title: Amount of systemic steroid medication is a strong predictor for the use of complementary and alternative medicine in patients with inflammatory bowel disease: results from a German national survey.
abstract: OBJECTIVE
  Previous studies have suggested that inflammatory bowel disease (IBD) patients rank high among users of complementary and alternative medicine (CAM). To further elucidate this phenomenon, we sent questionnaires to a large sample of IBD patients in Germany to determine the patterns and predictors of their CAM use.
  
  
  METHODS
  Pretested 73-item questionnaires were mailed to a randomly selected representative sample of 1000 IBD patients from the approximately 16,000 members and associates of the German Crohn's and Colitis Association. Predictors of CAM use were evaluated by logistic regression models.
  
  
  RESULTS
  Completed questionnaires were returned by 684 patients (female patients, 61.4%; Crohn's disease patients, 58.3%; ulcerative colitis patients, 38.2%). Of the 671 adult respondents, 344 (51.3%) had experience with CAM, and significantly more of the ulcerative colitis patients (59.8%) than the Crohn's disease patients (48.3%) had experience with CAM. There was no difference by gender. Homeopathy (52.9%) and herbal medicine (43.6%) were the most commonly used types of CAM. The most frequent personal reasons for CAM use were the search for an "optimum treatment" (78.9%) and the wish to stop taking steroids (63.8%). Using logistic regression, we found that total cortisone intake (P = 0.0077), but not duration of disease, was a strong predictor of CAM use. Other predictors were experience with psychosomatic and psychotherapeutic support (P = 0.0029), relaxation techniques (P = 0.0284), an academic education (P = 0.0173), a diet utilizing whole grains (P = 0.0123), and a normal body weight (P = 0.0215). Although 80% of patients indicated that they were interested in using CAM in the future, only 24.7% felt sufficiently informed about it.
  
  
  CONCLUSIONS
  More than 50% of a large group of German IBD patients had used CAM. Prolonged or intensive steroid treatment, an academic education, active ways of coping, and a health-conscious life-style are associated with CAM use. Given the potential side effects and interactions, the treating physician should focus on thorough information about the benefits and limitations of conventional and complementary treatment options, especially for IBD patients who have received prolonged or intensive steroid treatment.
authors.affiliation: Department of Internal Medicine, Kliniken Essen-Mitte, Germany. Jost.langhorst@gmx.de
authors.forename: Jost
authors.initials: J
authors.lastname: Langhorst
authors.forename: Inga B
authors.initials: IB
authors.lastname: Anthonisen
authors.forename: Ulf
authors.initials: U
authors.lastname: Steder-Neukamm
authors.forename: Rainer
authors.initials: R
authors.lastname: Lüdtke
authors.forename: Guenther
authors.initials: G
authors.lastname: Spahn
authors.forename: Andreas
authors.initials: A
authors.lastname: Michalsen
authors.forename: Gustav J
authors.initials: GJ
authors.lastname: Dobos
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D003093:Colitis, Ulcerative / Q000628:therapy*; D000529:Complementary Therapies / Q000706:statistics & numerical data*; D003424:Crohn Disease / Q000628:therapy*; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D006306:Health Surveys; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D013256:Steroids / Q000627:therapeutic use*
chemical_list: D013256:Steroids