surprised Dr. Hoffenberg
was what patients told him about
why: that it eased not just the pain,
but other symptoms, too.
“It was clear we had to study it,” he says.
Dr. Hoffenberg is gathering data
and blood from his patients, both
those who use marijuana and those
who don’t. Dr. Collins then analyzes
that blood to study the effects
of cannabinoids and THC at the
cellular and molecular level, both
in patients and in mice genetically
engineered to have IBD.
IBD is an inflammatory disease, and
what’s interested Dr. Collins most
is the effect marijuana has on the
“There’s some evidence
that one of those
compounds, CBD, is
immunosuppressive —
which in IBD is exactly
what we want,” says
Dr. Collins.
What the research stands to reveal
is more about how marijuana — and
THC, CBD, and the hundred other
known chemicals that come with
it, none of whose effects are well
documented — interacts with the
body, and the risks and rewards it
might involve. Patient, parent, and
industry interest in those answers is
high, especially with regard to kids
and teens: what effect might it have
on growing bodies, both short-term
and long? Hoffenberg and Collins’ team
is leading the way toward finding out.
In the meantime, Dr. Hoffenberg
cautions that marijuana is no
substitute for treatments already
proven to work. Whatever it is, “it’s
not a magic cure-all,” he says.
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