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Background and Aims

Functional gastrointestinal disorders are common and costly to the healthcare system. In the MANTRA 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 versus 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 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. 62% of multidisciplinary clinic patients saw allied clinicians. 65% (30/46) standard-care versus 76% (74/97) multidisciplinary clinic patients achieved global symptom improvement 12 months after end of treatment (P=0.17), while 20% (9/46) versus 37% (36/97) rated their symptoms as "5/5 much better" (P=0.04). ≥50-point reduction in Irritable Bowel Syndrome (IBS) Severity Scoring System occurred in 38% versus 66% (P=0.02), respectively, for IBS patients. Anxiety and depression were greater in the standard-care than multidisciplinary clinic (12 vs 10, P=0.19) and quality of life lower in standard-care than the multidisciplinary clinic (0.75 vs 0.77, P=0.03). An incremental cost-effectiveness ratio found that for every additional $3,555 AUD spent in the multidisciplinary clinic, a further quality-adjusted life-year was gained.

Conclusion

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.

You can read an interview with the lead study author here, and about the clinical implications of the study here.