Complementary alternative medicine in patients with inflammatory bowel disease: use and attitudes

BACKGROUND: A widespread increase in the use of complementary alternative medicine (CAM) by patients with inflammatory bowel disease (IBD) has been recognized. The aim of our study was to evaluate both the extent and the determinants of CAM use by outpatients with IBD. METHODS: Outpatients of the IBD centre at the University Hospital of Berne and patients of two gastroenterology private practices in Olten (Switzerland) completed a mailed self-administrated questionnaire regarding alternative medicine. The questionnaire addressed the following topics: demographic variables; disease-related data; the use of 16 types of complementary medicine; comparison between attitudes towards alternative versus conventional medicine and out-of pocket expenses. RESULTS: Alternative medicine has been used by 47% of the patients. Diagnosis, duration and activity of disease, gender, age, previous surgery were not predictive for the use of CAM. The most commonly used CAM methods were: homeopathy, acupuncture and traditional Chinese medicine. Reasons cited for the use of CAM were: lack of satisfaction with and side effects of conventional therapy and the perceived safety of CAM. Sixty-one percent of patients noted that their IBD had improved with the use of CAM. By contrast, 16% noted a flare during CAM therapies. Forty-seven percent of patients paid more than Euro400 per year for CAM. CONCLUSIONS: Complementary medicine use is common in patients with IBD. Frequently cited reasons for the use of complementary therapies were safety of CAM; dissatisfaction with conventional therapies, including their side effects; and that CAM can be used in addition to conventional therapy.     

Enteroscopy in children and adults with inflammatory bowel disease

Inflammatory bowel disease(IBD) includes Crohn's disease(CD), ulcerative colitis and unclassified entities. CD commonly involves the terminal ileum and colon but at the time of diagnosis it can be confined to the small bowel(SB) in about 30% of the patients, especially in the young ones. Management of isolated SB-CD can be challenging and objective evaluation of the SB mucosa is essential in differentiating CD from other enteropathies to achieve therapeutic decisions and to plan the follow-up. The introduction of cross-sectional imaging techniques and capsule endoscopy(CE) have significantly expanded the ability to diagnose SB diseases providing a non-invasive test for the visualization of the entire SB mucosa. The main CE limitations are the low specificity, the lack of therapeutic capabilities and the impossibility to take biopsies. Device assisted enteroscopy(DAE) enables histological confirmation when traditional endoscopy, capsule endoscopy and cross-sectional imaging are inconclusive and also allows therapeutic interventions such as balloon stricture dilation, intralesional steroid injection, capsule retrieval and more recently stent insertion. In the current review we will discuss technical aspect, indications and safety profile of DAE in children and adults with IBD.     

Complementary and alternative medicine use by patients with inflammatory bowel disease: An Internet survey.

OBJECTIVES: To determine the degree and determinants of the use of complementary and alternative medicine (CAM) by patients with inflammatory bowel disease (IBD) with the use of the Internet and to compare the results with those found by using a similar survey in patients attending gastroenterology clinics in Calgary, Alberta. SUBJECTS AND METHODS: A cross-sectional survey of 263 patients with IBD with the use of a World Wide Web-based, structured questionnaire was conducted. RESULTS: Complementary therapies had been used by 46% of patients in the previous two years. Current use was reported by 34%. Vitamins, herbal products and natural health practices were the most commonly reported therapies. Side effects and lack of effectiveness of standard therapies were the most commonly cited reasons for seeking complementary medicine. However, despite this, respondents who had previously received surgery, or intravenous or oral steroids were less likely to be current CAM users. Important differences between the determinants of and reasons for CAM use in the present study and those of a similar study of IBD patients in a local tertiary care setting were noted. CONCLUSIONS: Complementary medicine use is common in patients with IBD. Differences in the determinants of and reasons for CAM use noted between the present Internet sample and a gastroenterology clinic sample suggest that conclusions from the present study and from previous studies based only on clinic samples provide a limited view of CAM use by people with IBD. More comprehensive assessments are needed.     

Complementary and alternative medicine use by patients with inflammatory bowel disease: results from a postal survey

AIMS: Thirty to 50% of north American patients with inflammatory bowel disease (IBD) have been reported to use complementary and alternative medicine (CAM). There is no data in France. The aim of this study was to evaluate the frequency of CAM use and the reasons in a French population of patients with IBD. PATIENTS AND METHODS: An anonymous postal survey was done with a questionnaire mailed to all the patients with IBD, 16 to 79 year-old, followed-up in a public and a private medical centre of Reims, between January 2001 and December 2003. RESULTS: The final sample included 447 patients; 325 (72.7%) filled up the questionnaire: 219 (67.4%) had Crohn's disease, 94 (28.8%) ulcerative colitis and 12 (3.7%) indeterminate colitis. Sixty-nine patients (21.2%) reported CAM use for IBD. The mean number of CAM used simultaneously was 2.9. The most frequently used CAM treatment was homeopathy (40.6%), followed by magnetism (34.8%) and acupuncture (33.3%). The majority of patients (74.8%) never talked about CAM use with their IBD physician. Multivariate analysis showed that the factors significantly associated with CAM use were female gender (odds ratio (OR)=3.5, CI95%: 1.8-6.9), the low level of confidence in their doctor (OR=4.8, CI95%: 1.1-19.8) and the research of informations about their disease (OR=4.6, CI 95%: 2.0-10.7). CONCLUSION: Twenty-one percent of patients with IBD are using CAM, most of the time without talking about it with their physician. The quality of the relationship between the patient and his physician and female sex, more than the perceived severity of the disease, were the main determinants of that use.     

Complementary and alternative medicine use by Canadian patients with inflammatory bowel disease: results from a national survey

OBJECTIVE: Previous studies of complementary and alternative medicine (CAM) use by patients with inflammatory bowel disease (IBD) have relied on samples from specialty clinics. The aim of this study was to determine the prevalence of use and perceived outcomes of CAM in a large, diverse IBD population. METHODS: A postal survey of the members of the Crohn's and Colitis Foundation of Canada gathered data on demographic, disease, and conventional IBD treatment characteristics, and on the use and perceived effects of CAM. Respondents were characterized as not using CAM, as past or present users of CAM for their IBD, or as present users of CAM for other reasons. Comparisons between groups were made with the chi(2) test. RESULTS: The final sample included 2847 IBD patients. Current or past use of CAM for IBD was reported by 1332 patients, of whom 666 continued their use of CAM. Use was lowest in the eastern provinces and highest in the west. Only 15% had used CAM before their IBD diagnosis. Herbal therapies were the most commonly used (41% of CAM users). Improvements in sense of well-being, IBD symptoms, and sense of control over the disease were the most commonly reported benefits. Only 16% of prior CAM users reported any adverse effect of CAM use. A complementary practitioner was consulted by 34%. During the previous year, 46% had spend more than $250 on CAM. CONCLUSIONS: Use of CAM by IBD patients is very common. Most of these patients attribute significant benefits to their CAM use. Few report significant adverse events.     

Altered body composition profiles in young adults with childhood-onset inflammatory bowel disease

Abstract

Background: Patients with inflammatory bowel disease (IBD) often develop alterations in body composition in terms of their proportions of lean mass and fat mass, as well as reduced bone mineral density (BMD). However, there are limited data on the skeletal muscle index (SMI) and percentage fat (fat %) for young adults with childhood-onset IBD. Our aim was to investigate the body compositions of these patients, with the focus on SMI and fat %.

Methods: Body composition was estimated by dual x-ray absorptiometry for 94 young adults with childhood-onset IBD aged 18–27?years, 65 of whom had ulcerative colitis. The Z-scores for SMI, fat %, and BMD were calculated using the normative data from 1,289 individuals with corresponding age. Based on the SMI and fat % Z-scores, each patient was classified as having a body composition profile that was: (i) normal; (ii) obese (fat % Z-score >1); (iii) myopenic (SMI Z-score <??1); or (iv) myopenic-obese.

Results: A higher proportion of young adults with childhood-onset IBD had a body composition profile classified as myopenic (24%) or myopenic-obese (9%), as compared to the controls (myopenic [16%, p?=?.016]; myopenic-obese [2%, p?=?.002]). Patients with the myopenic or myopenic-obese profile had significantly lower total body BMD Z-scores (?1.3?±?0.7 and ?1.4?±?0.9, respectively) than patients with the normal profile (?0.2?±?1.1; p?<?.001 and p?=?.004, respectively). Diagnosis of IBD in childhood represented an additional risk for low BMD, regardless of SMI Z-score.

Conclusion: Young adults with childhood-onset IBD have a high risk for having altered body composition traits.

• Summary

• Young adults with childhood-onset IBD carry a high risk for altered body composition traits. The myopenic and myopenic-obese body composition profiles were more frequently observed in patients with IBD than controls, and these profiles were strongly associated with low BMD.

     

Paucity of mycobacteria in mucosal bowel biopsies from adults and children with early inflammatory bowel disease

BackgroundThe presence of Mycobacterium avium subspecies paratuberculosis (MAP) has previously been inferred in the genesis of Crohn's disease (CD), and a higher incidence of MAP PCR positivity has been demonstrated in the gut and peripheral blood of CD patients than in healthy individuals. The objective of this prospective study was to assess the potential etiological role of MAP in the pathogenesis of CD.MethodsThe presence of mycobacteria was assessed in bowel biopsies from newly diagnosed, treatment naïve Norwegian patients with IBD, including CD and ulcerative colitis (UC), as compared to a hospital-based cohort of CD and UC patients. Biopsies were collected from the small and large bowel in 354 individuals with suspected IBD. Detection of mycobacteria was performed by long-term cultivation in combination with direct detection by MAP IS900-specific PCR.ResultsAmong the specimens included from the patients with early IBD, samples from only two of the patients with CD (2.7%) and two of the non-IBD controls (1.5%) exhibited a positive growth signal. None of the CD patients and only one of the non-IBD controls was MAP PCR positive. Only the single PCR positive non-IBD control was also mycobacterial culture positive with Mycobacterium avium subsp. hominissuis. In the referral patients with long-term IBD, the prevalence of growth signal and MAP PCR positivity was higher (52 and 9%, respectively).ConclusionsThese findings demonstrate the paucity of MAP in the gut of treatment naïve CD patients. This study does not provide evidence for a role of MAP in early IBD.     

Metabolic bone disease in adults with inflammatory bowel disease.

Bone loss is seen frequently in those with inflammatory bowel disease (IBD). It appears to be more common in those with Crohn's disease than in those with ulcerative colitis. Corticosteroids play an important role in the development of osteoporosis. The prevalence of osteoporosis in IBD, the effects of corticosteroids on bone metabolism, and treatment options are reviewed.     

Arthritis associated with inflammatory bowel disease in children

The records of 102 children with inflammatory bowel disease (44 with ulcerative colitis, 58 with Crohn's disease) were reviewed for evidence of joint disease unassociated with erythema nodosum. Thirteen children had arthritis, four had ulcerative colitis, and nine had Crohn's disease. Arthritis tended to be pauciarticular; ankles, knees, elbows and hips were most commonly affected. In three patients arthritis preceded bowel symptoms, in two the onset of arthritis and bowel disease was concurrent, and in eight arthritis appeared after the onset of bowel symptoms. The relationship between arthritis and specific features reflecting activity and severity of the bowel disease was examined in detail. Twenty-one attacks of arthritis, ranging in duration from two days to 12 weeks (mean, 31 days) were documented. Thirteen attacks occurred when the bowel disease was symptomatic; nine occurred within one month of a flare of the bowel disease. Most exacerbations of bowel disease in patients who had arthritis were unaccompanied by joint complaints. None of the features reflecting activity or severity of the bowel disease was more common in patients with arthritis than in those without arthritis.Supported in part by grant AM 20582 from the National Institute of Arthritis, Metabolism and Digestive Diseases.     

Management of inflammatory bowel disease in adults

Optimal care of the inflammatory bowel diseases, Crohn's disease and ulcerative colitis, requires a broad understanding of disease pathophysiology and therapeutic alternatives. The goals of therapy are accurate diagnosis and timely treatment to both induce and maintain a clinical remission and improve patient quality of life. Most patients can be adequately treated using a combination or aminosalicylates, antibiotics, and corticosteroids, though many patients with Crohn's disease will require immunomodulators, such as azathioprine or 6-mercaptopurine. The development of novel biologic therapies, particularly infliximab, have dramatically improved our ability to medically manage more severe Crohn's disease and ulcerative colitis patients. This review will focus on the medical management of inflammatory bowel disease in adults.     

Fatigue in children and adolescents with inflammatory bowel disease

AIM To identify factors other than active disease and anemia that contribute to fatigue in pediatric inflammatory bowel disease(IBD).METHODS We performed an electronic search in Medline and EMBASE from their inception to May 2017 using the search term "fatigue" or the related keywords "physical impairment" and "inflammatory bowel disease" with the filter "child"(age 0-18 years). Cross-sectional and case-control studies were included. We restricted our search to studies published in English. We used the PRISMA checklist and flow diagram. Duplicate articles were manually deleted in End Note. To identify further relevant studies, we checked the reference lists of the selected articles.RESULTS We identified 149 papers, of which 19 were retrieved for full text review. Eleven studies were subsequently excluded because fatigue was not evaluated as an outcome measure. Eight papers focused on the desired topic and were discussed in the final analysis. A lack of uniformity of outcome measures made the pooling of data impossible. In all but one study, questionnaires were used to evaluate fatigue. In the remaining study, an accelerometer was used to measure daily activities, sleeping time and their relationships with fatigue in a more quantifiable manner. Adolescents with IBD are significantly more fatigued than healthy controls. In addition to active disease, increased anxiety or depression and disturbed family relationships were frequently reported predictors of fatigue. Quantitative measurement of physical activity in patients with Crohn's disease showed a reduction in the number of steps per day, and patients with ulcerative colitis had a shorter duration of physical activity during the day.CONCLUSION Fatigue in pediatric IBD is related to a combination of biological, functional and behavioral factors, which should all be taken into account when managing fatigue.     

Cryptosporidial infection in children with inflammatory bowel disease

Background and aimsCryptosporidiosis is usually a self-limiting illness in healthy patients. However, it can cause severe life threatening complications in immunocompromised patients. The effect of cryptosporidial infection on inflammatory bowel disease (IBD) has not been well studied and available literature is largely restricted to adult case reports. The purpose of this study is to describe the clinical characteristics of cryptosporidial infection in children with IBD.MethodsStool studies from children with IBD presenting with presumed relapse during the period 2005–2011 were reviewed retrospectively. Cryptosporidial infection was diagnosed by stool enzyme immunoassay. An age matched control group of IBD patients without cryptosporidial infection was used for comparison.ResultsMedical records of 170 IBD patients were reviewed and a total of 149 presumed relapses were identified. Cryptosporidial infection was found in seven of the 39 patients with positive stool studies (four ulcerative colitis/three Crohn's disease) presenting with relapse. The median age was 13 years (range: 3–17) and five patients were female. The median duration of the IBD was 18 months (range 2–48 months). All but one patient had stable disease prior to acquiring infection. Five patients required hospitalization due to significant dehydration. Three of the five patients treated with nitazoxanide had significant clinical improvement in 3 days. All patients had complete resolution of symptoms by three weeks and no infection related complications were noted. In comparison to patients with cryptosporidial infection, the control group required an increased need for escalation of therapy (71% vs. 0.0%, p = 001) and higher re-hospitalization rates (24% Vs.0.0%, p = 0.54) within 6 months following indexed relapse.ConclusionIn IBD patients, cryptosporidiosis can cause significant illness leading to increased need for hospitalization. In the absence of appropriate stool studies, cryptosporidiosis can be misdiagnosed as disease relapse and lead to inappropriate therapy. Nitazoxanide appears to be effective along with supportive therapy.     

Sclerosing cholangitis in children with inflammatory bowel disease

Background: Primary sclerosing cholangitis (PSC) with inflammatory bowel disease (IBD) has been rarely reported in children.
Aim: To describe the clinical presentation, sequential liver function test abnormalities, radiological bile duct anomalies and liver histology in four children with PSC and IBD.
Methods: Over a period of 18 years, four of 130 patients with IBD developed abnormal liver function tests. Three of the four patients had ulcerative colitis and the other Crohn's disease. All four patients had baseline and follow-up liver function tests, percutaneous transhepatic cholangiography and a needle biopsy of the liver.
Results: The four patients at presentation had minimal symptoms or signs of liver disease. All had elevation of serum transaminases, gamma glutamyl transferase and/or alkaline phosphatase. Three had the typical onion skin fibrosis of bile ducts. Percutaneous transhepatic cholangiography demonstrated irregularity and beading of the hepatic and common bile ducts in three patients. The other with normal cholangiography had fibrosing cholangitis on liver biopsy and was considered to have small duct disease.
Conclusions: We conclude that yearly biochemical assessment of liver function should be performed on all children with IBD, and if abnormal should raise the suspicion of PSC. The latter diagnosis can be confirmed by liver biopsy and cholangiography.