Multidisciplinary Care Yields Better Outcomes in DGBIs

Patients with functional gastrointestinal disorders —also known as disorders of gut-brain interaction (DGBIs)—as defined by Rome IV criteria experienced more improvement in symptoms and better overall outcomes when cared for in a multidisciplinary clinic vs those who received standard care from a gastroenterologist only, Australian researchers found.

“In the MANTRA study, we demonstrated that multidisciplinary care resulted in superior clinical and cost outcomes, when compared with standard gastroenterologist-only care at end of treatment,” the authors stated. “In this study we evaluate the longer-term outcomes.”

In this longer-term, modified intention-to-treat analysis, 97 patients were randomized to receive care at a multidisciplinary clinic while 46 received gastroenterologist-only standard care. The clinic team comprised gastroenterologists, dieticians, gut hypnotherapists, psychiatrists, and biofeedback physiotherapists.

The primary outcome was global symptom improvement, assessed using a 5-point Likert scale at 12 months after the end of treatment. Secondary outcomes included symptoms, specific disorder status, psychological state, quality of life, and cost.

Of patients who received care through the multidisciplinary clinic, 76% (74/97) achieved the primary outcome of global symptom improvement vs 65% (30/46) of the standard-care group (P=0.17), while 37% (36/97) vs 20% (9/46) vs rated their symptoms as “5/5 much better” (P=0.04). Among patients with irritable bowel syndrome (IBS), 66% of those who received multidisciplinary care achieved a ≥50-point reduction on IBS Severity Scoring System, vs 38% of those receiving standard care.

Anxiety and depression were reduced and quality of life was better among patients treated in the multidisciplinary clinic, as well, and the investigators found that for every additional $3555 AUD spent in the multidisciplinary clinic a further quality-adjusted life year was gained.

“Twelve 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,” the authors concluded.

—Rebecca Mashaw

Reference:
Basnayake C, Kamm MA, Stanley A, et al. Long term outcome of multidisciplinary versus standard gastroenterologist care for functional gastrointestinal disorders. A randomised trial. Clin Gastroenterol Hepatol. Published online December 9, 2021. DOI: https://doi.org/10.1016/j.cgh.2021.12.005