THE ROLE OF INTEGRATIVE HEALTH IN IBD CARE

Transcription

1 THE ROLE OF INTEGRATIVE HEALTH IN IBD CARE Maria R. Mascarenhas February

2 OBJECTIVES What is Integrative Health? How often is it used in patients in the US and in patients with IBD? What are the modalities used? What is the Integrative Health Program at CHOP?

3 WHAT IS INTEGRATIVE MEDICINE? relationship-centered care that focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, healthcare professionals and disciplines to achieve optimal health and healing. American Academy of Pediatrics 3

4 If a non-mainstream practice is used together with conventional medicine, it s considered complementary. If a non-mainstream practice is used in place of conventional medicine, it s considered alternative. integrative health care involves bringing conventional and complementary approaches together in a coordinated way. 4

5 COMPONENTS Natural Products Herbs Vitamins and minerals Probiotics Nutrition Mind and Body Practices Yoga Chiropractic and osteopathic manipulation Meditation/mindfulness Massage therapy Acupuncture Relaxation techniques (breathing, guided imagery, progressive muscle relaxation) Tai chi, Qi gong, healing touch, Reiki Hypnotherapy Other Traditional healers, Ayurveda, TCM, Homeopathy, Naturopathy 5

6 NCCIH: Use of Complementary Health Approaches Among Children Aged 4 17 Years in the United States: National Health Interview Survey Compared data from 2007 & 2012 surveys 17,321 interviews CAM use was unchanged: 12% in 2007 & 11.6% in 2012 Increase in yoga use: 2.3% in 2007 to 3.1% in 2012 Most commonly used complementary health approaches non-vitamin, non-mineral dietary supplements chiropractic/om, yoga, tai chi or gi gong Most common indications back or neck pain, head or chest cold anxiety or stress other musculoskeletal conditions

7 HOW OFTEN IS IH USED IN IBD? Common in pediatric IBD: 84% Predictors of IH use more severe disease prior adverse effects with conventional medications Only 24% of patients considered themselves to be using IH Common therapies used vitamins/supplements stress management techniques diet exercise Most families wanted to learn more (77%) Physicians are the most common source of knowledge for patients regarding IH Serpico et al,

8 NUTRITION Diets SCD, diet low in fermentable carbohydrate, gluten-free, anti inflammatory, IGG4-guided exclusion diet, high fiber, low residue, semivegetarian diet, Mediterranean diet, Paleo Enteral diet therapy Exclusive or partial Supplements Curcumin, omega-3, vitamin D, prebiotics, probiotics 8

9 HERBAL THERAPY UC Aloe vera gel Superior to placebo in inducing remission/response UC Wheat grass juice Superior to placebo in inducing remission/response UC Andrographis paniculata extract (HMPL-004) Superior to placebo in inducing remission/response UC Topical Xilei-san Superior to placebo in inducing remission/response UC Curcumin Superior to placebo in maintaining remission UC Boswelia serrata gum resin As effective as mesalamine UC Plantago ovata seeds As effective as mesalamine UC Evening primrose oil Similar relapse rates to fish oil CD Wormwood Superior to placebo in inducing remission CD Tripterygium wilfordi Preventing clinical recurrence of post op CD Ng et al,

10 MIND-BODY MODALITIES More research in IBS than IBD More data in adults Most beneficial therapies Cognitive Behavioral Therapy improves depression, functioning & QOL Relaxation & mindfulness IBS+ IBS Biofeedback & yoga Pain, IBS+IBD, anxiety Hypnosis decreased inflammation & improved QOL Yeh et al,

11 YOGA Few studies, although widely used CHOP study: Dr Albenberg Benefits mood enhancing properties inhibition of physiologic stress & inflammation improved regulation of sympathetic nervous system & hypothalamic-pituitary-adrenal system improved quality of life Yeh 2017, Cramer

12 EXERCISE Limited data Improves bone mineral density Regular exercise early in life may help prevent CD exert a beneficial effect on disease course improve inflammatory parameters improve psychological status improve quality of life help with stress management Moderate exercise improves mucosal immune function maintains a healthy microbiome Hashash et al

13 MASSAGE & ACUPUNCTURE Massage therapy poorly studied in IBD Acupuncture improve inflammation & symptoms animal & human studies Current clinical trials Encouraging but are insufficient to recommend these therapies as alternatives to conventional IBD therapies Stein

14 SLEEP Increased prevalence of sleep disturbances Factors: disease activity, depression, female sex, smoking, corticosteroid & narcotic use Over a 6 month period, poor sleep was associated with increased risk of flare in CD but not UC Microbiome changes in animal models More research needed Swanson et al,

15 AROMATHERAPY Essential oils Methods: aerial diffusion, direct inhalation, topical, ingestion Risks Allergic reactions, skin irritation, drug interactions Benefits Relief of pain & anxiety, enhancement of energy & short term memory, relaxation Examples Lavender: anxiety, tension & sleep Peppermint & Ginger: nausea Mandarin: insomnia, indigestion & nausea

16 At CHOP Integrative Nutrition Program Food Reactions Clinic Integrative Gastroenterology Outpatient & Inpatient Consultation Programs Patient Family Staff Community Clinical Care Research Innovation Education Acupuncture Massage Yoga Mindfulness Aromatherapy Energy therapies An evidence-based Center of Excellence Pharmacy Child Life Nursing Chaplain Pain Team Subspecialist network Psychology Employee Wellness

17 INTEGRATIVE GASTROENTEROLOGY Target Audience Patients with GI symptoms: dyspepsia, reflux, nausea, colic constipation & gastroparesis IBD IBS Osteopathic manipulation IH Nutrition visits at same time

18 MIND BODY MODALITIES Active Planning Patients Yoga Mindfulness Outpatient acupuncture Child Life therapies Parents Yoga Reiki Aromatherapy Massage Inpatient acupuncture Reiki/healing touch Clinical hypnosis Staff Yoga Mindful awareness MBSR Reiki 18

19 19

20 CHOP.edu