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.     

Why patients with inflammatory bowel disease use or do not use complementary and alternative medicine: a Canadian national survey.

BACKGROUND: The use of complementary and alternative medicine (CAM) is common in patients with inflammatory bowel disease (IBD). OBJECTIVES: To determine the factors associated with use of CAM, the reasons commonly cited for use or nonuse of CAM, and the correlations between the factors associated with use of CAM and reasons for CAM use. SUBJECTS: The study included 2828 members of the Crohn's and Colitis Foundation of Canada. METHODS: Subjects were mailed a questionnaire that included items on demographic characteristics, disease and treatment history, health attitudes and behaviours, and reasons for use or nonuse of CAM. Logistical regression was used to determine significant associations with current CAM use. RESULTS: In patients with Crohn's disease and ulcerative colitis, CAM use was associated with more severe disease activity, use of CAM for other purposes, use of exercise and prayer for IBD, and a desire for an active role in treatment decisions. CAM use was also associated with younger age in those with Crohn's disease, and less confidence in their IBD physician in those with ulcerative colitis. The most common reasons for CAM use were a desire for greater control, having heard or read that CAM might help, and the emphasis CAM places on treating the whole person. The most common reasons for not using CAM were that conventional treatments were successful, that not enough was known about CAM and a belief that CAM would not help. CONCLUSION: Disease activity and health attitudes and behaviours, but not demographic characteristics, are associated with CAM use by those with IBD.     

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 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.     

Use of complementary and alternative medicine in patients with inflammatory bowel disease: results of a cross-sectional study in Norway

Abstract

Objective. To determine the proportion of complementary and alternative medicine (CAM) use in patients with inflammatory bowel disease (IBD) and to identify demographic and clinical factors that are associated with CAM use. Material and methods. In this cross-sectional study design, patients with confirmed diagnosis of ulcerative colitis (UC) or Crohn's disease (CD), and ≥18 years old, attending outpatient clinics at 14 hospitals in Norway were eligible to complete questionnaires including demographics, clinical variables, and the International CAM Questionnaire (I-CAM-Q). Results. Of 460 patients included in the study, 430 had evaluable questionnaires (response rate 93%). Forty-nine percent (95% CI: 44–54) had used some type of CAM within the past 12 months. CAM services were utilized by 27% (95% CI: 23–31) of the patients, 21% (95% CI: 16–23) reported use of CAM products, and 28% (95% CI: 23–31) used CAM self-help practices. The most common pattern of CAM use was to combine CAM services and CAM products. Significantly, more UC patients (56%) than CD patients (44%) reported CAM use, p = 0.03. In UC, only the presence of at least one comorbid condition was directly related to CAM use. In CD, being a woman, being aged 31–50 years, having a higher education level, and experiencing adverse drug reactions from IBD medication were factors independently associated with the use of CAM. Conclusion. Use of CAM was common among IBD patients attending outpatient clinics. Both demographic and clinical factors were associated to CAM use, but the factors differed in their significance for UC and CD.     

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.     

An international survey of the use and attitudes regarding alternative medicine by patients with inflammatory bowel disease

OBJECTIVE: There is a perception of increasing and widespread use of alternative medicine for inflammatory bowel disease (IBD). We assessed the usage of alternative therapies among patients with IBD, whether there were similar or contrasting variables that were predictive of such use, and contrasted the use in four different centers in North America and Europe. METHODS: Patients in four IBD centers completed a self-administered questionnaire regarding alternative medicine. The centers were in Cork, Los Angeles, Stockholm, and Winnipeg. Patient demographics, the use of 18 types of alternative medicine, and attitudes towards alternative and conventional medicine were compared. A multiple logistic regression analysis was used. RESULTS: Fifty-one percent of 289 patients used some form of alternative medicine. The percentages of use by site were Cork = 31%, Los Angeles = 68%, Stockholm = 32%, and Winnipeg = 57%. The six most commonly used therapies in descending order were: exercise (28%), prayer (18%), counseling (13%), massage (11%), chiropractic (11%), and relaxation (10%). Only 7% used acupuncture or homeopathy and 5% used herbal medicine. The highest odds ratios (confidence intervals [CIs]) for using any form of alternative medicine were associated with: being single 3.1 (1.7-5.7), Los Angeles patient 4.4 (2.3-8.3), Winnipeg patient 2.7 (1.3-5.9), and an increase of alternative medicine use of 2.7% for every M.D. visit (CI, 2-11%/visit). The patient age, gender, disease diagnosis, or duration of disease were not predictive of any type of alternative medicine use. Regarding attitudes, respondents from Cork were most favorable toward alternative medicine use and least favorable toward conventional medicine. Based on attitudes, subjects were more likely to use alternative medicine if they were not satisfied with conventional therapy, viewed hospitals as dangerous places, thought that alternative medicine practitioners should have a role in hospitals, and felt their medical situation was hopeless. CONCLUSIONS: Fifty-one percent of respondents used some form of alternative medicine. The use was greater among the North American patients than the European ones. Respondents were more likely to use alternative medicine if they were single, in a higher income bracket, and an urban dweller.     

Association of adherence to therapy and complementary and alternative medicine use with demographic factors and disease phenotype in patients with inflammatory bowel disease

Background and aimsPrevious studies have suggested an increasing use of complementary and alternative medicine (CAM) in patients with inflammatory bowel disease (IBD). Furthermore, a significant number of IBD patients fail to comply with treatment. The aim of our study was to evaluate the prevalence of non-adherence and the use of CAM in Hungarian patients with IBD.MethodsA total of 655 consecutive IBD patients (CD: 344, age: 38.2 [SD 12.9] years; UC: 311, age: 44.9 [15.3] years) were interviewed during the specialist visit by self-administered questionnaire including demographic and disease-related data as well as items analyzing the extent of non-adherence and CAM use. Patients taking more than 80% of each prescribed medication were classified as adherent.ResultsThe overall rate of self-reported non-adherence (CD: 20.9%, UC: 20.6%) and CAM (CD: 31.7%, UC: 30.9%) use did not differ between Crohn's disease (CD) and ulcerative colitis (UC). The most common causes of non-adherence were: forgetfulness (47.8%), too many/unnecessary pills (39.7%), being afraid of side effects (27.9%) and too frequent dosing. Most common forms of CAM were herbal tea (47.3%), homeopathy (14.6%), special diet (12.2%), and acupuncture (5.8%). In CD, disease duration, date of last follow-up visit, educational level and previous surgeries were predicting factors for non-adherence. Alternative medicine use was associated in both diseases with younger age, higher educational level, and immunosuppressant use. In addition, CAM use in UC was more common in females and in patients with supportive psychiatric/psychological therapy.ConclusionsNon-adherence and CAM use is common in patients with IBD. Special attention should be paid to explore the identified predictive factors during follow-up visits to improve adherence to therapy and improving patient–doctor relationship.     

Concerns of patients with inflammatory bowel disease: results from a clinical population

OBJECTIVE: The impact of chronic illness is influenced not just by physical symptoms but also by psychosocial factors. The aim of this study was to determine the concerns of inflammatory bowel disease (IBD) patients in a clinical sample, if concerns differ between patients from varied clinical and demographic variables, and if concerns influence well-being beyond the influence of physical symptoms. METHODS: Subjects (n = 259) completed a validated measure of concerns specific to IBD and provided demographic and disease-related information. RESULTS: The most intense concerns involved both physical (e.g., energy level) and psychosocial issues (e.g., achieving full potential). There were numerous differences in disease concerns based on ability to work but none based on disease duration. Factor analysis yielded three indices: body image and interpersonal concerns, general physical impact, and disease stigma. Age and education only affected certain concern indices in subgroups of patients. Greater concerns negatively influenced well-being beyond the influence of physical symptoms. CONCLUSION: Psychosocial factors, in addition to physical symptoms, play an important role on the impact of illness in patients with IBD.     

Complementary and alternative medicine in patients with inflammatory bowel disease: The results of a population-based inception cohort study (IBSEN)

Background and aimsThe use of complementary and alternative medicine (CAM) has been increasing in recent decades. Our aim was to determine the proportion of CAM use among patients with inflammatory bowel disease (IBD) in a longitudinal, population-based cohort and to identify predictive factors for CAM use.MethodsThe Inflammatory Bowel South-Eastern Norway (IBSEN) study is a population-based IBD cohort that has been followed prospectively for 10 years. The ten-year follow-up was conducted from 2000 to 2004 and included a questionnaire regarding CAM, a structured interview, a review of hospital records, a clinical examination, laboratory tests, and an ileocolonoscopy.ResultsOf the 620 patients evaluated at the ten-year follow-up, 517 (84%) completed the CAM questionnaire, 353 had ulcerative colitis (UC), 164 had Crohn's disease (CD), and 50% were male. Thirty percent reported the use of CAM at some point since their IBD diagnosis, and 7.5% reported current CAM use. More CD patients than UC patients reported CAM use (38% vs. 27%, respectively; p = 0.01). Younger age, female gender, and higher education level predicted CAM use in UC, whereas younger age was the only predictor of CAM use in CD. Thirty-six percent of the CAM users were mostly satisfied or very satisfied with the treatment.ConclusionOne third of the patients in this population-based cohort had used CAM at some point during a ten-year disease course, but only 7.5% reported current CAM use. CAM use was more common in the CD than in the UC patients. Only socio-demographic factors, such as age, gender and education, predicted CAM use.     

Apolipoprotein A-IV is an independent predictor of disease activity in patients with inflammatory bowel disease

BACKGROUND: ApoA-IV, an apolipoprotein (apo) with antioxidant, antiatherogenic, and antiinflammatory properties, was recently demonstrated to inhibit dextran sulfate sodium (DSS)-induced experimental colitis in mice. We therefore hypothesized that apoA-IV may be associated with disease activity in patients with inflammatory bowel disease (IBD). METHODS: We addressed this question by testing for associations between apoA-IV genotypes, apoA-IV plasma levels, inflammatory parameters, and clinical disease activity in 206 patients with Crohn's disease (CD), 95 subjects with ulcerative colitis (UC), and 157 healthy controls. RESULTS: In CD patients, apoA-IV plasma levels were inversely associated with C-reactive protein (CRP) (P = 0.005) and disease activity (P = 0.01) in univariate analysis. In multiple logistic regression analysis, apoA-IV levels were identified as an independent predictor of elevated CRP (odds ratio [OR] 0.956, 95% confidence interval [CI]: 0.916-0.998, P = 0.04) and active disease (OR 0.957, 95% CI: 0.918-0.998, P = 0.04). In UC patients the apoA-IV gene variant 360 His (P = 0.03) but not apoA-IV levels (P = 0.15) were associated with increased disease activity in univariate analysis. This association, however, was lost in multiple logistic regression analysis (OR 3.435, 95% CI 0.995-11.853, P = 0.05). CONCLUSIONS: To our knowledge, this is the first study to demonstrate an association of apoA-IV with disease activity in patients with CD. Further studies are needed to define the relationship of apoA-IV to IBD.     

Risk factors in German twins with inflammatory bowel disease: Results of a questionnaire-based survey

IntroductionEnvironmental factors may play an important role in the pathogenesis of IBD. The history of patients of the German IBD twin study was analyzed by questionnaires and interviews.MethodsRandomly selected German monozygotic (MZ) and dizygotic (DZ) twins with at least one sibling suffering from IBD (n = 512) were characterized in detail including demography, medical history and concomitant medications. Controls comprised of non-twin IBD patients (n = 392) and healthy subjects (n = 207).ResultsThe most significant variables that were associated with Crohn's disease (CD) or ulcerative colitis (UC) included living abroad before time of diagnosis (OR, 4.32; 95% CI, 1.57–13.69), high frequency of antibiotic use (MZ CD OR, 5.03; 95% CI 1.61–17.74, DZ CD OR, 7.66; 95% CI, 3.63–16.82, MZ UC OR, 3.82; 95% CI, 1.45–10.56, DZ UC OR, 3.08; CI, 1.63–5.92), high consumption of processed meat including sausage (MZ CD OR, 7.9; 95% CI, 2.15–38.12, DZ CD OR, 10.75; 95% CI, 4.82–25.55, MZ UC OR, 5.69; 95% CI, 1.89–19.48, DZ UC OR, 18.11; 95% CI, 7.34–50.85), and recall of bacterial gastrointestinal infections (MZ CD OR, 15.9; 95% CI, 4.33–77.14, DZ CD OR, 17.21; 95% CI, 4.47–112.5, MZ UC OR, 5.87; 95% CI, 1.61–28.0, DZ UC OR, 11.34; 95% CI, 4.81–29.67).ConclusionsThis study reinforced the association of life style events, in particular a specific dietary and infections history, with IBD. Alteration of gut flora or alterations of the mucosal immune system in reactivity to the flora could be an important factor to explain the relationship between life-style and disease.     

Patterns of traditional Chinese medicine use in patients with inflammatory bowel disease: a population study in Taiwan

BACKGROUND/AIMS: Many researchers have reported on the utilization of complementary and alternative medicine by patients with inflammatory bowel disease (IBD). The aim of this study was to investigate the use of traditional Chinese medicine (TCM) by all IBD patients within the National Health Insurance in Taiwan. METHODOLOGY: The complete ambulatory visits records of TCM in 2004 were obtained from the National Health Insurance Research Database. For all IBD patients identified from the registry for catastrophic illness patients, patterns of TCM visits were analyzed. RESULTS: The prevalence of IBD in Taiwan was 5.6 per 100,000 persons at the end of 2004. Of 1,206 IBD patients, 440 (37%) patients have in total 3,169 TCM visits in 2004. Women were more likely to use TCM than men (40.5% vs. 34.3%). Among the TCM users of the IBD patients, 200 (45.5%) patients had gastroenterological diagnoses at their TCM visits. Most of their TCM visits contained herbal remedies (90%), followed by manual therapy (11.7%) and acupuncture (9.8%). CONCLUSIONS: The high utilization rate of TCM among the IBD patients in Taiwan implied that their needs of medical care were not satisfied by the mainstream Western medicine. The TCM herbal regimens deserve further studies.     

Factors associated with changes in self-reported health status in infliximab-treated inflammatory bowel disease patients: results from a case management survey

Background: Canadian inflammatory bowel disease patients treated with infliximab are predominantly managed through a nationwide case management system, named BioAdvance^®. Methods: A web-based survey was provided to patients currently receiving infliximab therapy within BioAdvance^®. Patients were categorized according to health trajectories: decliners, non-changers, moderate increasers and strong increasers. Factors associated with health trajectories were identified using multivariable multinomial logistic regression. Results: 918 of 1160 respondents were inflammatory bowel disease patients reporting health status. Strong increasers were more likely to use educational tools than non-changers (adjusted odds ratio [aOR]: 1.65; 95% CI: 1.03–2.64), to be treated for ulcerative colitis (aOR: 2.05; 95% CI: 1.16–3.64) and to perceive case management as important (aOR: 2.52; 95% CI: 1.56–4.09). Younger (aOR: 0.72; 95% CI: 0.63–0.83) and French-speaking (aOR: 0.34; 95% CI: 0.18–0.63) patients were less likely to miss workdays. Patients were more likely to have missed workdays prior to joining the case management program. Conclusions: Inflammatory bowel disease patients receiving infliximab within the nationwide case management system report a positive impact on health status and absenteeism.     

A comparison of self-perceived health status in inflammatory bowel disease and irritable bowel syndrome patients from a Canadian national population survey.

OBJECTIVE: To determine whether differences exist in perceptions of physical health, mental health and stress levels between patients with inflammatory bowel disease (IBD) and patients with irritable bowel syndrome (IBS). METHODS: Data were obtained from the 2005 Canadian Community Health Survey, which had a sample size of 132,947 Canadians. Information on 4441 participants aged 19 years or older who reported that they had been diagnosed with Crohn's disease (n=474), ulcerative colitis (n=637) or IBS (n=3330) was analyzed regarding perceptions of their physical health, mental health, stress levels and activity levels. RESULTS: Overall, IBD patients reported being in fair to poor health (P<0.01) more often than IBS patients. In addition, IBS patients were more likely than IBD patients to report poor mental health status (P<0.01) and greater stress levels (P<0.01). In multivariate analyses, having IBS or IBD along with another chronic disease significantly increased the odds of reporting poorer health status. CONCLUSIONS: People with IBD were more likely to experience fair or poor general health. IBS patients reported higher levels of stress and poorer mental health than IBD patients. When IBS or IBD coexisted with another chronic condition, activity participation at home and at work was significantly more likely to be impaired.