P-138 Complementary and Alternative Medicine Use in Children with Inflammatory Bowel Diseases

Abstract

The prevalence of children diagnosed with inflammatory bowel diseases (IBD) has increased over the past few decades. There also is increasing recognition of interest in complementary and alternative medicine (CAM) in patients with chronic diseases, although practitioner and patient definitions of CAM can be variable. Therefore, the aim of our study was to determine how families of pediatric IBD patients use and define CAM. We approached families of IBD patients ages 2–18 years receiving medical care from Nationwide Children's Hospital (NCH) Division of Gastroenterology in July 2014 during a clinic visit and asked them to complete a questionnaire. Questions were organized into the following categories: demographic and disease information; medications and therapies; interest in and attitudes towards CAM; and perceptions of healthcare providers with regards to CAM. CAM was defined as non-pharmaceutical therapy. Enteral therapy, an accepted therapeutic approach in Crohn's disease, was not included in our definition, while multivitamins, probiotics, and prayer were included. Statistical analyses were provided by the Biostatistics core (NCH Research Institute). The research protocol was approved by the NCH Research Institute Institutional Review Board. The questionnaire was completed by 104 patients (mean age 13.86 years ± 3.11 yrs; range 5–18 yrs). The majority of patients had Crohn's disease (75%); 19% had ulcerative colitis and 6% had indeterminate colitis. Patients used an average of 3.09 ± 1.29 medications. All respondents (100%) reported use of 1 or more CAM therapies as defined by our questionnaire, although only 23% considered any of these therapies to be CAM by their own definition. Patients who reported side effects from conventional medications were more likely to implement changes in diet (P = 0.001), seek care from an alternative medicine professional (P = 0.02), and to be interested in learning more about CAM (P = 0.01). Patients with self-reported moderate or severe disease activity were more likely than patients with mild or quiescent disease activity to be interested in CAM (P = 0.002). The most commonly reported CAM therapies were vitamins/supplements (97%), stress management techniques (61%), and dietary changes (57%). There were no significant differences in CAM utilization or interest by disease type. The majority of patients reported that their physicians had a neutral (68%) or positive (29%) impact on their decision to use or not use CAM. Furthermore, 77% of families reported at least some interest in learning more about CAM. Thirty-three percent felt uninformed about CAM versus 15% feeling sufficiently informed. Interest in, and use of, CAM therapies by children at the NCH IBD center is high, particularly by patients with more severe disease and those who report more medication side effects. Our study is unique in that it analyzed CAM use according to different categories, and questioned patients about the impact and knowledge of their GI providers in regards to CAM use. Improved understanding of family and patient interest in CAM could facilitate important discussion between patients and practitioners about ways to treat IBD symptoms. Additional research is necessary to understand what more pediatric specialists can offer patients and families on this topic.