Complementary, Integrative, and Holistic Medicine: Integrative Approaches to Pediatric Ulcerative Colitis

Alycia Leiby; Minal Vazirani

doi:10.1542/pir.34-9-405

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Alycia Leiby, MD*
Minal Vazirani, MD^†

^*Pediatric Gastroenterology and Nutrition, Goryeb Children's Hospital/Atlantic Health System, Morristown, NJ, and Department of Pediatrics, Mount Sinai School of Medicine, New York, NY.
^†Integrative Medicine, Barnabas Health Ambulatory Care Center, Siegler Center for Integrative Medicine, Livingston, NJ.

Author Disclosure
Drs Leiby and Vazirani have disclosed no financial relationships relevant to this article. This commentary does not contain discussion of unapproved/investigative use of a commercial product/device.

Abbreviations:

IBD:: inflammatory bowel disease
UC:: ulcerative colitis
5-ASA:: 5-aminosalicylate
CAM:: complementary and alternative medicine
QoL:: quality of life
ECN:: E Coli Nissle

Introduction

Twenty-five percent of inflammatory bowel disease (IBD) occurs in childhood, with 2 of 100,000 children age 1 to 17 years diagnosed as having ulcerative colitis (UC) in North America. (1) In a genetically predisposed individual, environmental factors lead to a dysregulated adaptive immune response to luminal commensal bacterial antigens, resulting in IBD. Although diet, infections, medications, and lack of breastfeeding have been implicated, further research is needed to elucidate the complex environmental and genetic interaction producing IBD. (2)(3)(4) Pediatric UC is often more extensive at initial presentation, with a 20% colectomy rate at 1 year in severe disease. (5) The risk of colorectal cancer, a potential long-term complication, is increased in those with a longer duration and earlier age of disease onset and greater extent of inflammation. (6)

Conventional treatment of UC includes the use of corticosteroids to induce remission in moderate to severe disease and topical 5-aminosalicylate (5-ASA) as maintenance therapy. Recent prospective data confirmed the steroid-sparing effects of maintenance therapy with the immune-modulating thiopurine drugs 6-mercaptopurine and azathioprine in moderate to severe disease unresponsive to 5-ASA agents. (7) In children in whom conventional therapy fails, infliximab, a monoclonal antibody directed against tumor necrosis factor α, has been effective. (8) Despite evidence of benefit, the risk of infection and malignancy affect acceptance of administering these immune-modifying agents.

The incidence of complementary and alternative medicine (CAM) use in pediatric IBD patients ranges from 40% to 70%. (9)(10)(11)(12) The common reason for using CAM is concern about adverse effects and the lack of efficacy of conventional therapies. Use of CAM was increased, particularly in patients with worse quality of life (QoL). (11)(13) This …