An integrated multidisciplinary clinical care model comprising care from gastroenterologists, dietitians, gut-focused hypnotherapists, psychiatrists, and behavioral physiotherapists was associated with greater improvement in symptom relief in patients with functional gastrointestinal (GI) disorders, according to study results in The Lancet Gastroenterology & Hepatology.
The open-label study enrolled 144 consecutive new referrals of patients between the ages of 18 and 72 years with functional GI disorders. These disorders included irritable bowel syndrome (IBS) (n=85), functional dyspepsia (n=39), constipation (n=8), fecal incontinence (n=1), centrally mediated abdominal pain (n=1), and “other” disorders (n=10).
After explanation of the study protocol to participants via telephone, researchers randomly allocated patients to either gastroenterologist-only standard care (n=46) or multidisciplinary care (n=98). Patients in the multidisciplinary clinic care group obtained care from gastroenterologists as well as dietitians, gut-focused hypnotherapists, psychiatrists, and behavioral (biofeedback) physiotherapists. The standard care group received care from only gastroenterologists or colorectal surgeons.
At baseline, patients completed the GI Symptom Severity Index (GISSI), Somatic Symptom Scale 8, Hospital Anxiety and Depression Scale (HADS), Euro-Qol 5D-5L (EQ-5D-5L), and the RAND 36-item Short Form Survey. The primary outcome, assessed at clinic discharge or 9 months after the initial visit, was achievement of a score of 4 (slightly better) or 5 (much better) on a 5-point Likert scale that assessed global symptom improvement.
A significantly greater proportion of patients in the multidisciplinary care group reported global symptom improvement compared with patients assigned to standard care (84% vs 57%, respectively; risk ratio 1.5; 95% CI, 1.13-1.93; P =.00045). In addition, more patients who received multidisciplinary care had adequate relief of symptoms in the past 7 days (83% vs 63%; P =.01) and rated themselves as “much better” on the 5-point Likert scale (51% vs 28%; P =.01).
A greater than or equal to 50% reduction in all GISSI symptom clusters was more likely in the multidisciplinary care group relative to the gastroenterologist-only group. Investigators observed a greater than or equal to 50-point reduction in the IBS symptom severity scale in 38% of patients with IBS in the standard care group and 66% of patients with IBS in the multidisciplinary care group (P =.017). In the subgroup of patients with functional dyspepsia, they found no statistically significant difference between the standard and multidisciplinary care groups in terms of a 50% reduction in the Nepean Dyspepsia Index (27% vs 46%, respectively; P =.47).
Although the median HADS scores did not significantly differ between the 2 groups after treatment (10 in multidisciplinary care vs 13 in standard care; P =.096), the median EQ-5D-5L quality of life visual analogue scale was lower in patients assigned to standard care (70 vs 75; P =.0087). In addition, the median Somatic Symptom Scale-8 score was higher in patients who received standard care vs patients who received multidisciplinary care (10 vs 9, respectively; P =.082).
Receipt of multidisciplinary care was associated with a greater median hospital cost per patient ($2485 vs $2421; P =.0085). In spite of these higher costs, the costs per patient achieving the primary outcome was greater among patients who received standard care ($3136 vs $2549).
Limitations of this study were its single-center design, the subjective nature of the primary outcome, and the inability to mask the interventions.
The investigators concluded that the study demonstrates “that integration of effective treatment-specific dietary, behavioral, and psychological interventions into clinical care appears to provide superior clinical outcomes and more cost-effective treatment.”
Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
Basnayake C, Kamm MA, Stanley A, et al. Standard gastroenterologist versus multidisciplinary treatment for functional gastrointestinal disorders (MANTRA): an open-label, single-centre, randomised controlled trial. Lancet Gastroenterol Hepatol. 2020;5(10):890-899.