Complementary & Alternative Therapies in IBD
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1 Complementary & Alternative Therapies in IBD Laurie Rosales, APRN-CNP OSU Wexner Medical Center Division of Gastroenterology, Hepatology and Nutrition
2 Complementary & Alternative Probiotics Cannabis Fish Oil Mind-Body therapies Acupuncture Cognitive Behavioral Therapy Mindfulness Hypnotherapy Yoga Exercise Medicine
3 Probiotics friendly bacteria or good bacteria Bacteria that live in the body to help defend from infections caused by bad bacteria Pre-biotics: contain a form of food that the probiotic likes
4 Probiotics Not all commercial probiotics are alike Yogurt, VSL#3, Align, Culturelle, Mutaflor, Florastor Vary in quality and potency Suppression growth of pathogenic bacteria Improvement of intestinal barrier function Induce protective cytokines and suppress proinflammatory cytokines (TNF) in the mucosa. Decrease pain
5 Probiotics Yogurt Contain live or active cultures Not all live cultures will survive the acidic environment or colonize in the GI tract Pasteurized: kills the bacteria Lactose: may worsen symptoms in some people
6 Probiotics VSL#3 high-concentration with 8 live bacterial strains (Streptococcus thermophilus, 4 strains of Lactobacilli, 3 strains of Bifidobacteria Best studied for pouchitis, IBS and UC
7 Probiotics Evidence VSL#3 Pouchitis Prevention of initial pouchitis 1 year after IPAA surgery Maintenance of remission in pouchitis after ATB given VSL#3 Ulcerative Colitis Can be used for induction of remission Can be used along with 5- ASA for remission VSL#3 Crohn s Disease Not recommended Shen, et al (2014) Inflamm Bowel Dis Mimura, et al (2004) Gut Gionchetti, et al (2003) Gastroenterology Shen, et al (2005) Aliment Pharmacol Ther Sood, et al (2009) Clin Gastroentrol Hepatol Tursi, et al (2010) Am J Gastrolenterol Miele, et al (2009) Am J Gastroentrol. Fedorak, et al (2015) Clin Gastroenterol Hepatol
8 Probiotics Summary VSL#3 Reasonable for pouchitis and in combination with conventional therapy in UC Help fight or prevent infections (C-diff) Help with diarrhea, constipation, IBS, IBD Lack of coverage by insurance *Vary in cost, formulation, potency and efficacy *Not regulated by the U.S. Food and Drug Administration (FDA) like prescription medications
9 Cannabis Medical marijuana Derived from plant Cannabis sativa Composed of 70 different cannabinoid compounds (cannibal and THC) Schedule I substance-illegal for recreational and medicine use (federal law) 29 states allow for medical use Reported relief of symptoms: nausea, abdominal pain, diarrhea No objective evidence that it decreases inflammation
10 Cannabis Evidence Ulcerative Colitis Improves QOL but no difference in remission rates in patients with dormant UC Similar rates of remission when cannabis added to 5- ASA in stable UC patients Crohn s Disease 1 RCT, more patients with clinical response to cannabis vs placebo, but overall no difference in remission rates, CRP level and increased QOL. Naftali, et al. (2011) Isr Med Assoc J. Lahat, et al (2012) Digestion Naftali, et al (2013) Clin Gastroenterol Hepatol. Irving, et al (2018). Inflamm Bowel Dis
11 Cannabis Side effects: confusion, ataxia, dizziness, nausea, vomiting Chronic use: cognitive impairments, deficits in motivation, learning, and memory, increased risk of MVA, decreased fertility, increased risk of surgery (after 6 months of use) Summary Should only be used in clinical trials under physician supervision
12 Fish Oil Derived from tuna, salmon, mackerel, or sardines Contains Omega-3 polyunsaturated fatty acids (n-3 PUFAs), docosahexaenoic acid (DHA), and eicosapentaenoic acid (EPA)
13 Fish Oil Evidence Ulcerative Colitis May decrease steroid requirement May decrease fecal calprotectin Does not prevent relapse May help maintain remission Crohn s Disease Does not prevent relapse Summary Generally safe Fishy breath odors Overall, not recommended for IBD Feagan, et al (2008) JAMA Seider, et al (2005) Clin Gastroenterol Hepatol. Middleton, et al (2002) Aliment Pharmacol Ther. Scaioli, et al (2018) Clin Gastroenterol Hepatol
14 Mind-Body Therapies Psychological stress + IBD are related Depression, anxiety, stress, poor QOL Cognitive behavioral therapy Talk therapy (psychotherapy) Improvements in QOL, depression & anxiety Does not influence course of IBD Use as complement to conventional therapy
15 Mind-Body Therapy Mindfulness No improvement in inflammatory markers Use as complement to conventional therapy for improving QOL, anxiety and depression Acupuncture Generally safe and well tolerated Adverse effects: small, local superficial hematomas, mild bleeding, infections Can be used as a complement to conventional therapy Hypnotherapy (gut directed) Decrease the risk of relapse in patients with remission Possible therapy for both IBD and IBS Use as complement to conventional therapy for improving symptoms
16 Mind-Body Therapies Yoga Improves QOL, anxiety, abdominal pain No effect on disease activity and inflammatory markers Use as complement to conventional therapy for improving QOL Exercise Higher QOL, improves bone mineral density, possible lower rates of relapse Use as complement to conventional therapy for improving QOL and bone density Individually tailored Avoid strenuous exercise with moderate-severe active disease
17 Conclusion Larger well-designed research is needed to validate specific complementary & alternative therapy for IBD use Natural does not always mean safe or better Use these therapies as complementary, not as an alternative to the conventional therapy Talk with your gastroenterologist about the use of CAM
18 Questions
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