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The Different Drummer: Non-traditional Therapeutic Approaches

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Inflammatory Bowel Disease

Part of the book series: Clinical Gastroenterology ((CG))

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Abstract

Clinicians are frequently asked about the use of complementary and alternative medications (CAM) in the setting of inflammatory bowel disease (IBD), given the significant numbers of patients who do not respond optimally to conventional therapy. Largely, the interest for CAM therapies from patients has outpaced the scientific evidence for such therapies. While there is some existing evidence and few controlled trials, most CAM studies are small, use heterogeneous populations, and have inconsistent results. Larger controlled studies are needed to make meaningful statements on their efficacy. Despite this, CAM therapies are likely here to stay, and patients will continue to inquire about them, so the onus in on practicing clinicians to appreciate the existing data, the relevant patients groups studied, and present all treatment options to patients in a clear and evidence-based fashion, which will further allow practitioners to build trust with patients with IBD and optimize their care. The aim of this review is to present the existing data on probiotics, fecal microbiota transplantation, helminths, herbs and botanicals including cannabis, and mind-body practices as CAM therapy for IBD.

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References

  1. Hilsden RJ, Verhoef MJ, Rasmussen H, Porcino A, DeBruyn JCC. Use of complementary and alternative medicine by patients with inflammatory bowel disease. Inflamm Bowel Dis. 2011;17(2):655–62.

    Article  PubMed  Google Scholar 

  2. Langhorst J, Anthonisen IB, Steder-Neukamm U, Luedtke R, Spahn G, Michalsen A, et al. Patterns of complementary and alternative medicine (CAM) use in patients with inflammatory bowel disease: perceived stress is a potential indicator for CAM use. Complement Ther Med. 2007;15(1):30–7.

    Google Scholar 

  3. Hemarajata P, Versalovic J. Effects of probiotics on gut microbiota: mechanisms of intestinal immunomodulation and neuromodulation. Therap Adv Gastroenterol. 2013;6(1):39–51.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Ng SC, Plamondon S, Kamm MA, Hart AL, Al-Hassi HO, Guenther T, et al. Immunosuppressive effects via human intestinal dendritic cells of probiotic bacteria and steroids in the treatment of acute ulcerative colitis. Inflamm Bowel Dis. 2010;16(8):1286–98.

    Article  PubMed  Google Scholar 

  5. Wasilewski A, Zielińska M, Storr M, Fichna J. Beneficial effects of probiotics, prebiotics, synbiotics, and psychobiotics in inflammatory bowel disease. Inflamm Bowel Dis. 2015;21(7):1674–82.

    Article  PubMed  Google Scholar 

  6. Tursi A, Brandimarte G, Giorgetti GM, Forti G, Modeo ME, Gigliobianco A. Low-dose balsalazide plus a high-potency probiotic preparation is more effective than balsalazide alone or mesalazine in the treatment of acute mild-to-moderate ulcerative colitis. Med Sci Monit. 2004;10(11):PI126–31.

    CAS  PubMed  Google Scholar 

  7. Sood A, Midha V, Makharia GK, Ahuja V, Singal D, Goswami P, et al. The probiotic preparation, VSL#3 induces remission in patients with mild-to-moderately active ulcerative colitis. Clin Gastroenterol Hepatol. 2009;7(11):1202–9, 1209.e1.

    Google Scholar 

  8. Tursi A, Brandimarte G, Papa A, Giglio A, Elisei W, Giorgetti GM, et al. Treatment of relapsing mild-to-moderate ulcerative colitis with the probiotic VSL#3 as adjunctive to a standard pharmaceutical treatment: a double-blind, randomized, placebo-controlled study. Am J Gastroenterol. 2010;105(10):2218–27.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Kuisma J, Mentula S, Jarvinen H, Kahri A, Saxelin M, Farkkila M. Effect of lactobacillus rhamnosus GG on ileal pouch inflammation and microbial flora. Aliment Pharmacol Ther. 2003;17(4):509–15.

    Article  CAS  PubMed  Google Scholar 

  10. Gionchetti P, Rizzello F, Venturi A, Brigidi P, Matteuzzi D, Bazzocchi G, et al. Oral bacteriotherapy as maintenance treatment in patients with chronic pouchitis: a double-blind, placebo-controlled trial. Gastroenterology. 2000;119(2):305–9.

    Article  CAS  PubMed  Google Scholar 

  11. Gionchetti P, Rizzello F, Helwig U, Venturi A, Lammers KM, Brigidi P, et al. Prophylaxis of pouchitis onset with probiotic therapy: a double-blind, placebo-controlled trial. Gastroenterology. 2003;124(5):1202–9.

    Article  PubMed  Google Scholar 

  12. Mimura T, Rizzello F, Helwig U, Poggioli G, Schreiber S, Talbot IC, et al. Once daily high dose probiotic therapy (VSL#3) for maintaining remission in recurrent or refractory pouchitis. Gut. 2004;53(1):108–14.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Matthes H, Krummenerl T, Giensch M, Wolff C, Schulze J. Clinical trial: probiotic treatment of acute distal ulcerative colitis with rectally administered Escherichia coli Nissle 1917 (EcN). BMC Complement Altern Med. 2010;10:13.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Kruis W, Fric P, Pokrotnieks J, Lukás M, Fixa B, Kascák M, et al. Maintaining remission of ulcerative colitis with the probiotic Escherichia coli Nissle 1917 is as effective as with standard mesalazine. Gut. 2004;53(11):1617–23.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Kruis W, Schütz E, Fric P, Fixa B, Judmaier G, Stolte M. Double-blind comparison of an oral Escherichia coli preparation and mesalazine in maintaining remission of ulcerative colitis. Aliment Pharmacol Ther. 1997;11(5):853–8.

    Article  CAS  PubMed  Google Scholar 

  16. Rembacken BJ, Snelling AM, Hawkey PM, Chalmers DM, Axon AT. Non-pathogenic Escherichia coli versus mesalazine for the treatment of ulcerative colitis: a randomised trial. Lancet (London, England). 1999;354(9179):635–9.

    Article  CAS  Google Scholar 

  17. Naidoo K, Gordon M, Fagbemi AO, Thomas AG, Akobeng AK. Probiotics for maintenance of remission in ulcerative colitis. Cochrane Database Syst Rev. 2011;12:CD007443.

    Google Scholar 

  18. Mallon P, McKay D, Kirk S, Gardiner K. Probiotics for induction of remission in ulcerative colitis. Cochrane Database Syst Rev. 2007;4:CD005573.

    Google Scholar 

  19. Bourreille A, Cadiot G, Le Dreau G, Laharie D, Beaugerie L, Dupas J-L, et al. Saccharomyces boulardii does not prevent relapse of Crohn’s disease. Clin Gastroenterol Hepatol. 2013;11(8):982–7.

    Article  PubMed  Google Scholar 

  20. Marteau P, Lémann M, Seksik P, Laharie D, Colombel JF, Bouhnik Y, et al. Ineffectiveness of lactobacillus johnsonii LA1 for prophylaxis of postoperative recurrence in Crohn’s disease: a randomised, double blind, placebo controlled GETAID trial. Gut. 2006;55(6):842–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Van Gossum A, Dewit O, Louis E, de Hertogh G, Baert F, Fontaine F, et al. Multicenter randomized-controlled clinical trial of probiotics (lactobacillus johnsonii, LA1) on early endoscopic recurrence of Crohn’s disease after lleo-caecal resection. Inflamm Bowel Dis. 2007;13(2):135–42.

    Article  PubMed  Google Scholar 

  22. Schultz M, Timmer A, Herfarth HH, Sartor RB, Vanderhoof JA, Rath HC. Lactobacillus GG in inducing and maintaining remission of Crohn’s disease. BMC Gastroenterol. 2004;4:5.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Fedorak RN, Feagan BG, Hotte N, Leddin D, Dieleman LA, Petrunia DM, et al. The probiotic VSL#3 has anti-inflammatory effects and could reduce endoscopic recurrence after surgery for Crohn’s disease. Clin Gastroenterol Hepatol. 2015;13(5):928–35.e2.

    Google Scholar 

  24. van Nood E, Vrieze A, Nieuwdorp M, Fuentes S, Zoetendal EG, de Vos WM, et al. Duodenal infusion of donor feces for recurrent Clostridium Difficile. N Engl J Med. 2013;368(5):407–15.

    Article  PubMed  Google Scholar 

  25. Brandt LJ, Aroniadis OC, Mellow M, Kanatzar A, Kelly C, Park T, et al. Long-term follow-up of colonoscopic fecal microbiota transplant for recurrent Clostridium Difficile infection. Am J Gastroenterol. 2012;107(7):1079–87.

    Article  PubMed  Google Scholar 

  26. Kunde S, Pham A, Bonczyk S, Crumb T, Duba M, Conrad H, et al. Safety, tolerability, and clinical response after fecal transplantation in children and young adults with ulcerative colitis. J Pediatr Gastroenterol Nutr. 2013;56(6):597–601.

    Article  PubMed  Google Scholar 

  27. Moayyedi P, Surette MG, Kim PT, Libertucci J, Wolfe M, Onischi C, et al. Fecal microbiota transplantation induces remission in patients with active ulcerative colitis in a randomized controlled trial. Gastroenterology. 2015;149(1):102–9.e6.

    Google Scholar 

  28. Rossen NG, Fuentes S, van der Spek MJ, Tijssen JG, Hartman JHA, Duflou A, et al. Findings from a randomized controlled trial of fecal transplantation for patients with ulcerative colitis. Gastroenterology. 2015;149(1):110–8.e4.

    Google Scholar 

  29. Vaughn BP, Vatanen T, Allegretti JR, Bai A, Xavier RJ, Korzenik J, et al. Increased intestinal microbial diversity following fecal microbiota transplant for active Crohn’s disease. Inflamm Bowel Dis. 2016;22(9):2182–90.

    Article  PubMed  Google Scholar 

  30. Suskind DL, Brittnacher MJ, Wahbeh G, Shaffer ML, Hayden HS, Qin X, et al. Fecal microbial transplant effect on clinical outcomes and fecal microbiome in active Crohn’s disease. Inflamm Bowel Dis. 2015;21(3):556–63.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Vermeire S, Joossens M, Verbeke K, Wang J, Machiels K, Sabino J, et al. Donor species richness determines Faecal microbiota transplantation success in inflammatory bowel disease. J Crohns Colitis. 2016;10(4):387–94.

    Article  PubMed  Google Scholar 

  32. De Leon LM, Watson JB, Kelly CR. Transient flare of ulcerative colitis after fecal microbiota transplantation for recurrent Clostridium Difficile infection. Clin Gastroenterol Hepatol. 2013;11(8):1036–8.

    Article  PubMed  Google Scholar 

  33. Hilsden RJ, Verhoef MJ, Best A, Pocobelli G. Complementary and alternative medicine use by Canadian patients with inflammatory bowel disease: results from a national survey. Am J Gastroenterol. 2003;98(7):1563–8.

    Article  PubMed  Google Scholar 

  34. Ganguli SC, Cawdron R, Irvine EJ. Alternative medicine use by Canadian ambulatory gastroenterology patients: secular trend or epidemic? Am J Gastroenterol. 2004;99(2):319–26.

    Article  PubMed  Google Scholar 

  35. Ng SC, Lam YT, Tsoi KKF, Chan FKL, Sung JJY, Wu JCY. Systematic review: the efficacy of herbal therapy in inflammatory bowel disease. Aliment Pharmacol Ther. 2013;38(8):854–63.

    Article  CAS  PubMed  Google Scholar 

  36. Gerhardt H, Seifert F, Buvari P, Vogelsang H, Repges R. Therapy of active Crohn disease with Boswellia serrata extract H 15. Z Gastroenterol. 2001;39(1):11–7.

    Article  CAS  PubMed  Google Scholar 

  37. Holtmeier W, Zeuzem S, Preiss J, Kruis W, Böhm S, Maaser C, et al. Randomized, placebo-controlled, double-blind trial of Boswellia serrata in maintaining remission of Crohn’s disease: good safety profile but lack of efficacy. Inflamm Bowel Dis. 2011;17(2):573–82.

    Article  PubMed  Google Scholar 

  38. Krebs S, Omer TN, Omer B. Wormwood (Artemisia absinthium) suppresses tumour necrosis factor alpha and accelerates healing in patients with Crohn’s disease – a controlled clinical trial. Phytomedicine. 2010;17(5):305–9.

    Article  CAS  PubMed  Google Scholar 

  39. Omer B, Krebs S, Omer H, Noor TO. Steroid-sparing effect of wormwood (Artemisia absinthium) in Crohn’s disease: a double-blind placebo-controlled study. Phytomedicine. 2007;14(2–3):87–95.

    Article  CAS  PubMed  Google Scholar 

  40. Tang T, Targan SR, Li Z-S, Xu C, Byers VS, Sandborn WJ. Randomised clinical trial: herbal extract HMPL-004 in active ulcerative colitis – a double-blind comparison with sustained release mesalazine. Aliment Pharmacol Ther. 2011;33(2):194–202.

    Article  CAS  PubMed  Google Scholar 

  41. Sandborn WJ, Targan SR, Byers VS, Rutty DA, Mu H, Zhang X, et al. Andrographis paniculata Extract (HMPL-004) for active ulcerative colitis. Am J Gastroenterol. 2013;108(1):90–8.

    Article  PubMed  Google Scholar 

  42. Hanai H, Iida T, Takeuchi K, Watanabe F, Maruyama Y, Andoh A, et al. Curcumin maintenance therapy for ulcerative colitis: randomized, multicenter, double-blind, placebo-controlled trial. Clin Gastroenterol Hepatol. 2006;4(12):1502–6.

    Article  CAS  PubMed  Google Scholar 

  43. Singla V, Pratap Mouli V, Garg SK, Rai T, Choudhury BN, Verma P, et al. Induction with NCB-02 (curcumin) enema for mild-to-moderate distal ulcerative colitis – a randomized, placebo-controlled, pilot study. J Crohns Colitis. 2014;8(3):208–14.

    Article  PubMed  Google Scholar 

  44. Lang A, Salomon N, Wu JCY, Kopylov U, Lahat A, Har-Noy O, et al. Curcumin in combination with mesalamine induces remission in patients with mild-to-moderate ulcerative colitis in a randomized controlled trial. Clin Gastroenterol Hepatol. 2015;13(8):1444–9.e1.

    Google Scholar 

  45. Pertwee RG. The diverse CB1 and CB2 receptor pharmacology of three plant cannabinoids: delta9-tetrahydrocannabinol, cannabidiol and delta9-tetrahydrocannabivarin. Br J Pharmacol. 2008;153(2):199–215.

    Article  CAS  PubMed  Google Scholar 

  46. Lahat A, Lang A, Ben-Horin S. Impact of cannabis treatment on the quality of life, weight and clinical disease activity in inflammatory bowel disease patients: a pilot prospective study. Digestion. 2012;85(1):1–8.

    Article  PubMed  Google Scholar 

  47. Naftali T, Lev LB, Yablecovitch D, Yablekovitz D, Half E, Konikoff FM. Treatment of Crohn’s disease with cannabis: an observational study. Isr Med Assoc J. 2011;13(8):455–8.

    PubMed  Google Scholar 

  48. Naftali T, Bar-Lev Schleider L, Dotan I, Lansky EP, Sklerovsky Benjaminov F, Konikoff FM. Cannabis induces a clinical response in patients with Crohn’s disease: a prospective placebo-controlled study. Clin Gastroenterol Hepatol. 2013;11(10):1276–80.e1.

    Google Scholar 

  49. Ravikoff Allegretti J, Courtwright A, Lucci M, Korzenik JR, Levine J. Marijuana use patterns among patients with inflammatory bowel disease. Inflamm Bowel Dis. 2013;19(13):2809–14.

    Article  PubMed  Google Scholar 

  50. Storr M, Devlin S, Kaplan GG, Panaccione R, Andrews CN. Cannabis use provides symptom relief in patients with inflammatory bowel disease but is associated with worse disease prognosis in patients with Crohn’s disease. Inflamm Bowel Dis. 2014;20(3):472–80.

    Article  PubMed  Google Scholar 

  51. Gerich ME, Isfort RW, Brimhall B, Siegel CA. Medical marijuana for digestive disorders: high time to prescribe? Am J Gastroenterol. 2015;110(2):208–14.

    Article  PubMed  Google Scholar 

  52. Fleming J, Fabry Z. The hygiene hypothesis and multiple sclerosis. Ann Neurol. 2007;61(2):85–9.

    Article  PubMed  Google Scholar 

  53. Weinstock JV, Elliott DE. Helminths and the IBD hygiene hypothesis. Inflamm Bowel Dis. 2009;15(1):128–33.

    Article  PubMed  Google Scholar 

  54. Summers RW, Elliott DE, Urban JF, Thompson RA, Weinstock JV. Trichuris suis therapy for active ulcerative colitis: a randomized controlled trial. Gastroenterology. 2005;128(4):825–32.

    Article  PubMed  Google Scholar 

  55. Bernstein CN, Singh S, Graff LA, Walker JR, Miller N, Cheang M. A prospective population-based study of triggers of symptomatic flares in IBD. Am J Gastroenterol. 2010;105(9):1994–2002.

    Article  PubMed  Google Scholar 

  56. Langhorst J, Hofstetter A, Wolfe F, Häuser W. Short-term stress, but not mucosal healing nor depression was predictive for the risk of relapse in patients with ulcerative colitis: a prospective 12-month follow-up study. Inflamm Bowel Dis. 2013;19(11):2380–6.

    Article  PubMed  Google Scholar 

  57. Langhorst J, Mueller T, Luedtke R, Franken U, Paul A, Michalsen A, et al. Effects of a comprehensive lifestyle modification program on quality-of-life in patients with ulcerative colitis: a twelve-month follow-up. Scand J Gastroenterol 2007;42(6):734–45.

    Google Scholar 

  58. Jedel S, Hoffman A, Merriman P, Swanson B, Voigt R, Rajan KB, et al. A randomized controlled trial of mindfulness-based stress reduction to prevent flare-up in patients with inactive ulcerative colitis. Digestion. 2014;89(2):142–55.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  59. Elsenbruch S, Langhorst J, Popkirowa K, Müller T, Luedtke R, Franken U, et al. Effects of mind-body therapy on quality of life and neuroendocrine and cellular immune functions in patients with ulcerative colitis. Psychother Psychosom. 2005;74(5):277–87.

    Article  PubMed  Google Scholar 

  60. Keefer L, Taft TH, Kiebles JL, Martinovich Z, Barrett TA, Palsson OS. Gut-directed hypnotherapy significantly augments clinical remission in quiescent ulcerative colitis. Aliment Pharmacol Ther. 2013;38(7):761–71.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  61. Joos S, Brinkhaus B, Maluche C, Maupai N, Kohnen R, Kraehmer N, et al. Acupuncture and moxibustion in the treatment of active Crohn’s disease: a randomized controlled study. Digestion. 2004;69(3):131–9.

    Article  PubMed  Google Scholar 

  62. Joos S, Wildau N, Kohnen R, Szecsenyi J, Schuppan D, Willich SN, et al. Acupuncture and moxibustion in the treatment of ulcerative colitis: a randomized controlled study. Scand J Gastroenterol. 2006;41(9):1056–63.

    Article  PubMed  Google Scholar 

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Correspondence to Eugene F. Yen MD, FACG .

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Yen, E.F. (2017). The Different Drummer: Non-traditional Therapeutic Approaches. In: Cohen, R. (eds) Inflammatory Bowel Disease. Clinical Gastroenterology. Humana Press, Cham. https://doi.org/10.1007/978-3-319-53763-4_12

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