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Sinclair J, Brooks-Warburton J, Bottoms L. Perceptions, behaviours and barriers towards exercise practices in inflammatory bowel disease. PLoS One 2024; 19:e0299228. [PMID: 38578737 PMCID: PMC10997097 DOI: 10.1371/journal.pone.0299228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 02/04/2024] [Indexed: 04/07/2024] Open
Abstract
Inflammatory bowel disease (IBD), a chronic disease affecting the digestive tract, has a significant impact on health-related quality of life. Pharmaceutical treatment is typically adopted, yet exercise is increasingly becoming recognized as an adjunct therapy. This study aimed to explore the perspectives, behaviours, and barriers of IBD patients in terms of their exercise habits. A 16-item closed-ended questionnaire was completed by 463 adult IBD patients (Ulcerative colitis = 57.02%, Crohn's dis-ease = 40.60% and Other = 2.38%) (Female = 76.67%, Male = 22.46 and Non-binary = 0.86%). The questionnaire was divided into three sections: baseline/demographic characteristics, disease characteristics, and exercise perceptions, beliefs, and behaviours. Significantly (P<0.001) more participants (63.07%) reported that they engage regularly with exercise compared to those who do not; however, engagement was significantly lower in female patients (59.72%) compared to males (74.04%). Respondents also rated significantly (P<0.001) that a combination of factors prevents engagement in exercise (74.30%). Moderate intensity exercise was the predominant (P<0.001) aerobic modality (39.04%), the majority (P<0.001) response was that patients undertake no resistance training (27.74%), and significantly more (P<0.001) patients indicated that they don't know whether resistance training can influence IBD either positively (57.53%) or negatively (62.33%). Whilst it is encouraging that IBD patients are engaging regularly with exercise, the reduced levels of engagement in females and lack of knowledge/ engagement with resistance training, indicate that future implementation and educational developments are necessary to enhance exercise in females and resistance training engagement in all IBD patients.
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Affiliation(s)
- Jonathan Sinclair
- Research Centre for Applied Sport, Physical Activity and Performance, School of Sport & Health Sciences, Faculty of Allied Health and Wellbeing, University of Central Lancashire, Lancashire, United Kingdom
| | | | - Lindsay Bottoms
- Centre for Research in Psychology and Sport Sciences, School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire, United Kingdom
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2
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Mousavi T, Nikfar S, Abdollahi M. Comprehensive study on the administrative, economic, regional, and regulatory prospects of complementary and alternative medicine (CAM) in inflammatory bowel disease (IBD). Expert Rev Clin Pharmacol 2021; 14:865-888. [PMID: 33993811 DOI: 10.1080/17512433.2021.1925108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
Introduction: Due to the high cost, low effectiveness, and adverse effects plus the life-long nature of inflammatory bowel disease (IBD), and misconception on safety, efficacy, and cost-effectiveness of complementary and alternative medicine (CAM), the market demand for CAM has risen over the past decades. A critical review of patients' and physicians' attitudes, market drivers, economic aspects, regulatory roles, and regional distribution is lacking.Areas covered: Through relevant databases, the existing English language literature concerning the association of CAM use with IBD was collected over the past two decades. Data was then analyzed, comprehensively summarized in tables/figures, and justified concerning administrative, organizational, regional, economic, and regulatory perspectives.Expert opinion: Although CAM utilization is more prevalent among younger, female, and high-educated IBD patients, issues concerning weak study designs, limited-time period/regional distribution of recent surveys, and lack of economic evaluations on CAM make it entirely unfeasible to draw a firm conclusion. Regulators are lagging in meeting the dire need of IBD patients, especially the elderly. Lack of legislation regarding registration, sales monitoring, licensing, insurance coverage, efficacy/safety assessments, post-marketing surveillance, quality assurance, and reference pricing alongside the limited support for CAM research are the main matters that should be urgently addressed.
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Affiliation(s)
- Taraneh Mousavi
- Toxicology and Diseases Group (TDG), Pharmaceutical Sciences Research Center (PSRC), the Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences, Tehran, Iran.,Department of Toxicology and Pharmacology, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Shekoufeh Nikfar
- Personalized Medicine Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran.,Evidence-Based Evaluation of Cost-Effectiveness and Clinical Outcomes Group, Pharmaceutical Sciences Research Center (PSRC), and the Pharmaceutical Management and Economics Research Center (PMERC), the Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences, Tehran, Iran.,Department of Pharmacoeconomics and Pharmaceutical Administration, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Abdollahi
- Toxicology and Diseases Group (TDG), Pharmaceutical Sciences Research Center (PSRC), the Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences, Tehran, Iran.,Department of Toxicology and Pharmacology, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.,Personalized Medicine Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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Lamers CR, de Roos NM, Koppelman LJM, Hopman MTE, Witteman BJM. Patient experiences with the role of physical activity in inflammatory bowel disease: results from a survey and interviews. BMC Gastroenterol 2021; 21:172. [PMID: 33853535 PMCID: PMC8046271 DOI: 10.1186/s12876-021-01739-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 03/29/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Physical activity may affect disease activity in patients with inflammatory bowel disease. We used a survey to investigate this association and performed interviews to get a better understanding of patient experiences, and therefore the nature of this association. METHODS Patients with Crohn's disease (CD, n = 176) and ulcerative colitis (UC, n = 162) completed the short Crohn's Disease Activity (sCDAI) or Patient Simple Clinical Colitis Activity Index (P-SCCAI) and the Short Questionnaire to Assess Health-enhancing physical activity (SQUASH). Associations were investigated by multiple linear regression. Semi-structured interviews (7 CD, 7 UC) were conducted to assess patient experiences with the role of physical activity in their disease. RESULTS The majority of survey participants were in remission (70%) and adhered to the Dutch physical activity guidelines (61%). In Crohn's disease, the total physical activity score was inversely associated with disease activity, even after adjustment for confounders (β = - 0.375; p = 0.013). No association between physical activity and disease activity was found in ulcerative colitis. Of the interviewees, 86% experienced beneficial effects of physical activity, such as improved general fitness, quality of life and self-image. However, during periods of active disease they struggled to find the motivation and perseverance to be physically active due to physical barriers. CONCLUSIONS Crohn's disease participants with a higher physical activity level had a lower disease activity. This inverse association was not found in ulcerative colitis. Interviews revealed that IBD patients generally experience beneficial effects from physical activity, although the barriers caused by active disease may put them off to be physically active.
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Affiliation(s)
- Carlijn R Lamers
- Department of Gastroenterology and Hepatology, Hospital Gelderse Vallei, Willy Brandtlaan 10, 6716 RP, Ede, The Netherlands. .,Division of Human Nutrition and Health, Wageningen University and Research (WUR), Stippeneng 4, 6708 WE, Wageningen, The Netherlands.
| | - Nicole M de Roos
- Division of Human Nutrition and Health, Wageningen University and Research (WUR), Stippeneng 4, 6708 WE, Wageningen, The Netherlands
| | - Lola J M Koppelman
- Division of Human Nutrition and Health, Wageningen University and Research (WUR), Stippeneng 4, 6708 WE, Wageningen, The Netherlands
| | - Maria T E Hopman
- Department of Physiology, Radboud University Medical Center, Philips Van Leydenlaan 15, 6500 HB, Nijmegen, The Netherlands
| | - Ben J M Witteman
- Department of Gastroenterology and Hepatology, Hospital Gelderse Vallei, Willy Brandtlaan 10, 6716 RP, Ede, The Netherlands.,Division of Human Nutrition and Health, Wageningen University and Research (WUR), Stippeneng 4, 6708 WE, Wageningen, The Netherlands
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4
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Tangkiatkumjai M, Boardman H, Walker DM. Potential factors that influence usage of complementary and alternative medicine worldwide: a systematic review. BMC Complement Med Ther 2020; 20:363. [PMID: 33228697 PMCID: PMC7686746 DOI: 10.1186/s12906-020-03157-2] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 11/12/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To determine similarities and differences in the reasons for using or not using complementary and alternative medicine (CAM) amongst general and condition-specific populations, and amongst populations in each region of the globe. METHODS A literature search was performed on Pubmed, ScienceDirect and EMBASE. KEYWORDS 'herbal medicine' OR 'herbal and dietary supplement' OR 'complementary and alternative medicine' AND 'reason' OR 'attitude'. Quantitative or qualitative original articles in English, published between 2003 and 2018 were reviewed. Conference proceedings, pilot studies, protocols, letters, and reviews were excluded. Papers were appraised using valid tools and a 'risk of bias' assessment was also performed. Thematic analysis was conducted. Reasons were coded in each paper, then codes were grouped into categories. If several categories reported similar reasons, these were combined into a theme. Themes were then analysed using χ2 tests to identify the main factors related to reasons for CAM usage. RESULTS 231 publications were included. Reasons for CAM use amongst general and condition-specific populations were similar. The top three reasons for CAM use were: (1) having an expectation of benefits of CAM (84% of publications), (2) dissatisfaction with conventional medicine (37%) and (3) the perceived safety of CAM (37%). Internal health locus of control as an influencing factor was more likely to be reported in Western populations, whereas the social networks was a common factor amongst Asian populations (p < 0.05). Affordability, easy access to CAM and tradition were significant factors amongst African populations (p < 0.05). Negative attitudes towards CAM and satisfaction with conventional medicine (CM) were the main reasons for non-use (p < 0.05). CONCLUSIONS Dissatisfaction with CM and positive attitudes toward CAM, motivate people to use CAM. In contrast, satisfaction with CM and negative attitudes towards CAM are the main reasons for non-use.
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Affiliation(s)
- Mayuree Tangkiatkumjai
- Department of Clinical Pharmacy, Faculty of Pharmacy, Srinakharinwirot University, Nakhonnayok, 26120 Thailand
| | - Helen Boardman
- Division of Pharmacy Practice and Policy, School of Pharmacy, University of Nottingham, Nottingham, UK
| | - Dawn-Marie Walker
- School of Health Sciences, University of Southampton, Southampton, UK
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Akkol EK, Karpuz B, Sobarzo-Sánchez E, Khan H. A phytopharmacological overview of medicinal plants used for prophylactic and treatment of colitis. Food Chem Toxicol 2020; 144:111628. [PMID: 32738379 DOI: 10.1016/j.fct.2020.111628] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/26/2020] [Accepted: 07/14/2020] [Indexed: 12/26/2022]
Abstract
Inflammatory bowel diseases are chronic diseases that develop on the genetic background. They are characterized by an idiopathic, chronic course and periods of activation and remission. However, genetic and environmental factors are thought to play a role in its pathogenesis. Significant improvements in treatment strategies have been witnessed. Depending on the severity of the disease, mesalamine, immunosuppressants, anti-TNF, anti-integrin, Janus kinase inhibitors, and thiopurines can be used for treatment. However, these treatments have side effects such as headache, dizziness, nausea, loss of appetite, hair loss, gas, vomiting, rash, fever, and decreased white blood cell count. The search for treatment that may be a safer alternative, immunomodulatory, and immunosuppressive therapy has gained importance nowadays. Herbal medicine is preferred to treat a wide range of acute and chronic gastrointestinal diseases, including ulcerative colitis. Preclinical and clinical studies show that plants are promising in terms of their use in treating pathological conditions. The effectiveness of plants in treating ulcerative colitis has been determined. However, more studies are needed to explore the long-term effects of these herbal medicines. The present review presents information on medicinal plants and phytochemicals reported for use or potential of application in ulcerative colitis, a type of inflammatory bowel diseases.
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Affiliation(s)
- Esra Küpeli Akkol
- Department of Pharmacognosy, Faculty of Pharmacy, Gazi University, Etiler, 06330, Ankara, Turkey.
| | - Büşra Karpuz
- Department of Pharmacognosy, Faculty of Pharmacy, Gazi University, Etiler, 06330, Ankara, Turkey
| | - Eduardo Sobarzo-Sánchez
- Instituto de Investigación en Salud, Facultad de Ciencias de la Salud, Universidad Central de Chile, 8330507, Santiago, Chile; Department of Organic Chemistry, Faculty of Pharmacy, University of Santiago de Compostela, 15782, Santiago de Compostela, Spain.
| | - Haroon Khan
- Department of Pharmacy, Abdul Wali Khan University Mardan, 23200, Pakistan.
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Lee SH, Chang K, Seo KS, Cho YK, Song EM, Hwang SW, Yang DH, Ye BD, Byeon JS, Myung SJ, Yang SK, Park SH. Changes in prevalence and perception of complementary and alternative medicine use in Korean inflammatory bowel disease patients: results of an 8-year follow-up survey. Intest Res 2020; 18:192-199. [PMID: 32238788 PMCID: PMC7206343 DOI: 10.5217/ir.2019.00115] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 01/11/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND/AIMS The use of complementary and alternative medicine (CAM) is a global phenomenon, including inflammatory bowel disease (IBD) patients. We aimed to assess the change in prevalence and patterns of CAM use, and attitudes towards CAM over an 8-year time interval (2006 vs. 2014) among IBD patients in Korea. METHODS A total of 221 IBD patients (CD=142, UC=79) were asked to complete a questionnaire regarding CAM at two time points: at enrollment (2006) and 8 years later (2014/2015). RESULTS The proportion of patients ever using CAM increased significantly from 60.2% in 2006 to 79.6% in 2014 (P<0.001), while the proportion of current CAM users increased slightly (35.7% to 38.0%, P=0.635); 21.7% used CAM consistently at both time points. The proportion of patients who felt CAM was less effective (P<0.001) and more expensive (P=0.04) than conventional treatments increased over time. Also, the proportion among ever CAM users who perceived a positive effect from CAM significantly decreased in 2014 compared to 2006 (P=0.004). Higher education (adjusted odds ratio [aOR], 2.10), prior side effects to conventional therapies (aOR, 2.23), and prior use of corticosteroids (aOR, 2.51) were associated with CAM use. Interestingly, use of CAM before IBD diagnosis (aOR, 2.73) was significantly associated with consistent CAM use. CONCLUSIONS Although the attitudes toward CAM have become less favorable, the majority of IBD patients have experienced CAM with an overall increase of current CAM users over time. Moreover, more than half of current CAM users used CAM consistently over time.
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Affiliation(s)
- Sun-Ho Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kiju Chang
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ki Seok Seo
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yun Kyung Cho
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Mi Song
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Wook Hwang
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong-Hoon Yang
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byong Duk Ye
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong-Sik Byeon
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung-Jae Myung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Suk-Kyun Yang
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Hyoung Park
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Holik D, Včev A, Milostić-Srb A, Salinger Ž, Ivanišević Z, Včev I, Miškulin M. THE EFFECT OF DAILY PHYSICAL ACTIVITY ON THE ACTIVITY OF INFLAMMATORY BOWEL DISEASES IN THERAPY-FREE PATIENTS. Acta Clin Croat 2019; 58:202-212. [PMID: 31819315 PMCID: PMC6884387 DOI: 10.20471/acc.2019.58.02.02] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
It has been suggested that various environmental factors play a very important role in the etiology of inflammatory bowel diseases (IBDs) and that they have a significant effect on the course of these diseases. The aim of this study was to investigate the effect of daily physical activity on the activity of IBDs in therapy-free patients. This cross-sectional population based study was conducted in eastern Croatia from January to June 2016. The study included 312 patients, mean age 49.9±15.0 years, 53.2% of males and 46.8% of females; there were 63.4% of ulcerative colitis (UC) and 36.6% of Crohn’s disease (CD) patients. Sociodemographic characteristics of patients, data on their daily physical activity and type of therapy taken were collected through a specifically designed and validated questionnaire, while the activity of UC and CD was evaluated using the Mayo index and Harvey-Bradshaw index. The study showed that 24.0% of patients were not taking therapy. Daily physical activity was connected to IBD in study patients when taking both diseases collectively (Fisher exact test; p<0.001), as well as to the inactivity of CD (Fisher exact test; p=0.001) and UC (Fisher exact test; p=0.006), when observing each disease separately. Daily physical activity was connected to the inactivity of IBDs in patients not taking therapy. It is necessary to educate all IBD patients about the importance of physical activity in order to control their disease.
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Affiliation(s)
| | - Aleksandar Včev
- 1Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 2Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Department of Mathematics, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 4University of Zadar, Zadar, Croatia
| | - Andrea Milostić-Srb
- 1Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 2Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Department of Mathematics, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 4University of Zadar, Zadar, Croatia
| | - Željka Salinger
- 1Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 2Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Department of Mathematics, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 4University of Zadar, Zadar, Croatia
| | - Zrinka Ivanišević
- 1Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 2Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Department of Mathematics, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 4University of Zadar, Zadar, Croatia
| | - Ivan Včev
- 1Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 2Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Department of Mathematics, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 4University of Zadar, Zadar, Croatia
| | - Maja Miškulin
- 1Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 2Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Department of Mathematics, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 4University of Zadar, Zadar, Croatia
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8
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Fernández A, Simian D, Quera R, Flores L, Ibáñez P, Lubascher J, Figueroa C, Kronberg U, Pizarro G, Fluxá D. Complementary and alternative medicine in patients with inflammatory bowel disease: A survey performed in a tertiary center in Chile. Complement Ther Med 2018; 40:77-82. [PMID: 30219473 DOI: 10.1016/j.ctim.2018.07.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 07/30/2018] [Accepted: 07/31/2018] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES The aim of this study was to assess the type and prevalence of complementary and alternative medicine (CAM) use in patients with inflammatory bowel disease (IBD) who are treated at our center. DESIGN Observational, cross-sectional questionnaire-based study that included patients from the IBD program of our center. SETTING Tertiary clinical center in Santiago, Chile. MAIN OUTCOME MEASURES Types of CAM being used by patients with IBD. RESULTS A total of 200 patients were included, 68% ulcerative colitis, 29% Crohn's disease, and 3% non-classifiable IBD. Overall, 25% of the patients reported current use of CAM, 30% reported using in it the past, and 45% indicated that they had never used it before. The use of CAM was recommended in 20% of the patients by other healthcare professionals and in 10% of the patients by the gastroenterologist. Forty-nine percent of the patients informed the gastroenterologist that they were using CAM. Overall, 86% of the patients did not modify the conventional medical treatment (CMT). None of the patients who were using curcumin, homeopathic medicine, acupuncture or biomagnetism modified the CMT. CONCLUSIONS The type of CAM being used plays an important role when the patient makes the decision to inform the gastroenterologist. Other healthcare professionals play an important role in providing the advice to start CAM. Gastroenterologists must be aware of the high prevalence of CAM use in IBD patients, actively ask about CAM use and guide the patients who want to use CAM in a responsible and safe manner.
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Affiliation(s)
- Antonia Fernández
- Inflammatory Bowel Disease Research Fellow, Clínica Las Condes, Santiago, Chile
| | - Daniela Simian
- Academic Research Unit, Clínica Las Condes, Santiago, Chile
| | - Rodrigo Quera
- Inflammatory Disease Program, Gastroenterology Department, Clínica Las Condes, Santiago, Chile.
| | - Lilian Flores
- Inflammatory Disease Program, Gastroenterology Department, Clínica Las Condes, Santiago, Chile
| | - Patricio Ibáñez
- Inflammatory Disease Program, Gastroenterology Department, Clínica Las Condes, Santiago, Chile
| | - Jaime Lubascher
- Inflammatory Disease Program, Gastroenterology Department, Clínica Las Condes, Santiago, Chile
| | - Carolina Figueroa
- Inflammatory Disease Program, Gastroenterology Department, Clínica Las Condes, Santiago, Chile
| | - Udo Kronberg
- Colorectal Unit, Surgery Department, Inflammatory Bowel Disease program, Clínica Las Condes, Santiago, Chile
| | - Gonzalo Pizarro
- Inflammatory Disease Program, Gastroenterology Department, Clínica Las Condes, Santiago, Chile
| | - Daniela Fluxá
- Inflammatory Bowel Disease Research Fellow, Clínica Las Condes, Santiago, Chile
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9
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Abstract
Inflammatory bowel diseases (IBDs), including both Crohn's disease (CD) and ulcerative colitis (UC), are chronic autoimmune diseases. Both CD and UC have relapsing and remitting courses. Although effective medical treatments exist for these chronic conditions, some patients do not respond to these traditional therapies. Patients are often left frustrated with incomplete resolution of symptoms and seek alternative or complementary forms of therapy. Patients often search for modifiable factors that could improve their symptoms or help them to maintain periods of remission. In this review, we examine both the published evidence on the benefits of exercise clinically and the pathophysiological changes associated with exercise. We then describe data on exercise patterns in patients with IBDs, potential barriers to exercise in IBDs, and the role of exercise in the development and course of IBDs. While some data support physical activity as having a protective role in the development of IBDs, the findings have not been robust. Importantly, studies of exercise in patients with mild-to-moderate IBD activity show no danger of disease or symptom exacerbation. Exercise has theoretical benefits on the immune response, and the limited available data suggest that exercise may improve disease activity, quality of life, bone mineral density, and fatigue levels in patients with IBDs. Overall, exercise is safe and probably beneficial in patients with IBDs. Evidence supporting specific exercise recommendations, including aspects such as duration and heart rate targets, is needed in order to better counsel patients with IBDs.
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Affiliation(s)
- Michael Engels
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Raymond K Cross
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Millie D Long
- Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, NC, USA
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10
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Use of Complementary and Alternative Medicine in Inflammatory Bowel Disease Around the World. Gastroenterol Clin North Am 2017; 46:679-688. [PMID: 29173516 DOI: 10.1016/j.gtc.2017.08.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Use of complementary sand alternative medicine (CAM) is common among patients with inflammatory bowel disease (IBD). CAM can be broadly categorized as whole medical systems, mind-body interventions, biologically based therapies, manipulative and body-based methods, and energy therapies. Most do not use it to treat IBD specifically, and most take it as an adjunct to conventional therapy not in place of it. However, patients are frequently uncomfortable initiating a discussion of CAM with their physicians, which may impact adherence to conventional therapy. A greater emphasis on CAM in medical education may facilitate patient-physician discussions regarding CAM.
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11
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Portela F, Dias CC, Caldeira P, Cravo M, Deus J, Gonçalves R, Lago P, Morna H, Peixe P, Ramos J, Sousa H, Tavares L, Vasconcelos H, Magro F, Ministro P. The who-when-why triangle of CAM use among Portuguese IBD patients. Dig Liver Dis 2017; 49:388-396. [PMID: 28117198 DOI: 10.1016/j.dld.2016.12.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 12/29/2016] [Accepted: 12/30/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND The use of complementary and alternative medicines is increasing among chronic patients, particularly those afflicted with inflammatory bowel diseases. AIM This study aimed to address the prevalence of complementary and alternative medicines use among Portuguese inflammatory bowel diseases' patients. METHODS Patients were invited to fill an anonymous questionnaire concerning the use of complementary and alternative medicines. RESULTS Thirty-one per cent of the patients reported having used complementary and alternative medicines in the past, whereas 12% were using them by the time the questionnaire was administered. Fifty-nine per cent of the users did not share this information with their physician, whereas 14% and 8% discontinued their medication and periodical examination, respectively. Steroids prescription (OR=2.880) and a higher instruction level (OR=3.669) were predictors of complementary and alternative medicines use in this cohort. CONCLUSIONS Roughly a third of Portuguese IBD patients had used CAM. Steroid treatment and an academic degree are associated with CAM use. Given the potential side effects and interactions, patient information about the benefits and limitations of conventional and complementary treatments should be reinforced.
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Affiliation(s)
- Francisco Portela
- Serviço de Gastrenterologia, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal.
| | - Camila C Dias
- CIDES - Department of Health Information and Decision Sciences, Faculty of Medicine, University of Porto, Portugal; CINTESIS - Centre for Health Technology and Services Research, Porto, Portugal
| | - Paulo Caldeira
- Gastroenterology Department, Centro Hospitalar do Algarve, Portugal
| | - Marilia Cravo
- Serviço de Gastrenterologia, Hospital Beatriz Ângelo, Loures, Portugal
| | - João Deus
- Serviço de Gastrenterologia, Hospital Fernandes da Fonseca, Amadora, Portugal
| | | | - Paula Lago
- Gastroenterology Department, Centro Hospitalar Porto-Hospital Santo António, Portugal
| | - Henrique Morna
- Serviço de Gastrenterologia, Hospital do Funchal, Funchal, Portugal
| | - Paula Peixe
- Serviço de Gastrenterologia, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - Jaime Ramos
- Serviço de Gastrenterologia, Hospital dos Capuchos, Lisboa, Portugal
| | - Helena Sousa
- Gastroenterology Department, Centro Hospitalar do Algarve, Portugal; Biomedical Sciences and Medicine Department, University of Algarve, Portugal
| | - Lurdes Tavares
- Serviço de Gastrenterologia, Hospital de Santa Maria, Lisboa, Portugal
| | | | - Fernando Magro
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal; Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Portugal; MedInUP - Centre for Drug Discovery and Innovative Medicines, University of Porto, Portugal
| | - Paula Ministro
- Serviço Gastrenterologia, Centro Hospitalar de Tondela - Viseu, Viseu, Portugal
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Tolerance Limits, Self-understanding, and Stress Resilience in Integrative Recovery of Inflammatory Bowel Disease. Holist Nurs Pract 2017; 31:30-41. [PMID: 27782921 PMCID: PMC5134822 DOI: 10.1097/hnp.0000000000000189] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
People living with chronic inflammatory bowel disease (IBD) experienced that knowledge about their embodied tolerance limits, diet, mental problem solving, and change in lifestyle together with integrative health care could promote recovery from their diagnosed disease in calmer periods of suffering. A hermeneutic approach was used to analyze interviews with patients living with IBD outside hospitals. Thirteen young adults between 18 and 45 years of age in calmer phases of IBD participated in the study. Three main themes emerged from the analysis of the interviews: (1) Understanding limits in embodied tolerance, (2) Restoring balance is creating a new equilibrium, and (3) Creating resilience through integrative care. Anxiety, depression, stress, insomnia, and fatigue are known consequences of IBD and create a lower degree of well-being for the patients. The digestive system is very important in establishing the interface between the body and the external world. Properly functioning digestion, psychosocial stress reduction, and sleep quality are important to rebuild a balanced immune system. Stress resilience during a patient's recovery from IBD requires self-understanding, self-recognition, and psychosocial support from health care professionals at hospital outpatient clinics.
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Johari S, Joshi C, Gandhi T. Effect of Cyperus Rotundus on Cytokine Gene Expression in Experimental Inflammatory Bowel Disease. IRANIAN JOURNAL OF MEDICAL SCIENCES 2016; 41:391-8. [PMID: 27582588 PMCID: PMC4967483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND The protective effect of the chloroform extract of Cyperus rotundus (CHCR) is attributed to its anti-inflammatory and antioxidant activities. Cytokines, important regulators of inflammation and repair, play a key role in the pathogenesis of inflammatory bowel disease (IBD). Targeting these cytokines can effectively ameliorate the symptoms of IBD. The aim of the present study was to unravel the molecular mechanism through cytokine regulation in rats in experimental IBD. METHODS Sprague Dawley rats were randomly allocated to 5 groups (n=6). Group I served as the normal control. Group II served as the vehicle control and received 50% ethanol intracolonically on day 11 of the study. Group III served as the model control. Group IV and Group V were given standard drug 5-aminosalicylic acid (100 mg/kg) and CHCR (800 mg/kg), respectively, for 18 days once a day orally. Colitis was induced with dinitrobenzene sulfonic acid (180 mg/kg in 50% ethanol) intracolonically in groups III-V on day 11 of the study. On day 18, the rats were euthanized and colon tissues were removed for IL-4, IL-6, IL-12, and IFN-gamma gene expression studies using quantitative RT-PCR. RESULTS The expression levels of proinflammatory cytokines IL-4, IL-6, IL-12, and IFN-gamma were upregulated in the model control rats. Pretreatment with 5-aminosalicylic acid (100 mg/kg) and CHCR (800 mg/kg) significantly decreased the fold of the expression of the above cytokines. CONCLUSION CHCR acts as a molecular brake and downregulates the expression of proinflammatory cytokine genes; this is beneficial for reducing the severity of the experimental IBD. Thus, Cyperus rotundus is a safe, economical, and effective alternative for the treatment of patients with IBD.
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Affiliation(s)
- Sarika Johari
- Department of Pharmacology, Anand Pharmacy College, Anand, Gujarat, India,Correspondence: Sarika Johari, MPharm, PhD; Department of Pharmacology, Anand Pharmacy College, Anand, Gujarat, India Tel: +91 9375119907
| | - Chaitanya Joshi
- Department of Animal Biotechnology, College of Veterinary Science and Animal Husbandry, Anand Agricultural University, Anand, Gujarat, India
| | - Tejal Gandhi
- Department of Pharmacology, Anand Pharmacy College, Anand, Gujarat, India
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Nirmal SA, Gangurde SS, Dumbre PS, Pal SC, Mandal SC. Challenges and opportunities in the treatment of ulcerative colitis. World J Pharmacol 2015; 4:219-226. [DOI: 10.5497/wjp.v4.i2.219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 01/26/2015] [Accepted: 04/09/2015] [Indexed: 02/06/2023] Open
Abstract
Ulcerative colitis (UC) is an inflammatory destructive disease of the large intestine occurred usually in the rectum and lower part of the colon as well as the entire colon. Drug therapy is not the only choice for UC treatment and medical management should be as a comprehensive whole. Many synthetic drugs are available for the treatment of UC like 5-aminosalicylic acid, oral or systemic corticosteroids, immunomodulator, etc. but these drugs are associated with many serious side effects after long term use or have certain disadvantage or not suitable for the use in some patients. In short synthetic drugs have many disadvantages and for this reason effective and safe alternative drug treatment for the UC is the challenge. Herbal drugs are found to be very promising results of the treatment of UC and enzymatic level. Researchers explored many herbal drugs for the treatment and even many more may found effective in the treatment of UC. At this point we feel herbal medicine is the better alternative for the treatment of UC.
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Tangkiatkumjai M, Boardman H, Praditpornsilpa K, Walker DM. Reasons why Thai patients with chronic kidney disease use or do not use herbal and dietary supplements. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2014; 14:473. [PMID: 25481733 PMCID: PMC4295480 DOI: 10.1186/1472-6882-14-473] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 12/02/2014] [Indexed: 01/01/2023]
Abstract
BACKGROUND Despite a high prevalence of herbal and dietary supplement use (HDS) in pre-dialysis patients, the reasons are unknown as to why they decide to use HDS. Objectives of the cross-sectional and qualitative studies were to determine reasons for the use and non-use of HDS in Thai patients with chronic kidney disease (CKD). METHODS This prospective study recruited 421 patients with stage 3-5 CKD from two kidney clinics in Thailand, and 357 were followed up regarding their HDS use over 12 months. Patients receiving renal replacement therapy at baseline were excluded. Participants were interviewed at baseline and in the twelfth month regarding their HDS use, and reasons for their use or non-use of HDS. Among HDS users, 16 patients were enrolled in a qualitative study and were interviewed using eight-open ended questions about reasons for HDS use. Descriptive and thematic analyses were performed. RESULTS Thirty-four percent of patients with CKD consistently used HDS over the 12 months and 17% of all patients intermittently took them during the follow-up period. At baseline, family or friends' recommendation was the most common reason for HDS use (35%), followed by having a perception of benefits from using HDS (24%). During the follow-up period, perceived benefits of HDS was a frequently reported reason for either continuing with HDS use (85%) or starting to use HDS (65%). Negative experience from using HDS influenced patients to stop using them (19%). Although the main reason for non-use of HDS was trust in a doctor or effectiveness of conventional medicine (32%), doubt about the benefits from HDS or concerns about negative effects were frequently reported reasons for non-use (23%). Doctor's recommendations to avoid using HDS were the main influence for non-users (19%) and for those who had stopped using HDS (23%). The media and patients' social network had an impact on HDS use. CONCLUSIONS Patients who perceived benefits from HDS use were more likely to use HDS, whilst non-users had negative attitudes towards HDS. Health professionals therefore should educate patients and their relatives about the risks and benefits from using HDS.
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Affiliation(s)
- Mayuree Tangkiatkumjai
- />Division of Primary Care, School of Medicine, University of Nottingham, QMC, Nottingham, NG7 2UH UK
| | - Helen Boardman
- />Division of Social Research in Medicines and Health, School of Pharmacy, University of Nottingham, Nottingham, UK
| | - Kearkiat Praditpornsilpa
- />Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Dawn-Marie Walker
- />Division of Primary Care, School of Medicine, University of Nottingham, QMC, Nottingham, NG7 2UH UK
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Wan P, Chen H, Guo Y, Bai AP. Advances in treatment of ulcerative colitis with herbs: From bench to bedside. World J Gastroenterol 2014; 20:14099-14104. [PMID: 25339799 PMCID: PMC4202341 DOI: 10.3748/wjg.v20.i39.14099] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 05/30/2014] [Accepted: 07/16/2014] [Indexed: 02/06/2023] Open
Abstract
Ulcerative colitis (UC), an idiopathic inflammatory disorder in the colon, has become a clinical challenge, owing to the increasing incidence and poor prognosis. The conventional treatments for UC including aminosalicylates, corticosteroids, and immunosuppressants, induce remission in only half of patients. Meanwhile, the treatments often come with serious side effects which can be life-threatening. Herbal medicine, one of the most common traditional Chinese medicine modalities, has been introduced for centuries into clinical treatment of many human diseases such as infections and functional disorders. Recently, the potential effectiveness of herbs has been suggested as the treatment of UC, as shown by a variety of clinical trials and experimental studies. The herbs reported in the literature include aloe vera gel, butyrate, tormentil extracts, wheat grass juice, and curcumin. In the review, bioactivity of the herbs and their involvement in UC treatment are discussed.
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V VP, C G. Protective effect of marine mangrove Rhizophora apiculata on acetic acid induced experimental colitis by regulating anti-oxidant enzymes, inflammatory mediators and nuclear factor-kappa B subunits. Int Immunopharmacol 2013; 18:124-34. [PMID: 24269623 DOI: 10.1016/j.intimp.2013.11.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 10/09/2013] [Accepted: 11/07/2013] [Indexed: 01/12/2023]
Abstract
Ulcerative colitis is a disease that causes inflammation and ulcer in the lining of the large intestine. In this study we investigate the effect of Rhizophora apiculata (R. apiculata) on acetic acid induced colitis in mouse model. Experimental animals were randomized into four groups: normal untreated, colitis control, R. apiculata treated group and sulfasalazine treated group. R. apiculata significantly (p<0.01) decreased macroscopic score and wet weight of damaged colon compared to colitis control. This effect was confirmed biochemically by significant (p<0.01) reduction of colitis associated increase in myeloperoxidase activity. R. apiculata significantly (p<0.05) increased anti-oxidant enzymes such as superoxide dismutase (SOD) and glutathione (GSH) levels compared to colitis control. R. apiculata significantly (p<0.01) reduced lipid peroxides (LPO), nitric oxide (NO) and inflammatory mediators such as myeloperoxidase (MPO), lactate dehydrogenase (LDH), inducible nitric oxide synthase (iNOS), cyclooxygenase-2 (COX-2) and tumor necrosis factor-α (TNF-α) expressions compared to colitis control. R. apiculata treatment significantly (p<0.01) inhibits the translocation of NF-kB p65 and p50 subunits. Taken together these findings suggest that R. apiculata prevents acetic acid induced colitis in experimental mouse model and may serve as an excellent anti-oxidant and anti-inflammatory agent that could potentially be useful as a (natural) therapy for inflammatory bowel disease (IBD).
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Affiliation(s)
- Vinod Prabhu V
- Department of Biotechnology, Karunya University, Karunya Nagar, Coimbatore 641114, Tamil Nadu, India
| | - Guruvayoorappan C
- Department of Biotechnology, Karunya University, Karunya Nagar, Coimbatore 641114, Tamil Nadu, India.
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Abstract
Ulcerative colitis (UC) is a refractory, chronic, and nonspecific disease occurred usually in the rectum and the entire colon. The etiopathology is probably related to dysregulation of the mucosal immune response toward the resident bacterial flora together with genetic and environmental factors. Several types of medications are used to control the inflammation or reduce symptoms. Herbal medicine includes a wide range of practices and therapies outside the realms of conventional Western medicine. However, there are limited controlled evidences indicating the efficacy of traditional Chinese medicines, such as aloe vera gel, wheat grass juice, Boswellia serrata, and bovine colostrum enemas in the treatment of UC. Although herbal medicines are not devoid of risk, they could still be safer than synthetic drugs. The potential benefits of herbal medicine could lie in their high acceptance by patients, efficacy, relative safety, and relatively low cost. Patients worldwide seem to have adopted herbal medicine in a major way, and the efficacy of herbal medicine has been tested in hundreds of clinical trials in the management of UC. The evidences on herbal medicine are incomplete, complex, and confusing, and certainly associated with both risks and benefits. There is a need for further controlled clinical trials of the potential efficacy of herbal medicine approaches in the treatment of UC, together with enhanced legislation to maximize their quality and safety.
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Affiliation(s)
- Fei Ke
- Department of Surgery, The Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Praveen Kumar Yadav
- Department of Gastroenterology, The Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Liu Zhan Ju
- Department of Gastroenterology, The Shanghai Tenth People's Hospital, Tongji University, Shanghai, China,Address for correspondence: Dr. Liu Zhan Ju, Department of Gastroenterology, The Shanghai Tenth People's Hospital, Tongji University, No. 301 Yanchang Road, Shanghai-200 072, China. E-mail:
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Hedin CRH, Mullard M, Sharratt E, Jansen C, Sanderson JD, Shirlaw P, Howe LC, Djemal S, Stagg AJ, Lindsay JO, Whelan K. Probiotic and prebiotic use in patients with inflammatory bowel disease: a case-control study. Inflamm Bowel Dis 2010; 16:2099-108. [PMID: 20848469 DOI: 10.1002/ibd.21286] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The use of complementary and alternative medicine in inflammatory bowel disease (IBD) has been extensively studied. However, the use of probiotics and prebiotics is poorly documented, despite evidence of efficacy of particular probiotic strains in specific forms of IBD. METHODS A case-control study comprising interviewer-administered questionnaires was conducted in IBD patients and healthy controls. Data regarding use and knowledge of probiotics and prebiotics, demographic, and clinical information were collected. RESULTS In total, 334 participants (234 IBD, 100 controls) were interviewed. Significantly more IBD patients than controls had ever used probiotics to manage their health (Crohn's disease [CD] 43%, ulcerative colitis [UC] 51%, controls 21%, P < 0.001). Prebiotic use was negligible. On logistic regression analysis, having UC (odds ratio [OR] 4.30, 95% confidence interval [CI] 2.27-8.12) or CD (OR 3.05, 95% CI 1.66-5.60) were the strongest predictors of probiotic use. Within IBD patients the strongest predictor of probiotic use was current steroid use (OR 2.4, 95% CI 1.11-5.18). IBD patients had greater probiotic knowledge scores than controls (P = 0.003), although 20% of IBD probiotic users could not provide a definition of a probiotic. Less than half of IBD probiotic users discussed probiotic use with healthcare professionals, with commercial advertising being the primary source of information. CONCLUSIONS Patients with IBD use probiotics to manage their health but frequently choose strains without evidence of efficacy in IBD. Patients rely on nonclinical sources of information and often do not disclose probiotic use to healthcare professionals. Conventional healthcare providers should inquire about probiotic use among their patients and offer evidence-based advice.
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Regional variations in the use of complementary and alternative medicines (CAM) for inflammatory bowel disease patients in Italy: an IG-IBD study. J Crohns Colitis 2010; 4:291-300. [PMID: 21122518 DOI: 10.1016/j.crohns.2009.12.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2009] [Accepted: 12/14/2009] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIM Complementary and alternative medicines (CAM) are being used increasingly by patients with Crohn's disease (CD) and ulcerative colitis (UC). We aimed to assess the prevalence and usage of CAM in different geographical areas of Italy and possible predictors of their use. METHODS AND MATERIALS A structured questionnaire, administered to outpatients, attending 8 general hospitals and 9 tertiary referral centres, was completed by 2011 patients (909 CD, 1087 UC and 15 indeterminate colitis). 583 patients lived in the North, 659 in Central Italy and 769 in the South. RESULTS CAM users were 475 (23.6%) with no regional differences in their distribution. Usage correlated significantly with female gender (p=0.030), higher education (p=0.021), hospitalization rates (p=0.000), extra-intestinal complications (p=0.000), non-adherence to conventional treatments (p=0.054), adverse reactions to conventional treatments (p=0.000), and active disease (p=0.007); 5-ASA usage was associated with a more limited use of CAM (p=0.005). Dietary changes or supplements and prayer were significantly more frequently reported in South, while Northern Italian patients more frequently used homeopathy, herbal medicines and physical exercises. Patients in Central Italy adopted an intermediate behavior. CAM use ameliorated the patient's general well-being according to two thirds of the users. Costs were higher for Northern patients than in Central or Southern Italy. CONCLUSION One in four IBD patients in Italy use CAM. More money is spent on CAM in Northern Italy. Regional differences emerged as regards the type of CAM but not in terms of disease features, frequency of and reasons for CAM use, or perceived effects.
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Abstract
BACKGROUND Fatigue is common, disabling yet underappreciated, in patients with chronic diseases, including inflammatory bowel disease (IBD). AIMS To examine the literature and determine the prevalence and patterns of fatigue in IBD patients, to identify opportunities and directions for future research in this area. METHODS A systematic review using PubMed and Ovid Medline databases was conducted using search terms 'fatigue', 'Crohn', 'colitis' and 'inflammatory bowel disease'. A review of fatigue in other similar chronic diseases was also performed. RESULTS Ten studies were found to include data on fatigue in IBD patients; all were conducted between 1999 and 2009. However, only one study (in children) measured fatigue in IBD patients as a primary outcome. In patients in remission, the prevalence of fatigue in IBD patients ranges from 41 to 48%. Data are sparse and conflicting on whether fatigue severity is proportional to disease severity/activity. CONCLUSIONS Despite the clinical reality of fatigue, there are few published studies examining fatigue in IBD as a primary outcome. More data are needed on the prevalence, correlation between disease activity and fatigue severity, and putative pathogenic pathways involved in fatigue pathogenesis, before ultimately elucidating targeted therapies for fatigue in IBD patients.
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Affiliation(s)
- D R van Langenberg
- Monash University Department of Gastroenterology & Hepatology, Medicine, Box Hill Hospital, Box Hill, Melbourne, Vic., Australia.
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