Colon to Rectum

Clin Gastroenterol Hepatol. 2022;20(9):2102–11.e9

Basnayake C, Kamm MA, Stanley A, Wilson-O’Brien A, Burrell K, Lees-Trinca I, Khera A, Kantidakis J, Wong O, Fox K, Talley NJ, Liew D, Salzberg MR, Thompson AJ

Long-term outcome of multidisciplinary versus standard gastroenterologist care for functional gastrointestinal disorders: A randomized trial

Background and aims: Functional gastrointestinal disorders are common and costly to the healthcare system. In the Multidisciplinary Treatment of Functional Gastrointestinal Disorders study, the authors demonstrated that multidisciplinary care resulted in superior clinical and cost outcomes, when compared with standard gastroenterologist-only care at end of treatment. In this study they evaluate the longer-term outcomes.
Methods: In a single-center, pragmatic trial patients with Rome IV criteria-defined functional gastrointestinal disorders were randomized 1:2 to a gastroenterologist-only standard care versus a multidisciplinary clinic comprising gastroenterologists, dietitians, gut hypnotherapists, psychiatrists, and biofeedback physiotherapists. Outcomes in this study were assessed 12 months after the end of treatment. Global symptom improvement was assessed by using a 5-point Likert scale. Symptoms, specific disorder status, psychological state, quality of life, and cost were additional outcomes. A modified intention-to-treat (ITT) analysis was performed.
Results: Of 188 randomized patients, 143 (46 standard care, 97 multidisciplinary) formed the longer-term modified ITT analysis. 62% of multidisciplinary clinic patients saw allied clinicians. 65% (30/46) standard care versus 76% (74/97) multidisciplinary clinic patients achieved global symptom improvement 12 months after end of treatment (p = 0.17), whereas 20% (9/46) versus 37% (36/97) rated their symptoms as “5/5 much better” (p = 0.04). A ≥ 50-point reduction in Irritable Bowel Syndrome Severity Scoring System occurred in 38% versus 66% (p = 0.02), respectively, for irritable bowel syndrome patients. Anxiety and depression were greater in the standard care than multidisciplinary clinic (12 vs. 10; p = 0.19), and quality of life was lower in standard care than the multidisciplinary clinic (0.75 vs. 0.77; p =·0.03). An incremental cost-effectivness ratio found that for every additional AUD 3555 spent in the multidisciplinary clinic, a further quality-adjusted life year was gained.

Conclusions: 12 months after the completion of treatment, integrated multidisciplinary clinical care achieved a greater proportion of patients with improvement of symptoms, psychological state, quality of life, and cost, compared with gastroenterologist-only care.

Prof. Dr. M.A. Kamm, St. Vincent’s Hospital Melbourne, Fitzroy, Melbourne, VIC, Australia,

DOI: 10.1016/j.cgh.2021.12.005

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