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Studies investigating the effectiveness and safety of cannabis as a therapeutic option for IBD have reported conflicting findings, and recent reviews have not incorporated evidence from real-world studies. This systematic review assessed controlled non-interventional studies and interventional trials evaluating the effectiveness of delta-9-tetrahydrocannabinol (THC)-containing cannabis products in patients with IBD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The systematic review procedures\u2014including search strategy across four databases, literature screening, data extraction, qualitative result synthesis, and risk of bias assessment\u2014followed the Cochrane Handbook and adhered to PRISMA-compliant reporting. We used the GRADE approach to rate evidence quality for each outcome. Inclusion criteria: peer-reviewed research on effectiveness or safety of cannabis as treatment modality, control group must be present, quantitative measure of effect\/safety on IBD. Exclusion criteria: published before 2000, non-English, non-human research, non-cannabis\/THC exposures,\u2009&lt;\u20090.3% THC exposure, topical formulations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Four randomized clinical trials (RCTs), and four non-interventional studies met all inclusion criteria. Non-interventional studies exhibited serious or critical risk of bias, leading to their exclusion from evidence ratings. The four RCTs demonstrated high risk of bias, although their evidence quality ratings varied. RCTs assessed adverse events; however, limited safety information was provided. Improvements in one trial were reported for bloating (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200956) and appetite (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200956), both rated as low evidence quality. Results for clinical disease activity scores (4 trials,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009180), daily function, general well-being, general effect on health (1 trial,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200956), bowel movement frequency (3 trials,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009148), generic quality of life (3 trials,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009122) and pain (2 trials,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200988) were mixed. The outcomes of remission (3 trials,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009150), weight (1 trial,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200956), IBDQ (1 trial,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200960), endoscopic scores (2 trials,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200988), and nausea (1 trial,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200956), consistently failed to differ meaningfully between intervention and control. The evidence quality rating for these null or inconclusive results varied from low to medium, with the exception of weight, rated as high, though no effect was reported.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Current evidence is inconclusive as to whether THC-containing cannabis products might have a positive effect in IBD, given heterogenous findings and mostly low-to-moderate evidence quality. Higher quality cannabis research is needed given widespread utilization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>PROSPERO: CRD42023411910.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s42238-026-00456-2","type":"journal-article","created":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T00:53:57Z","timestamp":1780448037000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effectiveness of THC-containing cannabis for inflammatory bowel disease: a systematic review"],"prefix":"10.1186","volume":"8","author":[{"given":"Sebastian","family":"Jugl","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Perez-Vilar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven","family":"Galati","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sukhminder K.","family":"Sandhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hung-Kai","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shao-Hsuan","family":"Chang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yehua","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thorben","family":"Kurzbach","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Adkins","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingchuan","family":"Guo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Almut G.","family":"Winterstein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amie","family":"Goodin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,3]]},"reference":[{"key":"456_CR1","unstructured":"About MEMORY - MMJ Outcomes. 2024. 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Biomedicines. 2022;10(10):2439.","journal-title":"Biomedicines"}],"container-title":["Journal of Cannabis Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s42238-026-00456-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s42238-026-00456-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s42238-026-00456-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T02:33:32Z","timestamp":1786329212000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s42238-026-00456-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,3]]},"references-count":44,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["456"],"URL":"https:\/\/doi.org\/10.1186\/s42238-026-00456-2","relation":{},"ISSN":["2522-5782"],"issn-type":[{"value":"2522-5782","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,3]]},"assertion":[{"value":"18 November 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 May 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 June 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Not applicable.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The coauthors who were employees at the US Food and Drug Administration reviewed the study protocol, statistical analysis plan, and the manuscript for scientific accuracy and clarity of presentation, however, other officials at the US Food and Drug Administration had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The manuscript was subjected to administrative review before submission, but this review did not alter its content. Almut G. Winterstein, Yan Wang, and Amie Goodin received salary support from the state of Florida-funded Consortium for Medical Marijuana Clinical Outcomes Research, which conducts, shares, and supports research on the effect of medical marijuana on health conditions and symptoms and includes eleven universities in Florida. The Consortium had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.Almut Winterstein, Yan Wang, and Amie Goodin received salary support from the state of Florida-funded Consortium for Medical Marijuana Clinical Outcomes Research, which conducts, shares, and supports research on the effect of medical marijuana on health conditions and symptoms and includes eleven universities in Florida. The Consortium had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"92"}}