Standard gastroenterologist vs. multidisciplinary care to treat functional gastrointestinal disorders

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: