Complementary and alternative medicine (CAM) practices and dietary patterns in children with inflammatory bowel disease in Singapore and Malaysia

Phenotypic Differences and Clinical Outcomes of South Asian Children With IBD: A Singapore-Malaysia Study From the Asian PIBD Registry Network

BACKGROUND AND AIM

Existing literature largely contrasts pediatric inflammatory bowel disease (PIBD) phenotypic differences and outcomes of South Asians (SAs) with Caucasians. No published comparative data exist between SAs and non-SAs within Asia-Pacific. We aim to validate these comparisons within Asia-Pacific, comparing SAs ("Indian," "Bangladeshi," "Nepali," "Pakistani," "Sri Lankan (Sinhalese/Tamil)," and "Maldivian") with their non-SA ("Chinese," "Malay," "Eurasian", or "Others") counterparts in the multiethnic populations of Singapore and Malaysia.

METHODS

Clinical data from three centers in Singapore and Malaysia were compared, at baseline, 1-year (1YFU) and 5-year (5YFU) post-diagnosis, between SAs and non-SAs.

RESULTS

Baseline, 1YFU, and 5YFU data were analyzed in 366, 260 (71.0%), and 127 (34.7%) patients, respectively. Compared with non-SAs, SAs were significantly older (10.2 vs. 9.1 years, p = 0.013), had less very early-onset disease (15.5% vs. 33.0%, p = 0.001), a shorter time from symptom onset to diagnosis (5.9 vs. 8.9 months, p = 0.024), less growth retardation (5.9% vs. 14.0%, p = 0.035), and less comorbid liver diseases (1.4% vs. 9.4%, p = 0.002). SAs with Crohn's disease had more symptomatic perianal disease (18.3% vs. 9.4%, p = 0.016) and less isolated ileal L1 disease (10.2% vs. 20.7%, p = 0.057). No significant differences in induction therapies, maintenance immunosuppression or remission rates at 1YFU were noted, but at 5YFU, SAs had significantly lower rates of clinical remission (SA = 68.3% vs. non-SA = 84.9%, p = 0.036), steroid-free remission (SA = 53.7% vs. non-SA = 73.3%, p = 0.043), and mucosal healing (calprotectin < 300 ug/g, 0.0% vs. 80.0%, p = 0.048).

CONCLUSIONS

We report unique phenotypic differences in SA and non-SA children with IBD. SAs had poorer long-term clinical outcomes, although short-term outcomes and therapy usage patterns were comparable.

Medical Management of Pediatric Inflammatory Bowel Disease (PIBD) in the Asia Pacific Region: A Position Paper by the Asian Pan-Pacific Society for Pediatric Gastroenterology, Hepatology, and Nutrition (APPSPGHAN) PIBD Working Group

Pediatric inflammatory bowel disease (PIBD) is rising rapidly in many industrialised and affluent areas in the Asia Pacific region. Current available guidelines, mainly from Europe and North America, may not be completely applicable to clinicians caring for children with PIBD in this region due to differences in disease characteristics and regional resources constraints. This position paper is an initiative from the Asian Pan-Pacific Society for Pediatric Gastroenterology, Hepatology and Nutrition (APPSPGHAN) with the aim of providing an up-to-date, evidence-based approach to PIBD in the Asia Pacific region, taking into consideration the unique disease characteristics and financial resources available in this region. A group of pediatric gastroenterologists with special interest in PIBD performed an extensive literature search covering epidemiology, disease characteristics and natural history, management and monitoring. Gastrointestinal infections, including tuberculosis, need to be excluded before diagnosing IBD. In some populations in Asia, the Nudix Hydrolase 15 (NUD15) gene is a better predictor of leukopenia induced by azathioprine than thiopurine-S-methyltransferase (TPMT). The main considerations in the use of biologics in the Asia Pacific region are high cost, ease of access, and potential infectious risk, especially tuberculosis. Conclusion: This position paper provides a useful guide to clinicians in the medical management of children with PIBD in the Asia Pacific region.

Landscape of inflammatory bowel disease in Singapore

Inflammatory bowel disease (IBD), primarily Crohn’s disease and ulcerative colitis, had been widely recognized to affect the Western population. However, the notable rise in prevalence of IBD in Asia, including Singapore, had garnered much attention to the causal role of the shift in trend, and more importantly, effective and safe management of the conditions of these groups of patients in terms of therapy, healthcare economics as well as patient well-being. This review presents a summary of the current landscape of IBD in Singapore, and discuss on areas that can be explored to improve and better understand the local condition, as prevalence continues to grow.

Is the use of alternative therapy in children just another form of medicalisation? A prospective study

AIM

The use of complementary and alternative medicines (CAM) seems widespread in adults and children, despite the conflicting evidence regarding its effectiveness and safety. This study aims to investigate the prevalence of the use of CAM in a population of Italian children.

METHODS

This is a prospective observational study conducted in 4 family paediatric clinics, in Friuli Venezia Giulia, Italy, from February to June 2019. Children were enrolled after being visited. The use of CAM and essential therapies (ET) in the previous year was investigated with an anonymous questionnaire. The demographic characteristics of children and families were also collected.

RESULTS

Six hundred children were enrolled, mean age 5.8 years, 50% females. In the previous year, 358 (60%) children used both essential therapies and CAM, 209 children (35%) only essential therapies, 25 (4%) only CAM, and 8 (1%) no therapy. CAM was more frequently used in children whose parents have a higher educational level and come from high-income countries (P < .0001). Non-vaccinated children received more CAM than vaccinated ones (P < .003).

CONCLUSION

In our population, more than 60% of children receive CAM. The use of this medical approach seems strictly related to the social and cultural status of families.

Questionnaires assessing the use of complementary health approaches in pediatrics and their measurement properties: A systematic review

OBJECTIVES

To identify questionnaires assessing the use of complementary health approaches (CHA) in pediatrics, describe their content, and appraise the methodological quality of the studies and the measurement properties of the questionnaires.

METHOD

Major electronic databases were searched from 2011 to 2020. Studies which aimed to assess the use of CHA and studies which reported developing and validating CHA questionnaires in pediatrics were included. Two reviewers independently screened the studies, extracted the data, and rated the methodological quality of the studies and measurement properties of the questionnaires using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. When consensus was not reached, a third reviewer was consulted.

RESULTS

Thirty-eight studies were included. From these studies, 35 CHA questionnaires with a variety of different items were identified. Only two studies aimed to evaluate the measurement properties of two questionnaires. One questionnaire, available as a self- and proxy-report, was initially validated in children with juvenile idiopathic arthritis, and the other, available as an interviewer-administered questionnaire, was validated in children with cancer. According to the COSMIN, the methodological quality of both studies was inadequate or doubtful, and both questionnaires was not thoroughly validated.

CONCLUSION

This systematic review showed a lack of a thoroughly validated CHA questionnaire in pediatrics. However, two questionnaires were found to hold promise. To address this gap, one of the existing questionnaires should be adapted and further validated.

Parental satisfaction and perception of Progress in influencing the Practice of complementary health approaches in children with autism: a cross sectional survey from Negeri Sembilan, Malaysia

Background

Parents’ use of complementary health approaches (CHA) for children with autism spectrum disorder (ASD) are common despite the uncertain evidence of its benefit. Parents often adopt CHA due to dissatisfaction with conventional treatment. This study aimed to examine parents’ satisfaction with ASD treatment and their perception of progress in their child’s development. Parents’ use of CHA among children with ASD and the factors related were also evaluated.

Methods

Self-administered questionnaires were completed by 48 parents of children with ASD at a single tertiary referral hospital in Malaysia. Correlation analysis was used to explore associations between parental satisfaction scores, perception of progress scores and use of CHA.

Results

Use of CHA was reported by parents for 35.4% of children with ASD in the sample. Parents who were less satisfied with conventional treatment and parents who perceived poorer progress in their child’s development were more likely to use CHA. Strong positive relationship was found between parent satisfaction with ASD treatment scores and parent perception of progress scores, which indicates that parents who were satisfied with treatment were more likely to perceive greater progress in their child’s development. Improvement in child’s progress was most appreciated by parents in their child’s behavior (85.5%), social skills (83.3%) and motor skills (77.1%).

Conclusion

The use of CHA was common among children with ASD. Parents were more likely to practice CHA when they were less satisfied with conventional treatment and perceived poorer progress. A larger multicenter study is required to further explore the practice of CHA among children with ASD throughout Malaysia.