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Complementary and Alternative Treatments Are Needed to Enhance the Care of the Inflammatory Bowel Disease Patient
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Preface Complementary and Alternative Tr e a t m e n t s A r e N e e d e d t o Enhance the Care of the Inflammatory Bowel Disease Patient
Ali Keshavarzian, MD Ece A. Mutlu, MD, MBA Editors
Inflammatory bowel disease (IBD) is a complex chronic disorder with a rising number of patients in the United States and worldwide. Those of us who are taking care of the IBD patient recognize daily the limitations of standard medical therapies that we have to treat this disease. Current therapies are only partially effective even when it comes to controlling patient symptoms, targeting primarily one aspect of the disease pathogenesis (ie immune activation), and are also woefully inadequate, inducing mucosal healing by eliminating the inflammatory ulcerations in the gastrointestinal track in a significant majority. As such, flares of the disease are common especially in those with subclinical inflammation of the gastrointestinal tract. The causes of many of the IBD flares are unknown but seem to be related to modifiable lifestyle factors. Currently, there are few traditional treatments that may address such lifestyle factors, if any. Therefore, additional approaches to IBD care are much needed to assure the longterm well-being our patients for this lifelong disease, until a permanent cure for IBD can be found. Complementary and alternative treatments have the potential to help improve symptoms, quality of life, as well as in some instances, make an impact in inducing or maintaining remission in IBD. Such treatments can not only address immune activation but also target additional mechanisms that have been purported to play a role in the disease pathogenesis. In this issue of the Gastroenterology Clinics of North America, we have gathered a large number of experts in their respective fields to answer the
Gastroenterol Clin N Am - (2017) -–https://doi.org/10.1016/j.gtc.2017.09.001 0889-8553/17/ª 2017 Published by Elsevier Inc.
gastro.theclinics.com
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Preface
question of what additional complementary or alternative approaches can be helpful in management of the IBD patient. Together with them, we hereby present you the latest data on such treatments for IBD in an effort to fill a large gap in patient care. These data are in the form of short reviews, and many carefully selected, pertinent articles are also attached as references and can be the basis of additional reading, for those who are interested in further expanding their knowledge. Since it is not possible to cover any and all imaginable therapies within complementary and alternative realm, we have limited our topics to those most frequently asked about by our own patients. They still cover a wide range from dietary options and nutraceuticals, to fecal transplant to probiotics and probiotics, and treatments that make use of the mind-body connection as well as herbs, vitamins, minerals, and other therapies such as acupuncture and moxibustion. We also present tips on how to begin implementing in these therapies in a general gastroenterology practice. We hope that this issue will be useful in considering the addition of such therapies for every gastroenterologist to his/her practice. In addition to the knowledge in this field, we also hope that this issue enhances and expands communication between traditional care providers practicing at all levels (such as primary care physicians, gastroenterologists to physician extenders, nurses, and trainees and medical students) and alternative providers and strengthens the bond between them. We expect that nurturing such bonds can only be expected to improve IBD research by generating novel hypotheses and thereby developing or enriching new areas of research. Only then we can expect that our IBD patients will have all the options to pick and choose from, when it comes to enhancing their well-being. Sincerely, Your editors, Ali Keshavarzian, MD Rush University Medical Center Division of Digestive Diseases & Nutrition 1725 West Harrison Street Suite 206 Chicago, IL 60612, USA Ece A. Mutlu, MD, MBA Rush University Medical Center Division of Digestive Diseases & Nutrition 1725 West Harrison Street Suite 206 Chicago, IL 60612, USA E-mail addresses: [email protected] (A. Keshavarzian) [email protected] (E.A. Mutlu)
Preface Complementary and Alternative Tr e a t m e n t s A r e N e e d e d t o Enhance the Care of the Inflammatory Bowel Disease Patient
Ali Keshavarzian, MD Ece A. Mutlu, MD, MBA Editors
Inflammatory bowel disease (IBD) is a complex chronic disorder with a rising number of patients in the United States and worldwide. Those of us who are taking care of the IBD patient recognize daily the limitations of standard medical therapies that we have to treat this disease. Current therapies are only partially effective even when it comes to controlling patient symptoms, targeting primarily one aspect of the disease pathogenesis (ie immune activation), and are also woefully inadequate, inducing mucosal healing by eliminating the inflammatory ulcerations in the gastrointestinal track in a significant majority. As such, flares of the disease are common especially in those with subclinical inflammation of the gastrointestinal tract. The causes of many of the IBD flares are unknown but seem to be related to modifiable lifestyle factors. Currently, there are few traditional treatments that may address such lifestyle factors, if any. Therefore, additional approaches to IBD care are much needed to assure the longterm well-being our patients for this lifelong disease, until a permanent cure for IBD can be found. Complementary and alternative treatments have the potential to help improve symptoms, quality of life, as well as in some instances, make an impact in inducing or maintaining remission in IBD. Such treatments can not only address immune activation but also target additional mechanisms that have been purported to play a role in the disease pathogenesis. In this issue of the Gastroenterology Clinics of North America, we have gathered a large number of experts in their respective fields to answer the
Gastroenterol Clin N Am - (2017) -–https://doi.org/10.1016/j.gtc.2017.09.001 0889-8553/17/ª 2017 Published by Elsevier Inc.
gastro.theclinics.com
ii
Preface
question of what additional complementary or alternative approaches can be helpful in management of the IBD patient. Together with them, we hereby present you the latest data on such treatments for IBD in an effort to fill a large gap in patient care. These data are in the form of short reviews, and many carefully selected, pertinent articles are also attached as references and can be the basis of additional reading, for those who are interested in further expanding their knowledge. Since it is not possible to cover any and all imaginable therapies within complementary and alternative realm, we have limited our topics to those most frequently asked about by our own patients. They still cover a wide range from dietary options and nutraceuticals, to fecal transplant to probiotics and probiotics, and treatments that make use of the mind-body connection as well as herbs, vitamins, minerals, and other therapies such as acupuncture and moxibustion. We also present tips on how to begin implementing in these therapies in a general gastroenterology practice. We hope that this issue will be useful in considering the addition of such therapies for every gastroenterologist to his/her practice. In addition to the knowledge in this field, we also hope that this issue enhances and expands communication between traditional care providers practicing at all levels (such as primary care physicians, gastroenterologists to physician extenders, nurses, and trainees and medical students) and alternative providers and strengthens the bond between them. We expect that nurturing such bonds can only be expected to improve IBD research by generating novel hypotheses and thereby developing or enriching new areas of research. Only then we can expect that our IBD patients will have all the options to pick and choose from, when it comes to enhancing their well-being. Sincerely, Your editors, Ali Keshavarzian, MD Rush University Medical Center Division of Digestive Diseases & Nutrition 1725 West Harrison Street Suite 206 Chicago, IL 60612, USA Ece A. Mutlu, MD, MBA Rush University Medical Center Division of Digestive Diseases & Nutrition 1725 West Harrison Street Suite 206 Chicago, IL 60612, USA E-mail addresses: [email protected] (A. Keshavarzian) [email protected] (E.A. Mutlu)