Complementary and Alternative Medicine in Brazilian Patients With Inflammatory Bowel Diseases

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BACKGROUND: The conventional treatment of Inflammatory Bowel Disease (IBD) is based on drug therapy, but different studies have shown a progressive increase in the use of Complementary and Alternative Medicine (CAM), usually combined with conventional treatment, which is reported in rates between 31% and 51%. The most commonly used therapies depend on the country of the study. The aim of the study was to evaluate the prevalence of CAM use and the satisfaction with this therapy among IBD patients. METHODS: A cross-sectional study was performed in adult IBD outpatients with confirmed diagnosis (Crohn's Disease-CD, Ulcerative Colitis-UC), totalizing a sample of 145 eligible individuals. Data were collected from August 2016 to June 2017 in two Southeastern Brazilian reference centers. Sociodemographic variables and medical history were obtained from patient's medical records. Disease activity was evaluated by Harvey-Bradshaw Index (HBI) and Mayo Score to CD and UC respectively. Disease location and extension was classified through the Montreal classification to both diseases. Questionnaires were employed to evaluate HRQoL (IBDQ), anxiety and depression (HADS) and a semi structured interview was done with a questionnaire that contains the following sections of CAM: 1) CAM products- tea, probiotics, omega 3, homeopathy and herbal therapies. 2) Current or previous use, time duration of use, frequency, indication and patient satisfaction. Statistical analysis: descriptive statistics and association tests (P<0.05). Logistic regression models were performed to study association with clinical variables and CAM use. This study was approved by the Research Ethics Committee (CAAE: 67198117.6.0000.5257). RESULTS: One hundred and thirty-seven individuals were included, 52.55% were female and the mean age was 40.52y (±14.05). The disease duration was 11.86 y (±7.18); 71 (56.20%) patients had CD and 60 (43.80%) had UC. The majority of the individuals were in clinical remission (CD:67.11%; UC:55.00%) according to HBI and Mayo score. The HRQoL was classified as excellent in 23.53%, good in 47.06%, regular in 22.06% and poor in 7.35% of patients. Sixty one (44.53%) patients presented anxious and 29.93% presented depression according to HADS. Fifteen patients (11%) have used CAM for IBD treatment, such as tea (3.65%), probiotics (5.11%), omega-3 (2.19%), homeopathy (1.46%) and herbal therapies (0.73%). The specific rates of satisfaction for each CAM use were: tea (16.13%), probiotics (23.05%), omega-3 (0), homeopathy (26.67%) and herbal therapies (30%). There was no difference between CAM use in CD patients as compared to UC patients (P=0.40). There was no association between CAM use and clinical variables such as age (OR:1.001; CI95%:0.972-1.030; P=0.96), gender/female (OR:2.393; CI95%:1.0-5.72; P=0.05), IBDQ score (OR:0.995; CI95%:0.985-1.004; P=0.27), HADS anxiety score (OR:1.020; CI95%:0.940-1.107; P=0.63) or HADS depression score (OR:1.034; CI95%:0.943-1.134; P=0.47). CONCLUSION(S): The prevalence of CAM use was low among Southeastern Brazilian IBD patients. Despite this found, patients were satisfied with this therapy.