Amount of systemic steroid medication is a strong predictor for the use of complementary and alternative medicine in patients with inflammatory bowel disease: results from a German national survey

OBJECTIVES: Previous studies have suggested that inflammatory bowel disease (IBD) patients rank high among users of complementary and alternative medicine (CAM). To further elucidate this phenomenon, we sent questionnaires to a large sample of IBD patients in Germany to determine the patterns and predictors of their CAM use. METHODS: Pretested 73-item questionnaires were mailed to a randomly selected representative sample of 1000 IBD patients from the approximately 16,000 members and associates of the German Crohn's and Colitis Association. Predictors of CAM use were evaluated by logistic regression models. RESULTS: Completed questionnaires were returned by 684 patients (female patients, 61.4%; Crohn's disease patients, 58.3%; ulcerative colitis patients, 38.2%). Of the 671 adult respondents, 344 (51.3%) had experience with CAM, and significantly more of the ulcerative colitis patients (59.8%) than the Crohn's disease patients (48.3%) had experience with CAM. There was no difference by gender. Homeopathy (52.9%) and herbal medicine (43.6%) were the most commonly used types of CAM. The most frequent personal reasons for CAM use were the search for an "optimum treatment" (78.9%) and the wish to stop taking steroids (63.8%). Using logistic regression, we found that total cortisone intake (P = 0.0077), but not duration of disease, was a strong predictor of CAM use. Other predictors were experience with psychosomatic and psychotherapeutic support (P = 0.0029), relaxation techniques (P = 0.0284), an academic education (P = 0.0173), a diet utilizing whole grains (P = 0.0123), and a normal body weight (P = 0.0215). Although 80% of patients indicated that they were interested in using CAM in the future, only 24.7% felt sufficiently informed about it. CONCLUSIONS: More than 50% of a large group of German IBD patients had used CAM. Prolonged or intensive steroid treatment, an academic education, active ways of coping, and a health-conscious life-style are associated with CAM use. Given the potential side effects and interactions, the treating physician should focus on thorough information about the benefits and limitations of conventional and complementary treatment options, especially for IBD patients who have received prolonged or intensive steroid treatment.     

Clinical performance of the H. PYLORI QUIK CHEK™ and H. PYLORI CHEK™ assays,novel stool antigen tests for diagnosis of Helicobacter pylori

European Journal of Clinical Microbiology & Infectious Diseases - Infection with Helicobacter pylori is a global health issue, and rapid and accurate testing is a key to diagnosis. We aimed to...     

Predictors of Health Behavior Change After an Integrative Medicine Inpatient Program

Background

Health behavior change can improve physical and psychosocial outcomes in internal medicine patients.

Purpose

This study aims to identify predictors for health behavior change after an integrative medicine inpatient program.

Method

German internal medicine patients' (N?=?2,486; 80 % female; 53.9?±?14.3 years) practice frequency for aerobic exercise (e.g., walking, running, cycling, swimming), meditative movement therapies (e.g., yoga, tai ji, qigong), and relaxation techniques (e.g., progressive relaxation, mindfulness meditation, breathing exercises, guided imagery) was assessed at admission to a 14-day integrative medicine inpatient program, and 3, 6, and 12 months after discharge. Health behavior change was regressed to exercise self-efficacy, stage of change, and health locus of control (internal, external-social, external-fatalistic).

Results

Short-term increases in practice frequency were found for aerobic exercise: short- and long-term increases for meditative movement therapies and relaxation techniques (all p?p?p?Conclusion Health behavior change after an integrative medicine inpatient program was predicted by self-efficacy, stage of change, and health locus of control. Considering these aspects might improve adherence to health-promoting behavior after lifestyle modification programs.     

Prolonged fasting in patients with chronic pain syndromes leads to late mood-enhancement not related to weight loss and fasting-induced leptin depletion

Abstract

Periods of fasting are practiced worldwide on a cultural/religious background, and related mood-enhancing effects are postulated. We aimed to assess the effect of fasting on mood and to explore the interaction with neuroendocrine activation and leptin depletion in a controlled explorative study on consecutive inpatients (BMI < 35 kg/m²) of a nutritional ward. 36 subjects (38.9 ± 7.0 years; 29 female, BMI 26.7 ± 4.1 kg/m²) participated in an 8-day modified fast (300 kcal/day), 19 patients (38.1 ± 5.9 years; 18 female, 23.5 ± 4.1 kg/m²) received a mild low calorie diet. Measurements included daily ratings of mood (VAS), weight and levels of leptin and cortisol at four time-points of the 2-week study period. Weight loss was 4.8 ± 1.2 and 1.6 ± 0.9 kg in fasters and controls, respectively. Fasters showed a more pronounced decrease of leptin (58% vs. 20%; P < 0.001) and a 17% increase of cortisol levels (P < 0.001). Mood ratings increased significantly in the late phase of fasting (P < 0.01) but were not related to weight-loss, leptin-depletion or cortisol increase. Our findings suggest that fasting induces specific mood-enhancement. The physiological mediator appears to be neither leptin nor cortisol, the role of other mechanisms has to be further studied.     

35-year-old patient with metastasized carcinoid of Vater's ampulla--case report and review of the literature]

We report the case of a 35-year-old female patient with a metastasized carcinoid of the papilla of Vater which is a rare lesion. 96 cases have been published in world literature previously. The carcinoid of the papilla of Vater appears typically as a hormone inactive tumor. It becomes symptomatic by cholestasis and jaundice in most cases and not by carcinoid-syndrome. An association with von Recklinghausen's disease as described in 25% of cases was not given in our patient. In contrast to the duodenal carcinoid there is no linear relationship between primary tumor size and incidence of metastases. The correct diagnosis was proven by histologic and immunohistochemical methods on specimen taken after endoscopic papillotomy. In spite of sensitive diagnostic methods like endosonography and somatostatin-receptor-scintigraphy exact staging was made intraoperatively in this case. Three months after pylorus pancreatoduodenal resection with lymphadenectomy the patient remained well with no evidence of tumor recurrence.     

Fecal lactoferrin as a noninvasive biomarker in inflammatory bowel diseases

The diagnosis and management of inflammatory bowel diseases (IBD), i.e., Crohn's disease and ulcerative colitis, still present a number of challenges. The fecal biomarker lactoferrin has been shown to be useful in the diagnosis and management of these diseases. This review includes a discussion of the current literature on lactoferrin as a biomarker of intestinal disease, detection of disease activity in IBD, comparison of lactoferrin to endoscopy and histology, lactoferrin measurement in pediatric IBD and lactoferrin as a biomarker for monitoring medical treatment in IBD.     

Magnetic resonance colonography without bowel cleansing: a prospective cross sectional study in a screening population

BACKGROUND AND AIMS: To evaluate the diagnostic accuracy of magnetic resonance colonography (MRC) without bowel cleansing in a screening population and compare the results to colonoscopy as a standard of reference. METHODS: 315 screening patients, older than 50 years with a normal risk profile for colorectal cancer, were included in this study. For MRC, a tagging agent (5.0% Gastrografin, 1.0% barium sulphate, 0.2% locust bean gum) was ingested with each main meal within 2 days prior to MRC. No bowel cleansing was applied. For the magnetic resonance examination, a rectal water enema was administered. Data collection was based on contrast enhanced T1 weighted images and TrueFISP images. Magnetic resonance data were analysed for image quality and the presence of colorectal lesions. Conventional colonoscopy and histopathological samples served as reference. RESULTS: In 4% of all colonic segments, magnetic resonance image quality was insufficient because of untagged faecal material. Adenomatous polyps >5 mm were detected by means of MRC, with a sensitivity of 83.0%. Overall specificity was 90.2% (false positive findings in 19 patients). However, only 16 of 153 lesions <5 mm and 9 of 127 hyperplastic polyps could be visualised on magnetic resonance images. CONCLUSIONS: Faecal tagging MRC is applicable for screening purposes. It provides good accuracy for the detection of relevant (ie, adenomatous) colorectal lesions >5 mm in a screening population. However, refinements to optimise image quality of faecal tagging are needed.     

MR colonography vs. optical colonoscopy: comparison of patients’ acceptance in a screening population

The aim of this study was to compare optical colonoscopy to fecal-tagging-based MR colonography in a screening population in terms of comfort and acceptance ratings as well as for future preferences as colorectal cancer screening examinations. Two hundred eighty-four asymptomatic patients (mean age 59 years) underwent MRC and OC within 4 weeks. While MRC was based on a fecal tagging technique, OC was performed after bowel cleansing. For OC, sedatives and analgesics were used. Patients evaluated both modalities and certain aspects of the examination according to a 10-point-scale with higher scores denoting a worse experience. Furthermore, preferences for future examinations were evaluated. No significant difference was noted for the overall acceptance of OC (mean value 3.0) and MRC (mean value 3.4). For MRC, the placement of the rectal tube was rated as the most unpleasant part, whereas bowel purgation was regarded most inconvenient for OC. Patients aged 55 years and older perceived most aspects less unpleasant than younger patients. Of the patients, 46% preferred MRC for future screening examinations (OC: 44%). OC and MRC have comparable general acceptance levels in a screening population. Especially for patients declining endoscopy as a screening method MRC may evolve as an attractive alternative.