麻豆传媒

Functional gastrointestinal disorders (FGIDs) such as irritable bowel syndrome (IBS) and functional dyspepsia, are prevalent in the global adult population and are the most common conditions treated in gastrointestinal specialist practice.

Previous research has shown that with standard clinical care, often provided by a gastroenterologist in isolation, for patients with FGIDs are poor. Addressing the question of durable benefit, a group led by Chamara Basnayake, MD, of St Vincent's Hospital Melbourne and the University of Melbourne, conducted a follow-up analysis of patients in the

The aim was to assess a range of outcomes 12 months post treatment in patients receiving multidisciplinary versus standard care. Basnayake discussed the findings, published recently in , in an interview with the Reading Room.

What was the research and clinical context in which you designed this study?

Basnayake: Gastrointestinal societies and treatment reviews have recommended multidisciplinary care for patients with FGIDs, yet such care is rarely provided and, until recently, had not been compared with standard care in relation to treatment outcomes.

We had previously demonstrated that a multidisciplinary clinic resulted in superior clinical and cost outcomes for patients at the end-of-treatment point. In the current study, we wanted to evaluate the longer-term symptom status, psychological well-being, quality of life, and costs of healthcare utilization in comparison with the standard model. The important question for us was, were these results durable?

How was the study designed?

Basnayake: MANTRA was a pragmatic trial that randomized consecutive referrals of patients to the hospital; 188 adults with Rome IV criteria-defined FGIDs were randomized 1:2 to gastroenterology-only care or to a special multidisciplinary clinic comprising gastroenterologists, dietitians, gut-hypnotherapists, psychiatrists, and biofeedback physiotherapists. Patients ranked their symptom outcomes on a 5-point Likert scale. Data were collected at a median 563 days after initial appointment.

What were the main findings of the follow-up analysis?

Basnayake: Twelve months after completion of treatment, integrated multidisciplinary clinical care achieved almost twice as many patients -- 37% versus 20% -- reporting their symptoms as "much better." Apart from symptoms, there were benefits in psychological state, quality of life, and healthcare costs compared with gastroenterologist-only care.

Of the 143 patients who formed the longer-term modified intention-to-treat analysis, 65% of standard care versus 76% of multidisciplinary clinic patients achieved global symptom improvement 12 months after treatment cessation. For IBS patients in the multidisciplinary arm, there was a more than 50-point reduction from baseline scores on the IBS Severity Scoring System in 66% versus 38% in the standard care arm.

Were any of the follow-up results unexpected?

Basnayake: The multidisciplinary clinic users had more visits and had more treatment time, but our original study showed that the number of visits to the multidisciplinary clinic did not influence outcomes at end of treatment. And in this longer-term follow-up, the number of additional visits to the multidisciplinary clinic did not predict the global symptom score or patients rating their symptoms as "much better."

Why do you think the results were so positive, then, in the multidisciplinary arm?

Basnayake: We believe the integrated expertise of all clinicians, including coordinated multidisciplinary discussion, likely explained the positive outcomes.

How do these results compare with those of other similar studies?

Basnayake: Most studies in FGIDs evaluating the use of psychological, behavioral, and dietary treatments are provided in isolation. This study, in contrast, might be among a few that have evaluated a multidisciplinary model of care. This evaluation is important as the FGID patient population rarely presents with one singular problem. Many have comorbid psychological conditions and existing dietary restrictions. A model of care that comprehensively addresses these complexities has not been completed until now.

Furthermore, very few studies in FGIDs have reported symptom, quality of life, psychological, and cost outcomes beyond shorter-term follow-up, so ours stands out in the length of patient evaluation.

What's the takeaway message for gastroenterologists?

Basnayake: There are now numerous studies demonstrating that gastroenterologist-only care for FGIDs often produces unsatisfactory outcomes. This patient population is often complex and the gastroenterologist-only model is not a good fit. An integrated multidisciplinary model of clinic care appears to demonstrate better short- and longer-term health outcomes compared with traditional gastroenterologist-only care. Specialty clinics managing these disorders should consider implementing this multifaceted model.

You can read the abstract of the study here, and about the clinical implications of the study here.