Efficacy of an integrated multidisciplinary approach of patients with severe functional gastrointestinal
disorders.
R. Dellink1, J. Kruimel1, C. Leue2, J. Strik2, J. van Os2, A. Masclee1.
Department of Internal Medicine, Division of Gastroenterology1, and Department of Psychiatry2,
University Hospital Maastricht, Maastricht University, The Netherlands.
Background: Treatment of patients with functional gastrointestinal disorders (FGIDs), such as irritable
bowel syndrome (IBS), remains challenging especially in patients with severe and invalidating
symptoms. At our centre FGID patients with psychiatric comorbidity (mostly panic or mood disorder)
are referred to the Medical Psychiatric Unit (MPU). In an ambulatory setting, we provide a
standardized, integrated approach. After medical and psychiatric diagnostic procedures, the following
options are available: psychotherapy, treatment with SSRIs (selective serotonin reuptake inhibitors), or
a combination of both. Previously, we have shown that treatment at the MPU in a clinical setting is
cost-effective, but data about efficacy in the ambulatory setting are not available. The aim of this
observational study was therefore to evaluate our integrated multidisciplinary approach of patients with
FGIDs at the MPU with regard to control of gastrointestinal symptoms, psychiatric symptoms and
quality of life.
Methods: All patients who visited the MPU starting from August 2009 were asked to complete
validated questionnaires at their first visit and 6 months later: the Gastrointestinal Symptoms Rating
Scale (GSRS), the Cognitive Scale for Functional Bowel Disorders (CS-FBD), the State-Trait Anxiety
Inventory (STAI), the Hospital Anxiety and Depression Scale (HADS), and the SF-36 Health survey
(SF-36). Scores were compared using Wilcoxon-signed rank test. Results: 56 patients visited the MPU
during the study period. Of them, 80% completed questionnaires. Mean age was 43 years and 76%
was female; 64% was diagnosed with IBS, and 76% with a psychiatric disorder, of which 53% panic
disorder. Treatment: 46% SSRIs, 27% psychotherapy, and 27% both SSRIs and psychotherapy.
There was a significant improvement in score after 6 months for the GSRS (p=0.002), the STAI state
version (p=0.032), the Physical Role Functioning subscale of the SF-36 (p=0.017), the Bodily Pain
subscale of the SF-36 (p=0.018), and the Emotional Role Functioning subscale of the SF-36
(p=0.006). Conclusion: This is the first study to report about the effects of a standardized integrated
multidisciplinary approach of complex FGID patients in an ambulatory MPU-setting. These data
indicate that an integrated approach may be effective in improving gastrointestinal and psychological
symptoms and quality of life. Based on these encouraging findings a controlled trial focussing on
efficacy and costs is justified.