Cannabidiol, also known as CBD, has a number of known benefits for brain health, immunity, pain management, and gut health including for gallbladders. What is Cholecystitis and how CBD can be an effective remedy to it. Using CBD For Cholecystitis Treatment. CBD in gallbladder gallstones CBD has been shown to help treat symptoms linked to gallbladder issues by addressing gastrointestinal symptoms, supporting metabolism, & promoting brain health.
Cannabis – a word that stirs a lot of discussion and debate. But when we come to think of it, it’s just an herb, a plant that has been used for medicinal, religious, and trading purposes for decades. However, despite its historical merits, it is still considered controversial. Due to its psychotropic effects, it was declared illegal in the 17th century US.
Fortunately, a series of major discoveries about the plant and its connection to the human body prevailed. In 1964, scientists from Israel were able to identify and synthesize the cannabinoid tetrahydrocannabinol (THC). Soon after, other cannabinoids were identified, including cannabidiol (CBD). Another milestone achieved was in 1988 when scientists determined that the mammalian brain has receptor sites that respond pharmacologically to cannabinoids. These cannabinoid receptors comprise the endocannabinoid system (ECS), a network of specialized protein molecules embedded in cell membranes that affect various homeostatic functions.
Since those discoveries were made, more and more studies emphasizing the therapeutic effects of cannabis have been conducted. These boosted the popularity of CBD oil, a component of cannabis that doesn’t have the same hallucinogenic and mind-altering effect as the whole plant. Today, following some states’ legalization, CBD is slowly making its way to the mainstream pharmacological world.
How does CBD work?
CBD is one of the 85 known cannabinoids in cannabis. It is often confused and mistaken for THC, cannabis’ intoxicating component that gives the feeling of being “high.” CBD, however, does not trigger the same effect. Instead, it has been proven to have numerous healing properties, and it can counteract some negative effects of THC. In various studies, CBD has been identified as anti-inflammatory, anticonvulsant, anti-oxidant, anti-emetic, anti-tumorigenic, analgesic,
anxiolytic and antipsychotic. These properties make it a potential medicine for the treatment of numerous diseases.
CBD acts through the endocannabinoid system of the body. It also causes direct or indirect activation of various receptor-independent channels and different non-cannabinoid receptors and ion channels. These networks give CBD the ability to induce various effects through multiple molecular pathways. CBD’s interaction with these channels has been the subject of extensive research in the field of pharmacology. One of CBD’s most documented attributes is its anti-inflammatory property.
CBD for Inflammation
As we have emphasized time and again, inflammation is our body’s natural defense response to pathogens and injury. To a considerable extent, we need it. However, ongoing systemic inflammation is implicated in the development of many chronic and debilitating diseases. Patients with gallbladder and gastrointestinal issues should be particularly worried about chronic inflammation.
There are a lot of synthetic and natural anti-inflammatories available in the market today, but none of them work like CBD.
CBD counteracts inflammation via different pathways. It interacts with various receptors, hormones, fatty acids, and cell-signaling proteins to produce an anti-inflammatory effect. These may sound technical, but it is good to know that CBD has more ways than one to reduce or manage inflammation in the body.
5 CBD Health Benefits for Gallbladder and GI Patients
CBD can help patients suffering from the gallbladder and gastrointestinal diseases by:
1. addressing gastrointestinal symptoms and healing leaky gut.
2. reducing pain.
3. supporting metabolism.
4. supporting brain health.
5. supporting the immune system
CBD for Gut Health
Leaky gut is a common gastrointestinal problem characterized by various symptoms, including inflammation, gas, bloating, abdominal pain, and fatigue. It is caused by the disruption of the gut’s tight junctions to prevent the passage of toxic waste, undigested food, and harmful microorganisms into the bloodstream. Leaky gut may contribute to gallstones and the development of other GI diseases.
Although there is still no medicine that can instantly heal a leaky gut, there are many things we can do to help our body heal itself. We usually recommend the removal of any possible aggravations such as stress and avoidance of common food allergens. Once that is done, several supplements can be taken to allow the lining to heal.
One of the natural agents that can promote this action is CBD.
CBD decreases intestinal permeability by boosting the expression of a protein called claudin, which is responsible for cell-to-cell adhesion. CBD’s anti-inflammatory property also reduces intestinal damage mediated by a receptor pathway called PPARgamma. These mechanisms are beneficial not just for leaky gut patients but for those with inflammatory bowel diseases.
Patients with sepsis, Crohn’s disease, IBD, and BAD or bile acid diarrhea may also benefit from CBD’s ability to slow down gastric emptying and intestinal transit. Those with hyperacidity or GERD will also be glad that CBD can inhibit gastric acid secretion.
CBD for Pain Management
Cannabis is therapeutically famous as a pain-killer. That is why some patients with chronic pain or under palliative care are fighting to have access to it. Luckily, with the discovery of isolating CBD oil, many individuals can now use it legally and without the euphoric effect of THC in cannabis.
Upon ingestion or administration, CBD can bind to vanilloid receptors in the body, which mediate pain perception, inflammation, and body temperature. This is one reason why some studies refer to CBD as antinociceptive, which means it can block the detection of painful or damaging stimuli by sensory neurons. This pain-killing effect lasts longer and is more effective than normal analgesics. Some CBD oil users even attest that the perfect dose of CBD can match the pain relief brought by morphine and oxycodone.
CBD’s anti-inflammatory effect contributes to reducing chronic pain since inflammation only makes it worse. CBD’s ability to increase the production and release of the happy hormone, called serotonin, also plays a significant role in managing pain.
CBD for Metabolism
The endocannabinoid system plays a central role in the neuronal control of food intake and energy balance. Since the ECS comprises metabolic enzymes, it plays a crucial role in several metabolic functions like energy storage, nutrient transport, and insulin sensitivity. CBD can therefore aid in metabolism both directly and indirectly.
Aside from boosting metabolism by supporting digestion and gut health, CBD stimulates the genes and proteins that hasten the breakdown of fat. CBD can turn white fat into brown fat, decreasing the risk of diseases and potentially promoting weight loss. CBD reduces the expressions of proteins needed to create new fat cells within the body. It also helps burn calories quickly by increasing the activity of mitochondria, the powerhouse of our cells.
However, it is important to note that overstimulation of the endocannabinoid system may result in opposite effects. Too much cannabinoid intake can boost the odds of developing metabolic syndromes such as obesity and diabetes. CBD oils with small amounts of THC may also yield a different metabolic effect as THC stimulates appetite and decreases satiation.
CBD for Brain Health
Because of the mind-gut connection, many gallbladder and gastrointestinal patients are suffering from brain fog, depression, and anxiety. Inflammation in the gut translates to inflammation in the brain. And brain inflammation is more likely to develop into neurodegenerative disease.
The good thing is that CBD supports brain health too!
CBD acts upon the dopamine, serotonin, and opioid systems in the brain. The dopamine system is associated with cognition and motivation, while the serotonin system is related to mood and behavior. These hormonal functions are why CBD administration can reduce anxiety, depression, and stress. Its ability to activate serotonin receptors makes it a potential therapeutic agent for individuals suffering from addiction, PTSD, neuropathic pain, and negative symptoms of schizophrenia. CBD’s effect on dopamine levels also helps improve memory and focus.
For neuroprotection, CBD helps support cellular repair and detoxification. This can reduce the risk of developing age-related neurodegenerative diseases. CBD also facilitates a deep and restful sleep for those with insomnia and thus suffering from brain fog and lethargy.
CBD for the Immune System
CBD has a two-phased response in the immune system. Low doses have a stimulatory effect, and high dosages can trigger inhibitory activity. Either way, it can be beneficial to different sets of people.
A few studies show CBD’s effect against cancer and HIV. However, there is still much to learn about the ability of CBD to boost the immune system. At the moment, there is more proof of CBD’s anti-inflammatory effects, which in turn lowers the body’s overactive immune system. This is only good in cases where the body’s immune system has gone awry, such as in autoimmune diseases.
As a potent immune suppressor, CBD is beneficial for patients with lupus, arthritis, Parkinson’s, and multiple sclerosis, among others.
CBD Dosage and Side Effects
Numerous studies validate that cannabidiol is well tolerated and safe in humans, even at high dosages and with long-term use. Its safety and compatibility with the human body have a lot to be a naturally-occurring compound within the endocannabinoid system.
It isn’t easy to quantify what amount is enough or too little regarding dosage. There is a massive discrepancy in the amounts used in studies, from as low as 10 mg to 1300 mg. There are also different qualities and concentration levels among CBD oils which makes it difficult to set a standard. It also doesn’t help that the FDA still hasn’t recognized CBD as a supplement or prescription medicine.
Best CBD Oil
Because of the lack of regulation and standardization, there are a lot of low-quality CBD oils available in the market today. Even if it is not openly sold in many states, it is still easy to order CBD online. It is available in many forms like soft gel tablets, oil droplets, infused gum, and many more. Therefore, it is important to know what type and what brand of CBD oils you can trust.
We recommend a company called Elixinol which has a good reputation. You can tell by the prices just how concentrated they are. They are only sold on their website. Note that there is no THC in any of their products except for 0.3% in their X-pen. They have a live chat so contact them with any questions or concerns.
Fight Back Cholecystitis Symptoms With CBD
Our gallbladder plays an important role in our body. Its job is to store a digestive juice called bile. The gallbladder releases bile into our small intestine when our body required it to break down the fats. But if the bile gets trapped in our gallbladder, it can result in a dangerous condition called Cholecystitis. This condition refers to swelling and irritation of the gallbladder usually due to gallstones that block the tube leading out of the gallbladder.
Cholecystitis can be acute (begins suddenly) as well as chronic(lasting for a long time, mostly a lifetime) and requires immediate treatment. Today we will discuss more on Cholecystitis and how CBD can be an effective remedy to treat it.
Table of Contents
What Are The Symptoms Of Cholecystitis?
The most common symptom of cholecystitis is pain. Other symptoms of this condition include:
- Pain that spreads to your back or right shoulder
- Severe pain in your center or upper right abdomen
- Tenderness over your abdomen
The pain arising in cholecystitis may be sharp and gets worse while deep breathing. There can also be an inflammation of the pancreas caused by a gallstone blocking the ampulla of Vater. People suffering from chronic cholecystitis face recurring attacks of pain.
What Are The Causes Of Cholecystitis?
Inflammation of the gallbladder can result in cholecystitis. This inflammation can occur due to:
The most common cause of gallbladder inflammation is gallstones. These gallstones are hard particles that develop in our gallbladder. Gallstones can block the tube called the cystic duct which is responsible for sending bile to the small intestine. When the tube is blocked, bile builds up causing inflammation in the gallbladder.
A tumor can also stop bile from draining out of the gallbladder causing its buildup thus resulting in cholecystitis.
Blood Vessel Problems:
When your gallbladder doesn’t have a good blood supply due to any severe illness, it may lead to cholecystitis.
Other causes of Cholecystitis can be:
How Can Cholecystitis Be Treated?
If left untreated, this condition can cause severe problems such as gallbladder rupture. The treatment option for cholecystitis usually involves controlling the inflammation in the gallbladder. If the condition is acute, it may require surgical removal of the gallbladder.
Treatment options of cholecystitis may include:
- Fasting: Not drinking or eating anything in order to give relief to your gallbladder.
- Injecting Fluid: Receiving fluids intravenously in order to prevent dehydration
- Antibiotics: If the gallbladder is infected, you may require antibiotics to treat the infection.
- Pain medications: Pain medications can be recommended to reduce the chronic pain and inflammation in your gallbladder.
- Removal of Stones: A procedure called endoscopic retrograde cholangiopancreatography (ERCP) can be performed by your doctor to remove gallstones.
Other than the above-mentioned options certain lifestyle changes should also be done to prevent this condition from developing. These include losing weight slowly, maintaining a healthy weight as being overweight can increase the chances of developing gallstones. Choose a diet that is high in fruits, vegetables, whole grains, and low in fat.
Using CBD To Relieve Cholecystitis Symptoms
CBD has received a lot of attention in the last few years. This is completely due to its therapeutic properties in treating a variety of health ailments. CBD is not just a cannabinoid but an organic supplement that possesses medicinal and therapeutic qualities.
CBD is one of many identified cannabinoids present in the cannabis plant. This cannabinoid is not psychoactive and is extracted from the hemp plant which is a species of cannabis. On the other hand, the high-inducing cannabinoid THC is extracted from the marijuana plant. Studies have revealed that CBD can be a potent anti-inflammatory, anticonvulsant, antioxidant, antiemetic, anti-tumorigenic, analgesic, anxiolytic and antipsychotic remedy.
How does CBD work in our body?
Researchers say that there are Endocannabinoid Systems present in our body. This system helps our body in maintaining homeostasis by regulating various body functions such as pain, sleep, appetite, mood, and immune system. CBD, when consumed, interacts with the receptors present in our Endocannabinoid System and provides relief in various acute as well as chronic health issues.
These health issues include:
1. Acute and Chronic Pain
2. Anxiety and Depression
3. Sleep Issues
5. Epileptic Seizures
7. Nausea and Vomiting
9. Cardiovascular diseases
10. Brain-Related disorders
11. Bacterial Infections
12. Bone Related Problems
13. Skin Problems such as Acne, Psoriasis, Eczema, and more.
The Connection Between CBD And Cholecystitis
CBD has become a go-to for many individuals looking for a natural remedy for the issues they experience on a daily basis. CBD has been shown to help with a variety of different ailments and conditions that could inhibit people from living their lives to the fullest. Some of the most common uses of CBD are for pain management, inflammation reduction, and to aid in managing anxiety symptoms. That’s not all it can do, though. The cannabinoid can also help with nausea and muscle spasms and can promote relaxation of the body and mind. Every day, researchers are finding new ways that CBD can help people live healthier, happier lives.
As studied above, Cholecystitis results in inflammation of the gallbladder. To an extent inflammation is good but when it occurs due to the overreaction of the immune system, it results in ongoing, systemic inflammation which can result in many chronic diseases. CBD counteracts such inflammation by interacting with various receptors, hormones, fatty acids. CBD produces an anti-inflammatory effect thus helping in reducing inflammation caused in the gallbladder.
Another amazing benefit of CBD is relieving the pain arising in cholecystitis. CBD, when consumed, binds to the vanilloid receptors in the body which are related to pain perception, body temperature, and inflammation. The pain-relieving properties of CBD are highly effective in reducing chronic as well as acute pain arising due to such inflammation.
CBD has also been studied to reduce nausea and vomiting arising during chemotherapy sessions. Thus, it can also be used to reduce the symptoms of nausea and vomiting arising in Cholecystitis.
Final Thoughts on CBD For Cholecystitis
Cholecystitis is a debilitating condition and if not treated properly can lead to a loss of life. Thus, it becomes essential to treat this condition as soon as you start experiencing its symptoms. CBD can be a potent remedy to relieve the symptoms of such a condition. Other than that it can also prevent cholecystitis from entering our body by protecting our body from possible risk factors causing such conditions. Moreover, this cannabinoid is safe and non-psychoactive so you really do not need to worry about any high or side effects of consuming CBD oil. You can start with low doses at first and increase as per the desired result.
We hope you liked this article on CBD For Cholecystitis. Let us know your suggestions in the comment section below.
CBD Oil for Gallbladder – August 2022
How CBD May Affect the Gallbladder: Can CBD Help With Gallbladder Problems?
CBD has been shown to help relieve pain (9) , alleviate the effects of metabolic syndrome (10) , and restore the integrity of the intestinal wall (11) . These properties may help symptoms of gallbladder disorder.
CBD’s interaction with the body’s ECS (endocannabinoid system) may explain how the compound induces its purported therapeutic effects, working with the ECS as the system regulates bodily functions (12) .
The ECS comprises cannabinoid receptors like CB1 and CB2, enzymes, and cannabinoids ( 13) .
Pain perception, mood, sleep, hunger, memory, and motor control are all influenced by CB1 (cannabinoid receptors 1). Meanwhile, activated CB2 receptors on immune system cells provide an anti-inflammatory response to lessen pain and tissue damage .
According to a study, the activation of cannabinoid receptors suggests several beneficial approaches linked to metabolic syndrome (14) .
The researchers believe that endogenous cannabinoids and phytocannabinoids lessen the impact of metabolic disorders (15) .
CBD for Leaky Gut
A study showed that cannabinoids may help restore the integrity of the intestinal wall (16) .
Bloating, inflammation, gas, stomach discomfort, and fatigue are symptoms of a leaky gut (17) . T hese symptoms may also lead to common bile duct stones ( CBD stones) , GI disorders (18) , and jaundice ( 19) .
No pain-relieving medicine may quickly fix a leaky gut. However, reducing stress (20) and avoiding things that may cause allergic reactions ( 21) may help alleviate symptoms.
Supplements like crucial minerals (calcium, potassium, magnesium) may help the lining of the body heal and promote blood flow (22) .
Studies suggest that CBD may protect enterocytes (intestinal lining cells) against inflammatory damage, restoring intestinal mucosa integrity (23) .
The researchers also believe that natural and synthetic cannabinoids may help with GI function and intestinal barrier disorders (24) .
Intestinal barrier dysfunction is linked to the formation of gallstones ( 25) , solidified deposits of the digestive fluid in the gallbladder.
CBD for Metabolic Syndrome
Heart disease, including diabetes and stroke, are increased risks in those with metabolic syndrome (26) .
In 2012, the World Journal of Gastroenterology and Hepatology study showed that metabolic syndrome is linked to gallstone disease (27) .
In addition, researchers’ findings noted how CBD may aid in metabolic syndrome induced by lifestyle changes (28) .
Key targets for tissue damage involved in metabolic syndrome include the cardiovascular system, pancreas, and liver (29) .
The liver makes bile, a digestive juice. The bile then passes the concentrates to the gallbladder, storing the digestive juice for later use (30) .
CBD for Inflammation and Pain
CBD, the non-psychoactive component of Cannabis sativa L ., has been studied for its analgesic properties. CBD reduces pain and improves the quality of life in epilepsy patients (31) .
The most common gallbladder symptom is biliary colic (32) . The condition may induce intermittent abdominal pain and upper back pain (33) .
A natural chemical in Cannabis sativa, cannabidiol (34) is derived from Cannabaceae plants (hemp family) . There is less than 0.3% THC in the hemp plant.
THC is found in high concentrations in marijuana plants. High-THC marijuana is known to cause hallucinations and euphoria when smoked or drunk, and acute changes in blood flow and pressure (35) .
The ECS has cannabinoid receptors that interact with CBD (36) . CB1 receptors govern pain perception, whereas CB2 receptors control anti-inflammatory responses.
A study published in the European Journal of Pain showed that cannabidiol may alleviate pain and inflammation without side effects (37) .
Another study suggested that CBD may relieve pain and inflammation with its anti-inflammatory properties (38) .
Through its antioxidant and anti-inflammatory effects, CBD may alleviate the symptoms of leaky gut, pain sensation , and inflammation-related gastrointestinal syndrome (39) .
However, the FDA (Food and Drug Administration) currently only approves cannabis use to treat patients with epilepsy caused by two rare forms of seizure (40) .
Benefits of Using CBD to Help With Gallbladder Problems
The gut microbiome affects overall health. It regulates bacterial growth and development in the body (41) .
Studies show that CBD may help reduce pain ( 42) , regulate metabolic disorders ( 43) , and restore the integrity of the intestinal barrier (44) . CBD may also help reduce inflammation (45) , easing gallbladder pain-related symptoms.
Note that orally administered CBD products allow the compound to pass through the intestinal wall. Active compounds like CBD travel to the liver before being transported to their target site via the bloodstream.
Consult a healthcare expert before using CBD products like CBD oil to treat medical conditions like gallbladder discomfort.
How to Take CBD for Gallbladder Problems
One way to take CBD oil for gallbladder-related issues is under the tongue, immediately absorbed into the bloodstream.
Due to the absence of published clinical guidelines for CBD dosage, dosing will be done progressively titrating until pain relie f is achieved.
On the other hand, CBD topicals frequently include other helpful substances to boost their effectiveness in delivering pain relief (46) to target areas of the body.
CBD Dosage for Gallbladder Problems
There is no standard CBD dosage to ease gallbladder discomfort. Weight, pain intensity, metabolism, and genetics may affect dosing.
Still, research suggests that 1,500mg of CBD per day may be well tolerated in people (47) .
A CBD dose for gallbladder disease is not FDA-authorized. It is suggested to begin with low dosages of the best CBD oil and gradually raise the dose to get the desired impact.
Side Effects of Using CBD for Gallbladder Problems
There is no direct study of particular side effects of CBD for gallbladder issues. However, moderate side effects from CBD include dry mouth, nausea, lethargy, and headache (48) .
Cannabinoids may have a dose-dependent effect on body temperature, which may cause hypothermia or hyperthermia ( 49) . Nevertheless, CBD has not been linked to fatalities, and most people may use it without life-threatening side effects.
Can CBD Oil Help People Without Gallbladders?
Data from clinical investigations show that up to 20% of patients who undergo cholecystectomy (gallbladder removal) may develop diarrhea ( 50) .
Bloating or diarrhea after surgery usually improves within a few weeks (51) . However, blood clots may also occur after a gallbladder removal surgery.
Meanwhile, CBD may cause side effects, like diarrhea and reduced appetite, although these are often well tolerated (52) . CBD may also interact with other medications, like blood thinners.
To avoid increased risks of side effects, it is important to ask your doctor before using CBD, especially after a medical procedure like having your gallbladder removed.
What Is a Gallbladder?
The gallbladder is a pear-shaped organ located on the right side of the abdomen, beneath the liver. The bile ducts are a drainage system for the liver (53) .
The bile duct stores and moves bile from the gallbladder to the small intestine (54) . The gallbladder releases bile in response to neurohormonal signals (55) .
After eating, the gallbladder contracts, releasing bile into the duodenum, the first part of the small intestine.
Common Causes of Gallbladder Pain
Many conditions may cause pain in the gallbladder. One of the most common causes is blockage of the gallbladder ducts (56) .
Gallstones may form if the gallbladder is not emptying properly. Obesity and specific diets are risk factors for common bile duct stones (57) .
What Are Gallbladder Problems?
A common gallbladder condition is the formation of gallstones or cholelithiasis (58) . Gallstones are bile deposits that have solidified in the gallbladder .
The size may range from a grain of sand (sludge) to a golf ball. The patient may develop multiple gallstones concurrently (59) .
Gallstones have a higher incidence in women over 40 (60) . Women produce estrogen and progesterone more readily than men. Estrogen raises the level of cholesterol in bile, leading to the formation of gallstones.
Types of Gallstones
Cholesterol and pigment stones are two gallstones classified according to their risk factors and epidemiology (61) .
Around 80% of gallstones are cholesterol stones, commonly associated with blockage and inflammation. They account for almost 80% of gallstones and are related to obstruction and inflammatory gallstones or intrahepatic bile duct stone prevalence (62)
Common Symptoms of Gallbladder Problems
The patient may feel chronic pain radiating to the upper back ( 63) . This condition is known as acute cholecystitis (64) .
Symptoms of stones in the common bile include nausea, vomiting, bloody urine, stomach discomfort, and low blood pressure (65) .
Sludge forms in the gallbladder as cholesterol, calcium, bilirubin and other chemicals accumulate. No treatment is needed if the gallbladder sludge causes no symptoms (66) .
Often, the sludge is gone when the root cause is solved, like managing the symptoms of gallbladder problems.
Gallbladder Problem Treatments
Gallbladder discomfort causes severe abdominal pain that lasts for about five hours. If it worsens, doctors may consider other issues ( 67) .
Nonsteroidal anti-inflammatory drugs or narcotic pain medications may be used to control the pain of acute biliary colic (68) .
Oral probiotics are also available. Dietary probiotics are bacteria that are similar to gut bacteria (69) . Studies show that oral probiotics may reduce the amount of cholesterol in the body (70) .
Doctors may suggest ursodiol or chenodiol dissolve gallstones (71) . However, individuals should consult a doctor about the best treatment for gallbladder problems.
Physicians may also recommend surgery to remove the gallbladder (72) . After surgery, bile passes straight from the liver into the small intestine (73) .
If patients have small stones in the gallbladder (choledocholithiasis) (74) , these stones may block the cystic duct and result in severe pain and inflammation of the gallbladder (75) .
A scending cholangitis (bile duct inflammation) may spread through the duct. Doctors may suggest another gallbladder stone therapy or cholecystectomy if needed (76) . Nonsurgical options may include endoscopic (77) and interventional radiology ( 78) .
Clinical practice to diagnose gallbladder problems includes CT scan (79) , X-ray (80) , endoscopy (81) , laparoscopic cholecystectomy (82) , lithotripsy (83) , and ultrasonography (84) .
Through e ndoscopic r etrograde c holangiopancreatography (ERCP ) (85) , m agnetic resonance cholangiopancreatography (MRCP) (86) , endoscopic sphincterotomy, or intraoperative cholangiography (IOC) (87) , doctors may make a systematic review of diagnoses to help with follow-up care of patients with various conditions (88) .