The usage of complementary and alternative medicine in gastrointestinal patients visiting the outpatients’ department of a large tertiary care centre-views from Pakistan
Ghulamullah Lail1, Nasir Hassan Luck1, Abbas Ali Tasneem1,
Ayesha Aslam Rai1, Syed Mudassir Laeeq1, Zain Majid1,&
1Department of Hepato-gastroenterology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
Zain Majid, Department of Hepato-gastroenterology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
the use of complementary and alternative medicine (CAM) has increased over the last few years, and an emergent data suggests that some CAM modalities may be helpful in addressing gastrointestinal (GI) conditions. Our aimwas to find out the prevalence ofsuch practices for GI condition amongst patients visiting an Outpatients' department of a large tertiary care centre of Karachi, Pakistan.
patients visiting outpatient department of Hepatogastroenterology department at SIUT, Pakistan from March 2014 to March 2015, were included in this cross sectional study.A pre designed questionnaire was used that included the demographic data, primary disease of the patient, CAM modality used, reason for the use of CAM therapy and reasons for stopping it. Frequencies of different variables were computed using SPSS version 18.
906 patients were interviewed,Out of which 52% (471) weremales.The mean age at presentation was 39.81±12.4 years. 234 (25.8%) of the participants used one of the CAM modalities; Herbal medicine being most common one, seen in 122 (52.13%) followed by spiritual 61 (26%),and homeopathy 33 (14%). The duration of therapy was limited to six months in 161(68%), whereas 7 patients (2.9%) had prolonged duration of use of more than five years. Reasons for using CAM therapy included advice by family and friends in 66 patients (28%), personal will in 42 (17.94%), no benefit from allopathic treatment in 34 (14.5%),while high cost was the reason of use in 3(5%) of the patients. The most common reason for discontinuation of CAM was no benefit, seen in 113 patients (48.30%), followed by physician’s advice in 32 (17%) patients, and side effects in 19 (8%). On the other hand 44 patients (18.80%) reported benefit from the therapy while 14 (5.9%) were still continuing with CAM modality. Among the CAM users 140 (60.09%) were un-educated or had primary education while CAM nonusers had 328 (47%) were either uneducated or had primary education only correlation reveals P value 0.004.
significant numbers of patients used CAM therapy. A lower level of education was associated with increased usage of CAM while cost had no major impact on its usage.
CAM or alternative medicines are practices and therapeutics that
are not included in conventional medicine therapies. It is reported
that around 50% of the developed and over 80% of the underdeveloped
countries use CAM . Substantial rise in CAM usage
has been seen in the European countries in the last two decades .
Some example of CAM based therapies include massage therapies,
spinal manipulation, relaxation techniques, meditation, traditional
Chinese medications like
tai chi, qi gong and herbal medicines . CAM is a
field that has a great amount of public interest so modern doctors
must be aware of it . The use of CAM therapies does
have its costs though and around $ 34 billion are spent on it annually
USA . The various forms of CAM therapies vary according
to the type of illness and the nationality of the person .
Its usage in the field of gastroenterology is mostly seen amongst
patients with functional GI disorders . Functional
GI disorders amount for 40% of the visits to a GI clinic, this
range from GERD to constipation
to IBS .
One study in UK showed that CAM usage for GI symptoms and IBS was 26% and 48%
respectively . Nilsson K et al in their study involving
28 different CAM therapies in patients with functional GI disorders
showed that a minimum of at least one therapy had been tried by
all 137 patients
that were included in their study . ZC Yang et al
evaluated the use of CAM in GI and CLD patients, revealed that
39% of these patients had used CAM therapies, with Chinese herbal
medicine being the
most common type of CAM therapy used by them .
This questionnaire based cross sectional study was conducted in the
OPD of the GI department at the Sind Institute of Urology And Transplantation
(SIUT), a large tertiary care centre located in the province of Sind, Pakistan.
The study period was conducted in six month duration months that is from
February to August 2015. A total of 906 people were interviewed as per non
probability consecutive samplingfrom those who visited the OPD during this
period. 52% of the subjects were male while the rest were female. Those
excluded were either failed to consent or mentally challenged. The included
subjects were not only the local residences of Karachi city but also people
visiting our OPD from cities and villages of nearly all the provinces of
Pakistan. The visiting patients included men, women and children of all
age groups and religion.Our questionnaire was divided into two parts; the
first one involving the person’s demographic details, while the second one
dealt with the primary disease for which CAM used, which CAM modality used,
reason for use of CAM and reason for stopping CAM. Frequencies of different
variables were computed.Questions were asked and the questionnaires was
filled out personally by the principal investigator himself and an informed
consent was obtained prior to this. Data entry and analysis was done using
Statistical Program for Social Sciences Program (SPSS) version 18.0 and
frequencies, cross tabulations and chi square test were obtained.
A total of 906 patients were included in this study, out of which 471(52%) were males. The male to female ratio was 1.08:1. The mean age at presentation was 39.81±12.4 years. 234 (25.8%) of participants used one of the following CAM modalities(Herbal, Homeopathy or spiritual) Herbal medicine being most common one, seen in 122 patients (52.13%),spiritual therapy in 61 patients (26%), and homeopathy in 33 (14%) of the CAM users (Figure 1). The duration of therapy was limited to six months in 161(68%), whereas 7 (2.9%) reported had a duration of use of more than five years.The main reasons for use of CAM therapies included advice by family and friends seen in 66 patients (28%), personal will in 42 (17.94%), no benefit from allopathy 34 (14.5%) while high cost was the reason in 3(5%) of patients (Figure 2). The main reason for discontinuing the use of CAM was no benefit, seen in 113 (48.30%), followed by physician’s advice 32 (17%) patients, and side effects in 19 (8%). On the other hand 44 (18.80%) patients reported benefit from the therapy and 14 (5.9%) were still continuing with its use. AmongstCAM users, 140 (60.09%) were un-educated or had primary education while in CAM nonusers 328 (47%) were either uneducated or had primary education. A significant P value was seen for this correlation (P value 0.004).
CAM’s usage in the field of gastroenterology is mostly seen amongst patients
with functional GI disorders . Functional GI disorders
amount for 40% of the visits to a GI clinic, these ranges from GERD to constipation
to IBS . One study in UK showed that CAM usage for
GI symptoms and IBS was 26% and 48% respectively .
Nilsson K et al in their study involving 28 different CAM therapies in patients
with functional GI disorders showed that a minimum of at least one therapy
had been tried by all 137 patients that were included in their study .
ZC Yang et al evaluated the use of CAM in GI and CLD patients, revealed that
39% of these patients had used CAM therapies, with Chinese herbal medicine
being the most common type of CAM therapy used by them .
Hardly any research exists on the use of CAM therapies in the pediatric GI age
group .Another study showed that the use of CAM based therapies in pediatric
GI patients is around 40%, with the main reason of using such therapies being
non effective conventional medications, along with their adverse effects and
being absent from school for more than 5 days .
A Hung et al in their study about the prevalence
of CAM therapies in GI disease patients showed the use of CAM to be around
44% in 269 patients who were questioned,
with female gender being the main group. Most common reason of
using such therapies was said to be not being satisfied with the current
of these patients even reported improvement of their symptoms after
using CAM therapies and 30% of the patients did not disclosure their use
physicians mainly because their physicians did not inquire about
its use (reported by 80% of these patients) . CAM
based therapies are frequently used for chronic constipation. The main one
used is acupuncture
followed by herbal therapy . In another research
highlighting the use and cost of CAM in patients with functional
GI disorders showed ginger to be the most common CAM used for it. CAM usage
was seen more
in those having a higher level of education and those having anxiety
disorders . The prevalence of IBS is 5-20 % in
the general population and the use of CAM in them leads to a better control
of their symptoms
. More than 70% of the developing countries are
in use of CAM therapies . Having a rich cultural
history, the use of medicinal plants for healing purpose based on the unani system
(herbal) is very common in Pakistan and dates back to the Indus
civilization . While the use of CAM or alternative
medicine was found to be around 70-80% in Pakistani population .
Studies on the use of CAM therapies in Pakistan are still in its
early stages. Since most of the Pakistani population lies below the poverty
line and with
spiritual and religious beliefs deeply embedded in our society,
the use of CAM therapies is very common in our setup .
One study conducted at a large tertiary care hospital in Karachi, Pakistan
the use of CAM therapy amongst patients visiting the health care
centre was around 59%, with herbal medicine being the main type of CAM therapy
by homeopathic . Another study on the use of CAM
therapy in chronic hepatitis C patients at a Rawalpindi hospital
showed that the main reason of resorting to alternative medicine was the
cost of conventional
therapies . In our study we evaluated only few
modalities of CAM, the research can be expanded including Hijmaa,
different dietary products and acupuncture.
More than a quarter of patients use CAM therapies, commonest reason for use of CAM was family and friends advise while on contrary cost had no major impact on its usage. A lower level of education was associated with increased usage of CAM.
What is known about this topic
- More than a quarter of patients use CAM therapies;
- Commonest reason for use of CAM was family and friends’ advisewhile on contrary cost had no major impact on its usage;
- A lower level of education was associated with increased usage of CAM.
What this study adds
- Information on the use of CAM therapies in Pakistan;
- The most common one used;
- One of the largest studies on the use of CAM therapies in Pakistan.
Authors declare no competing interest.
Ghulamullah, Nasir Hassan Luck, Abbas wrote the manuscript including
the initial and final draft. Mudassir, Ayesha and Zain interviewed
the patients, collected the data. All authors have read and agreed
to the final manuscript.
Figure 1: showing the types of CAM therapies used in our patients
Figure 2: flow chart showing indication for CAM usage as seen in our patients
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