Gastro-intestinal problems

Fatty acid )5-oxidation defects often have an episodic character. In between the attacks of metabolic decompensation, plasma and urine parameters tend to virtually normal. On the other hand, several conditions have been recognized to yield metabolite profiles similar to those of fatty acid oxidation defects. Amongst these are feeding with medium-chain triglyceride containing feedstuffs, gastro-intestinal problems such as coeliac disease, and dysfunction of the respiratory chain. 

Treatment of constipation and other disorders of the gastro-intestinal tract may reduce flatulence problems. Medicines that increase peristalsis should not be used because of the risk of adverse reactions. 

The very low water solubility of key cannabis constituents aggravates still further the well-known variability of absorption from the gastro-intestinal tract, resulting in poor predictability of both the timing and intensity of peak effects by the oral route. Titration of dose against symptom relief, as is the norm for most individuals who smoke cannabis medicinally, is very difficult in these circumstances. An additional drawback is the production of larger quantities of the reputedly psychoactive metabolite 11-OH-THC as a result of the hepatic first-pass phenomenon. The use of whole plant cannabis-based medicinal extracts in liquid form delivered by a pump action oromucosal spray (Whittle et al. 2001) represents an attempt to overcome these problems and permit the patient to self-titrate to an optimal individualised daily dose. 

In older literature the circumvention of the hepatic first-pass effect is mentioned as an advantage for rectal administration of medicines. This is now known to be an invalid argument, since two out of three rectal veins end up in the portal vein. Rectal administration can be useful when a patient is vomiting, has swallowing problems, is unconscious, experiences severe gastro-intestinal complaints when taking the medicine orally (e.g. indomethacin), or for active substances with an unpleasant taste (especially for children). 

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