Multidisciplinary Approach Beneficial for Functional Gastrointestinal Disorders

July 16, 2020
Chamara Basnayake, MD

Chamara Basnayake, MD

A full diet and lifestyle evaluation could soon become the standard of care for treating certain gastrointestinal disorders.

A team, led by Chamara Basnayake, MD, Department of Gastroenterology, University of Melbourne, compared the outcome of gastroenterologist-only standard care with a multidisciplinary approach for patients with functional gastrointestinal disorders.

A small percentage of patients with functional gastrointestinal disorders generally see an improvement in symptoms after they are provided care by a gastroenterologist. While proven effective, psychological, behavioral, and dietary therapies are not generally provided.

In the open-label, single-center, pragmatic trial, the investigators 144 examined patients between 18-80 years old with a Rome IV criteria-defined functional gastrointestinal disorder.

The patients were randomly assigned to receive either gastroenterologist-only standard care (n = 46) or multidisciplinary clinic care (n = 98) that included gastroenterologists, dietitians, gut-focused hypnotherapists, psychiatrists, and behavioral physiotherapists.

In the multidisciplinary care group, 61 patients saw allied clinicians.

The randomization was stratified by Rome IV disorder and whether referred from gastroenterology or colorectal clinic.

The investigators assessed outcomes at clinical discharge or 9 months following the initial visit.

They also sought primary outcomes of a score of 4 or 5 on a five-point Likert scale assessing global symptom improvement.

The modified intention-to-treat analysis included all patients who attended at least 1 clinical visit and answered the primary outcome question.

A total of 26 patients in the standard-care group and 82 in the multidisciplinary-care group saw global symptom improvement (RR, 1,50; 95% CI, 1.13-1.93; P = 0.00045) 29 patients in the standard-care group and 81 patients in the multidisciplinary-care group had adequate relief of symptoms in the past 7 days (P = 0.010).

In addition, patients in the multidisciplinary-care group were more likely to experience a 50% or higher reduction in all Gastrointestinal Symptom Severity Index symptom clusters than the patients who were in the standard-care group.

There was a 50-point or higher reduction for patients with irritable bowel syndrome in the IBS-SSS in 10 of 26 standard-care patients and 13 of 28 patients in the multidisciplinary-care group (P = 0.017).

For patients with functional dyspepsia, there was a 50% reduction in the Nepean Dyspepsia Index in 3 of 11 patients in the standard-care group and 13 of 28 in the multidisciplinary-care group (P = 0.47).

Following treatment, the median HADS scores were higher in the standard-care group (13 [8–20] vs 10 [6–16]; P = 0.096) and the median EQ-5D-5L quality of life visual analogue scale was lower in the standard-care group compared with the multidisciplinary-care group (70 [IQR, 50–80] vs 75 [IQR, 65–85]; P = 0.0087). 

In addition, the 8 SF-36 scales did not differ between the groups at discharge.

Following treatment, the median Somatic Symptom Scale-8 score was higher in the standard-care group than in the multidisciplinary-care group (10 [IQR 7–7] vs 9 [5–13]; P = 0.082).

Also, the cost per successful outcome was higher in the standard-care group than the multidisciplinary-care group.

“Integrated multidisciplinary clinical care appears to be superior to gastroenterologist-only care in relation to symptoms, specific functional disorders, psychological state, quality of life, and cost of care for the treatment of functional gastrointestinal disorders,” the authors wrote. “Consideration should be given to providing multidisciplinary care for patients with a functional gastrointestinal disorder.”

The study, “Standard gastroenterologist versus multidisciplinary treatment for functional gastrointestinal disorders (MANTRA): an open-label, single-centre, randomised controlled trial,” was published online in The Lancet Gastroenterology & Hepatology.
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