Complementary and Alternative Medicine Use for GI Conditions
Complementary and Alternative Medicine Use for GI Conditions
CAM use is more common among adults with GI conditions (42%) compared with adults without GI conditions (28%). The adjusted odds ratio for CAM use among adults with GI conditions was 1.69. The most commonly used modalities in US adults with GI conditions include herbs and supplements, manipulative therapies, and mind body therapies. Moreover, 47% of those who specifically used at least one of their top three CAM modalities to address a GI condition used three or more modalities. The majority felt that CAM was helpful in addressing a GI condition and in maintaining health and well-being.
An increased frequency of CAM use among US adults with medical conditions has also been found for adults with arthritis and neurological conditions, but not for adults with cardiovascular disease. Earlier studies have found an association between CAM use and female gender, higher levels of education and income, and the presence of other medical conditions. Although these associations were also present in our population, after adjusting for these and other factors, having a GI condition was still significantly associated with CAM use.
We found that the prevalence of CAM use among US adults with GI conditions is similar to prior reports; however, given that we did not include the use of prayer or vitamins and minerals in our analysis as several prior reports do, our estimates likely reflect a somewhat higher prevalence of CAM use in comparison. Nonetheless, the majority of CAM use among US adults with GI conditions is not specifically targeted to address GI conditions.
A novel feature of our analysis is that we identified a subpopulation of individuals who specifically used CAM to address a GI condition. Within this population, the most common reasons for, and perceived benefits of, CAM use were related to general health and well-being and to a sense of self-efficacy.
Our study has several limitations. NHIS data are based on self-report and thus subject to misclassification and recall bias. Our definition of GI conditions is limited to those that were included in the survey. Thus, we may be missing a substantial number of individuals with small or large bowel disease, such as inflammatory bowel diseases and irritable bowel syndrome, chronic pancreatitis, and biliary diseases who did not respond to the questions about abdominal pain or nausea and/or vomiting. Furthermore, the severity and duration of GI-related disease could not be ascertained in this population, those using CAM to cope with symptoms related to a GI condition or side effects of a medication for a GI condition (e.g., depression, fatigue) are not captured, and NHIS only assesses in more detail the top three CAM modalities used by respondents. These factors may have resulted in an underestimation of both the overall use and condition-specific use of CAM among adults with GI conditions. However, we also cannot distinguish one-time CAM users from frequent users. In addition, there are a variety of special diets that are now popular among some GI patients (e.g., gluten-free, low FODMAP) that are not assessed on the NHIS. We tried to capture these populations by including visits to practitioners for special diets, which may also include visits to traditional nutritionists. Nonetheless, we may still have underestimated the prevalence of use of special diets in this population.
In conclusion, we found that 42% of adults with a GI condition who completed the survey had used CAM within the past year, and at least 7% of them had used CAM to specifically address a GI condition. In the latter population, 47% had used three or more CAM modalities in the past year and over 80% of CAM therapies used for GI conditions were perceived to be helpful. Further study of this population may provide clues for promising therapies worthy of further study, while enhancing communication between doctors and patients on this topic may promote better clinical use of evidence-based CAM therapies.
Discussion
CAM use is more common among adults with GI conditions (42%) compared with adults without GI conditions (28%). The adjusted odds ratio for CAM use among adults with GI conditions was 1.69. The most commonly used modalities in US adults with GI conditions include herbs and supplements, manipulative therapies, and mind body therapies. Moreover, 47% of those who specifically used at least one of their top three CAM modalities to address a GI condition used three or more modalities. The majority felt that CAM was helpful in addressing a GI condition and in maintaining health and well-being.
An increased frequency of CAM use among US adults with medical conditions has also been found for adults with arthritis and neurological conditions, but not for adults with cardiovascular disease. Earlier studies have found an association between CAM use and female gender, higher levels of education and income, and the presence of other medical conditions. Although these associations were also present in our population, after adjusting for these and other factors, having a GI condition was still significantly associated with CAM use.
We found that the prevalence of CAM use among US adults with GI conditions is similar to prior reports; however, given that we did not include the use of prayer or vitamins and minerals in our analysis as several prior reports do, our estimates likely reflect a somewhat higher prevalence of CAM use in comparison. Nonetheless, the majority of CAM use among US adults with GI conditions is not specifically targeted to address GI conditions.
A novel feature of our analysis is that we identified a subpopulation of individuals who specifically used CAM to address a GI condition. Within this population, the most common reasons for, and perceived benefits of, CAM use were related to general health and well-being and to a sense of self-efficacy.
Our study has several limitations. NHIS data are based on self-report and thus subject to misclassification and recall bias. Our definition of GI conditions is limited to those that were included in the survey. Thus, we may be missing a substantial number of individuals with small or large bowel disease, such as inflammatory bowel diseases and irritable bowel syndrome, chronic pancreatitis, and biliary diseases who did not respond to the questions about abdominal pain or nausea and/or vomiting. Furthermore, the severity and duration of GI-related disease could not be ascertained in this population, those using CAM to cope with symptoms related to a GI condition or side effects of a medication for a GI condition (e.g., depression, fatigue) are not captured, and NHIS only assesses in more detail the top three CAM modalities used by respondents. These factors may have resulted in an underestimation of both the overall use and condition-specific use of CAM among adults with GI conditions. However, we also cannot distinguish one-time CAM users from frequent users. In addition, there are a variety of special diets that are now popular among some GI patients (e.g., gluten-free, low FODMAP) that are not assessed on the NHIS. We tried to capture these populations by including visits to practitioners for special diets, which may also include visits to traditional nutritionists. Nonetheless, we may still have underestimated the prevalence of use of special diets in this population.
In conclusion, we found that 42% of adults with a GI condition who completed the survey had used CAM within the past year, and at least 7% of them had used CAM to specifically address a GI condition. In the latter population, 47% had used three or more CAM modalities in the past year and over 80% of CAM therapies used for GI conditions were perceived to be helpful. Further study of this population may provide clues for promising therapies worthy of further study, while enhancing communication between doctors and patients on this topic may promote better clinical use of evidence-based CAM therapies.
Source...