Robert J HilsdenMD PhD Frcpc and Marja J VerhoefPhD

The use of complementary and alternative medicine (CAM) by the general public is very common (Ernst, 2000).Therefore, it is not surprising that gastroenterologists frequently encounter patients who are using or want to use CAM to treat their gastrointestinal (GI) condition. Often these patients have used CAM before the development of their Gi condition. others have no prior experience with CAM but now wish to pursue it. Patients learn about CAM through friends or family, books, the media, or the internet, or they may have seen complementary practitioners. Managing these situations can be difficult for gastroenterologists because they may not be knowledgeable about the therapy and are likely to be hesitant to support a therapy without strong scientific evidence of its efficacy and safety. We will briefly review what is currently known about the use of CAM in GI disease and provide practical guidelines for informing and counseling patients. Finally, we will recommend some useful sources of information.

The term CAM will refer to the diverse collection of health systems and diagnostic and therapeutic modalities that are not part of the conventional western medical system. Examples of CAM include alternative medical systems (eg, homeopathy, traditional Chinese medicine, and Ayurveda), products derived from nature (eg, milk thistle, aloe vera, and other herbs), probiotics, orthomolecular medicine (eg, high dose vitamin C, coenzyme Q10), pharmacological interventions (eg, antineoplastons), manipulative and physical therapies (chiropractic, massage) and various procedures and devices (eg, colonic lavage and bioresonance). Many therapies are clearly outside of conventional medicine; however, for others, the borders are blurred. Common examples of complementary therapies that are finding a role in the conventional medical care of patients with Gi and liver disease include milk thistle (Silymarin), probiotics, hypnosis, and acupuncture. The ever growing number of abstracts on CAM at Digestive Disease Week is evidence of the emerging interest of biomedical scientists in CAM.

Practitioners of CAM and patients who use CAM often have a quite different view of disease and its treatment than conventional physicians. Concepts of disease and healing often emphasize holism and balance. A holistic approach is characterized by an emphasis on diagnosing and treating illness through an understanding of the whole person (ie, body, mind, and spirit) and how the individual interacts with the world around them. Health and disease are often viewed as a balance between dynamic, opposing forces. Disease may be seen as the result of a blockage or disruption of vital energy or an imbalance between two opposing forces (eg, ying and yang). Treatments are directed at restoring a healthy balance and flow in these forces and stimulating the self-healing potential of the body. These philosophies often lead to highly individualized treatments.

in many alternative medical systems, the patient plays a more active role in their treatment. The patient may be seen as the primary agent of healing helped by the guidance of the practitioner. The patient-centered focus of CAM, along with the common emphasis on health and well-being rather than on disease, may be particularly appealing to patients and may, in and of itself, have a healing effect.

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