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Burgell RE, Hoey L, Norton K, Fitzpatrick J. Treating disorders of brain-gut interaction with multidisciplinary integrated care. Moving towards a new standard of care. JGH Open 2024; 8:e13072. [PMID: 38770352 PMCID: PMC11103762 DOI: 10.1002/jgh3.13072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 04/06/2024] [Accepted: 04/13/2024] [Indexed: 05/22/2024]
Abstract
Disorders of brain-gut interaction (DGBI) are highly prevalent in our community with a negative burden on the quality of life and function. Symptoms are frequently food-induced, and psychological disorders are commonly co-morbid and contribute greatly to symptom severity and healthcare utilization, which can complicate management. Pathophysiological contributors to the development and maintenance of DGBI are best appreciated within the biopsychosocial model of illness. Established treatments include medical therapies targeting gastrointestinal physiology, luminal microbiota or visceral sensitivity, dietary treatments including dietary optimization and specific therapeutic diets such as a low-FODMAP diet, and psychological interventions. The traditional "medical model" of care, driven predominantly by doctors, poorly serves sufferers of DBGI, with research indicating that a multidisciplinary, integrated-care approach produces better outcomes. This narrative review explores the current evidence for multidisciplinary care and provides the best practice recommendations for physicians and healthcare systems managing such patients.
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Affiliation(s)
- Rebecca Elizabeth Burgell
- Gastroenterologist Functional GI Disorders ServiceAlfred Health and Monash UniversityMelbourneAustralia
| | - Louisa Hoey
- Clinical PsychologistFunctional GI Disorders service, Alfred HealthMelbourneAustralia
| | - Kate Norton
- Clinical Nurse SpecialistFunctional GI Disorders service, Alfred Health MelbourneMelbourneAustralia
| | - Jessica Fitzpatrick
- DietitianFunctional GI Disorders service, Alfred Health and Monash UniversityMelbourneAustralia
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Bray NA, Koloski NA, Jones MP, Do A, Pang S, Coombes JS, McAllister S, Campos J, Arthur L, Stanley P, DeMaria K, Chao CY, Catague R, Whaley A, Talley NJ, Holtmann GJ. Evaluation of a Multidisciplinary Integrated Treatment Approach Versus Standard Model of Care for Functional Gastrointestinal Disorders (FGIDS): A Matched Cohort Study. Dig Dis Sci 2022; 67:5593-5601. [PMID: 35362835 PMCID: PMC9652261 DOI: 10.1007/s10620-022-07464-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 02/14/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Functional gastrointestinal disorders (FGID) are linked to a variety of potential causes, and treatments include reassurance, life-style (including diet), psychological, or pharmacologic interventions. AIMS To assess whether a multidisciplinary integrated treatment approach delivered in a dedicated integrated care clinic (ICC) was superior to the standard model of care in relation to the gastrointestinal symptom burden. METHODS A matched cohort of 52 consecutive patients with severe manifestation of FGID were matched with 104 control patients based upon diagnosis, gender, age, and symptom severity. Patients in the ICC received structured assessment and 12-weeks integrated treatment sessions provided as required by gastroenterologist and allied health team. Control patients received standard medical care at the same tertiary center with access to allied health services as required but no standardized interprofessional team approach. Primary outcome was reduction in gastrointestinal symptom burden as measured by the Structured Assessment of Gastrointestinal Symptoms Scale (SAGIS). Secondary outcome was reduction in anxiety and depressive symptoms as measured by the Hospital Anxiety and Depression Scale (HADS). RESULTS Mixed models estimated the within ICC change in SAGIS total as -9.7 (95% CI -13.6, -5.8; p < 0.0001), compared with -1.7 (95% CI -4.0, 0.6; p = 0.15) for controls. The difference between groups reached statistical significance, -7.6 (95% CI -11.4, -3.8; p < 0.0001). Total HADS scores in ICC patients were 3.4 points lower post-intervention and reached statistical significance (p = 0.001). CONCLUSION This matched cohort study demonstrates superior short-term outcomes of FGID patients in a structured multidisciplinary care setting as compared to standard care.
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Affiliation(s)
- Nicola A. Bray
- grid.1003.20000 0000 9320 7537Faculties of Medicine and Health and Behavioural Sciences, University of Queensland/TRI, Brisbane, QLD Australia
| | - Natasha A. Koloski
- grid.412744.00000 0004 0380 2017Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD Australia ,College of Health Medicine and Wellbeing, University of Newcastle/AGIRA, Callaghan, NSW Australia
| | - Michael P. Jones
- grid.1004.50000 0001 2158 5405School of Psychological Sciences, Macquarie University, Ryde, NSW Australia
| | - Anh Do
- grid.412744.00000 0004 0380 2017Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD Australia
| | - Siong Pang
- grid.412744.00000 0004 0380 2017Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD Australia
| | - Jeff S. Coombes
- grid.1003.20000 0000 9320 7537Faculties of Medicine and Health and Behavioural Sciences, University of Queensland/TRI, Brisbane, QLD Australia
| | - Sarah McAllister
- grid.412744.00000 0004 0380 2017Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD Australia
| | - Jane Campos
- grid.412744.00000 0004 0380 2017Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD Australia
| | - Leela Arthur
- grid.412744.00000 0004 0380 2017Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD Australia
| | - Paul Stanley
- grid.412744.00000 0004 0380 2017Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD Australia
| | - Katherine DeMaria
- grid.412744.00000 0004 0380 2017Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD Australia
| | - Che-yung Chao
- grid.412744.00000 0004 0380 2017Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD Australia
| | - Rachel Catague
- grid.412744.00000 0004 0380 2017Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD Australia
| | - Amanda Whaley
- grid.412744.00000 0004 0380 2017Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD Australia
| | - Nicholas J. Talley
- College of Health Medicine and Wellbeing, University of Newcastle/AGIRA, Callaghan, NSW Australia
| | - Gerald J. Holtmann
- grid.1003.20000 0000 9320 7537Faculties of Medicine and Health and Behavioural Sciences, University of Queensland/TRI, Brisbane, QLD Australia ,grid.412744.00000 0004 0380 2017Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD Australia
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