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For managing patients suffering from functional gastrointestinal
disorder, clinicians should consider offering routine integrated multidisciplinary
care.
A study depicted that for treating functional gastrointestinal disorders, the multidisciplinary clinical care demonstrated superiority to standard gastroenterologist care regarding the quality of life, symptoms, psychological state, cost of care, and specific functional disorders.
An open-label, single-centre, pragmatic, randomized controlled (Multidisciplinary Treatment for Functional Gut Disorders [MANTRA]) trial was carried out to evaluate the outcomes of the standard gastroenterologist care approach versus a multidisciplinary care approach. This analysis recruited novel referrals of eligible participants (age 18-80 years) having Rome IV criteria-defined functional gastrointestinal diseases.
Participants were randomly allocated (1:2) to either gastroenterologist-only standard care group or multidisciplinary clinic care group (included dietitians, gastroenterologists, psychiatrists, behavioural/biofeedback physiotherapists, and gut-focused hypnotherapists). Stratification of randomization was done using Rome IV disorder and whether referred from colorectal or gastroenterology clinic. At clinical discharge or nine months after the first visit, the outcomes were examined.
A score of 5 (much better) or 4 (slightly better) on a 5-point Likert scale evaluating the global symptom improvement was the primary endpoint. The modified intention-to-treat analysis incorporated all individuals who had at least one clinical visit and who had replied to the principal outcome question.
The study recruited 188 patients with the probable functional gut disorder. Participants were randomized to either standard care (n=65) group or multidisciplinary care (n=123) group. Notably, 144 patients were included in the modified intention-to-treat analysis (Standard group: n=46); Multidisciplinary group: n=98). About 62% (61/98) of subjects in the multidisciplinary cohort saw the allied clinicians.
The global symptom improvement and alleviation of symptoms in the past 7 days
were attained in a substantially higher proportion of patients in the
multidisciplinary group compared to the standard group, as depicted in the
following table:
Compared to the patients in the standard cohort, the patients in the multidisciplinary cohort were more likely to witness a 50 % or greater decline in all Gastrointestinal Symptom Severity Index (GSSI) symptom clusters.
Of the individuals having irritable bowel syndrome, a 50-point or greater decline in Irritable bowel syndrome-Severity Scoring System (IBS-SSS) occurred less in the standard cohort compared to the multidisciplinary cohort. Of the individuals having functional dyspepsia, a 50% decline in the Nepean Dyspepsia Index (NPI) occurred less in the standard cohort compared to the multidisciplinary cohort, as shown in the following table:
Compared to the multidisciplinary cohort, the median Euro-Qol 5D-5L (EQ-5D-5L) quality of life visual analogue scale was considerably minimized in the gastroenterologist care group. At discharge, the eight Short Form 36 (SF-36) scales did not vary between the groups.
After therapy, the median Hospital Anxiety and Depression Scale
(HADS) scores, the median Somatic Symptom Scale-8 score, and the cost per
successful outcome was elevated in the standard-care group in comparison with
the multidisciplinary-care group. Thus, a multidisciplinary approach is superior to a
gastroenterologist-only clinic for treating functional gastrointestinal
disorders.
The Lancet Gastroenterology & Hepatology
Standard gastroenterologist versus multidisciplinary treatment for functional gastrointestinal disorders (MANTRA): an open-label, single-centre, randomised controlled trial
Chamara Basnayake et al.
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