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

中文翻译：

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多学科与标准胃肠病学家治疗功能性胃肠疾病的长期结果：一项随机试验

背景与目标

功能性胃肠道疾病对医疗保健系统来说是常见且昂贵的。在功能性胃肠道疾病的多学科治疗研究中，我们证明与治疗结束时的标准胃肠病专家护理相比，多学科护理可带来更好的临床和成本结果。在这项研究中，我们评估了长期结果。

方法

在一项单中心、务实的试验中，罗马 IV 标准定义的功能性胃肠道疾病患者以 1:2 的比例随机分配至仅由胃肠病学家提供的标准护理与由胃肠病学家、营养师、肠道催眠治疗师、精神科医生和生物反馈物理治疗师组成的多学科诊所。本研究的结果在治疗结束后 12 个月进行评估。使用李克特 5 点量表评估整体症状改善情况。症状、特定疾病状态、心理状态、生活质量和成本是额外的结果。进行了改良的意向治疗分析。

结果

在 188 名随机患者中，143 名（46 名标准治疗，97 名多学科）形成了长期改良意向治疗分析。62% 的多学科临床患者会见专职临床医生。65% (30/46) 标准治疗与 76% (74/97) 多学科临床患者在治疗结束后 12 个月实现整体症状改善 ( P  = .17)，而 20% (9/46) 与 37% (36/97) 将他们的症状评为“好 5/5” ( P  = .04)。对于肠易激综合征患者，肠易激综合征严重程度评分系统降低 ≥50 分的比例分别为 38% 和 66% ( P  = .02)。与多学科诊所相比，标准治疗中的焦虑和抑郁更严重（12 vs 10，P = .19），标准治疗的生活质量低于多学科诊所（0.75 vs 0.77，P  =·.03）。增加的成本效益比发现，在多学科诊所每增加 3555 澳元，就可以获得进一步的质量调整生命年。

结论

治疗完成 12 个月后，与仅胃肠病专家的护理相比，综合多学科临床护理在症状、心理状态、生活质量和费用方面得到改善的患者比例更高。Clinical trial.gov：编号 NCT03078634