- Fecal Incontinence
|Long-Term Outcome of Multidisciplinary Versus Standard Gastroenterologist Care for Functional Gastrointestinal Disorders: A Randomized Trial
Clin Gastroenterol Hepatol. 2022 Sep;20(9):2102-2111.e9.doi: 10.1016/j.cgh.2021.12.005. Epub 2021 Dec 9.
Chamara Basnayake 1, Michael A Kamm 2, Annalise Stanley 3, Amy Wilson-O'Brien 4, Kathryn Burrell 3, Isabella Lees-Trinca 3, Angela Khera 1, Jim Kantidakis 3, Olivia Wong 3, Kate Fox 3, Nicholas J Talley 5, Danny Liew 6, Michael R Salzberg 4, Alexander J Thompson 1
1St Vincent's Hospital Melbourne, Melbourne, Australia; University of Melbourne, Melbourne, Australia.
2St Vincent's Hospital Melbourne, Melbourne, Australia; University of Melbourne, Melbourne, Australia. Electronic address: firstname.lastname@example.org.
3St Vincent's Hospital Melbourne, Melbourne, Australia.
4University of Melbourne, Melbourne, Australia.
5University of Newcastle, Newcastle, Australia.
6Monash University, Melbourne, Australia.
Background & aims: Functional gastrointestinal disorders are common and costly to the healthcare system. In the Multidisciplinary Treatment of Functional Gastrointestinal Disorders study, we 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 we 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 vs 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 analysis was performed.
Results: Of 188 randomized patients, 143 (46 standard care, 97 multidisciplinary) formed the longer-term modified intention-to-treat analysis. Sixty-two percent of multidisciplinary clinic patients saw allied clinicians. Sixty-five percent (30/46) standard care versus 76% (74/97) multidisciplinary clinic patients achieved global symptom improvement 12 months after end of treatment (P = .17), whereas 20% (9/46) versus 37% (36/97) rated their symptoms as "5/5 much better" (P = .04). A ≥50-point reduction in Irritable Bowel Syndrome Severity Scoring System occurred in 38% versus 66% (P = .02), respectively, for irritable bowel syndrome patients. Anxiety and depression were greater in the standard care than multidisciplinary clinic (12 vs 10, P = .19), and quality of life was lower in standard care than the multidisciplinary clinic (0.75 vs 0.77, P =·.03). An incremental cost-effectivness ratio found that for every additional 3555AUD spent in the multidisciplinary clinic, a further quality-adjusted life year was gained.
Conclusions: 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.
Clinical trials: gov: number NCT03078634.