Inflammatory bowel disease (IBD) is a chronic and relapsing condition characterized by inflammatory infiltrates in the gastrointestinal tract, often requiring repeated exposures to steroids and other immunomodulators and frequent invasive procedures. The prevalence of IBD ranges between 12 and 40/100,000, with approximately 25% of all new patients diagnosed before 20 years of age (1
). Conventional therapies are associated with significant adverse effects, especially corticosteroids with their common side effects and negative impact on the growing and developing child and adolescent. Considering these factors, coupled with a rising interest in alternative therapies, it is not surprising that the use of complementary and alternative medicine (CAM) in chronic pediatric illnesses is reported to be as high as 30% to 70% (3
The National Institutes of Health define CAM as a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine. When prayer is included specifically for health reasons in the definition of CAM, 62% of US adults have used some form within the past 12 months. This value drops to 36% when prayer is excluded (6
). Numerous studies have evaluated the use of CAM in the adult IBD population (7
); however, the information on CAM in the pediatric population, most of which comes from countries other than the United States, is limited. US studies that used the 1996 Medical Expenditure Panel Survey database showed an overall prevalence of childhood CAM use between 1.8% and 2%, with an annual expenditure of $149 million on CAM visits and remedies (10
). It is interesting to note that these percentages were far lower when compared with other non-US estimates (12
). Yussman et al (11
) suggested regional differences within the United States, with the prevalence of CAM being more than 2-fold higher in western compared with northeastern states.
Data on CAM use in the pediatric IBD population are equally sparse. Published national and international pediatric studies report a wide range of use: 7% to 72% of this population have used CAM therapy or seen an alternative medicine practitioner (14
). Of these studies, 2 included patients from the United States, and only 1, Markowitz et al (16
), exclusively investigated US subjects but was limited specifically to the greater Philadelphia area and the surrounding counties in Delaware, New Jersey, and Pennsylvania. In the Markowitz et al study, patients were included based on census data from the 2000 US Census identifying the total number of children living in the surveyed area (16
). They estimated that the prevalence of CAM was 50.8% within the previous 12 months. The most common types of CAM used were identified as nutritional supplements, followed by special diets (milk-/dairy-free, low carbohydrates, gluten-free), and only a small percentage used herbal remedies (5.1%). Prayer was not included as an alternative therapy. The perceived benefits of CAM were not outlined. In their analysis, a diagnosis of Crohn disease, frequent school absences, and the use of corticosteroids, antibiotics, immunomodulators, and biological therapies were associated with increased prevalence of CAM use.
Heuschkel et al (15
) conducted a similar study and included children and young adults with IBD living in the United Kingdom, Michigan, and Massachusetts. The frequency of CAM use was 41%, and the most commonly reported treatments were megavitamins, dietary supplements, and herbal remedies. Prayer, included in a larger category of “environmental and lifestyle changes,” accounted for 10%. Dietary supplementation was not categorized as a CAM therapy. Overall perceived benefit was “a little” on a 3-point Likert scale. Variables increasing the likelihood of using alternative therapies included parental CAM usage and number of adverse effects from conventional therapies.
Our aim was to further characterize CAM use in an exclusively US pediatric IBD population. We sought to identify whether regional differences exist with CAM therapies in this patient group and to define any predictors to help identify patients who may use CAM. Additionally, we included a comparison group to establish whether differences exist in CAM use between pediatric patients with IBD and those with constipation, representing another group of children with a chronic gastrointestinal condition.