{
  "abstract": "Background Background and Aims: Since the legalization of cannabis and kratom in Thailand in 2022, their use has become widespread. However, data on their liver biochemistry in patients with underlying gastrointestinal and liver diseases remain limited.Methods We conducted a cross-sectional study among adult outpatients attending gastroenterology and hepatology clinics at a tertiary referral center in Southern Thailand between February 2024 and June 2025. Participants completed a structured questionnaire on cannabis and kratom use. Alanine aminotransferase (ALT) values over the preceding two years were retrieved retrospectively. Associations between substance use and longitudinal ALT levels were evaluated using linear mixed-effects models adjusting for age, sex, body mass index, cirrhosis, metabolic dysfunction–associated steatotic liver disease (MASLD), and alcohol consumption assessed by AUDIT.Results Among 819 participants, 60 (7.3%) reported cannabis use only, 60 (7.3%) kratom use only, 72 (8.8%) use of both substances, and 627 (76.6%) reported no use of either. Among 681 patients with chronic liver disease (CLD) and available ALT data, cannabis use was independently associated with a 17% higher ALT level compared with non-users (exp(β)=1.17, p=0.015). Kratom use was associated with a non-significant 10% lower ALT level (exp(β)=0.90, p=0.10). Higher ALT levels were also associated with male sex (exp(β)=1.26, p<0.001), younger age (per year: exp(β)=0.992, p<0.001), cirrhosis (exp(β)=1.13, p=0.014), MASLD (exp(β)=1.31, p<0.001), and hazardous alcohol consumption (exp(β)=1.38, p=0.014), whereas low-risk alcohol use was associated with lower ALT levels (exp(β)=0.87, p=0.012).Conclusions In this real-world cohort of patients with CLD, cannabis use was associated with modest but significant ALT elevation, whereas kratom use was not. These findings highlight the importance of routine screening, counseling, and monitoring of cannabis use in patients with CLD following legalization. Prospective studies with detailed exposure assessment are needed to clarify causality and long-term hepatic outcomes.",
  "authors": [
    {
      "affiliations": [
        "Prince of Songkla University, Thailand"
      ],
      "name": "Anatthaya Bunchana"
    },
    {
      "affiliations": [
        "Prince of Songkla University, Thailand"
      ],
      "name": "Apichat Kaewdech"
    }
  ],
  "title": "IDDF2026-ABS-0493 Cannabis and Kratom use and liver biochemistry in patients with gastrointestinal and liver diseases after legalization in Thailand",
  "uid": "9f97fc12-9007-5cd9-98c1-3c33cf405959"
}