Drugs not helping in functional GI disorders

Management of patients with functional gastrointestinal disorders needs to improve dramatically, given evidence that even specialist clinics aren’t making a difference to most patients.

According to a follow-up study of over 100 patients at St Vincent’s Hospital in Melbourne, only 38% of patients with functional gastrointestinal disorders reported an improvement in symptoms after one year.

The patients were mostly diagnosed with IBS (57%) and functional dyspepsia (28%) with symptoms including abdominal pain, diarrhea, constipation, dyspepsia and reflux.

Most patients (73%) received an endoscopic investigation such as a colonoscopy or gastroduodenoscopy. Treatment included low FODMAP diets (33%), proton-pump inhibitors (26%) or laxatives (11%) while 29% of patients were not offered any treatment.

Patients with functional dyspepsia or reflux-like symptoms were the least likely to improve as were patients treated with proton-pump inhibitors.

However patients prescribed a dietician-led, low FODMAP diet were more likely to improve than other patients.

Half of the patients who were working reported time off work because of their symptoms during the 12 months of follow-up and 64% of patients remained concerned about their symptoms.

Fewer than half of the patients (48%) said they received reassurance about their symptoms.

Noting that the clinic was a traditional ‘doctor-only’ outpatient clinic, the researchers said there had to be more of a focus on integrated and multidisciplinary care.

“Antidepressants were offered to only three patients, despite their established efficacy in modulating symptoms for irritable bowel syndrome, functional pain and functional dyspepsia,” the study said.

They added patients’ perceptions of their illness were also a strong determinant of outcomes.

“We believe attention to this cognitive aspect, and to mood disorders, needs to be part of the consultation and management strategy.”

Dr Chamara Basnayake, from the Hospital’s Department of Gastroenterology told the limbic there were significant costs and flow-on effects associated with suboptimal management of these disorders.

“A lot of these patients end up seeing their GP ten or 20 times a year. They see one gastroenterologist, they end up being unsatisfied and they don’t see another specialist for a couple of years but in the meantime, they see their GP 10 or 20 times, they are off work, and nothing gets sorted.”

He said it was an expensive model that had to change.

“These are actually the most common problems that we deal with as gastroenterologists and it makes sense that if there are patients like this all occupying our clinics, that we try to provide the best care possible.”

“If you effectively treat their symptoms, they are less likely to see their GP, they are more productive and less absent from the workforce and importantly, their quality of life is better.”

He said better access to allied health professionals for therapies such as low FODMAP diets, biofeedback therapy and gut focused hypnotherapy was critical.

A randomised controlled trial of standard care versus a multidisciplinary clinic was currently underway at St Vincent’s with early results expected in 2019.

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