Year 2021 / Volume 113 / Number 9
Original
Functional gastrointestinal disorders: real-life results of a multidisciplinary non-pharmacological approach based on group-consultations

627-634

DOI: 10.17235/reed.2020.7276/2020

Marta Tejedor, Daniel Alcalde, Cristina Cruces, Elena Hernando, Maria Carmen López-Martín, Rosa Briz, Almudena Calvache, Raquel Barranco, Luis Alonso Castillo, Inmaculada Chico, María de Lucas, Rosmery Marrufo Ramos, Raquel Rodríguez, María Delgado,

Abstract
Introduction: functional gastrointestinal disorders are prevalent and resource consuming. The use of group-consultations in these diseases is limited and no specific multidisciplinary programs have been developed. Methods: a multidisciplinary approach was used in patients with diverse functional gastrointestinal disorders attending group-consultations (group A). Five two-hour sessions were scheduled over a four-month period. Sessions consisted of a theoretical introduction (Pathophysiology, Low fodmap diet, Over the counter medications, Mediterranean diet, and Laughter therapy workshop) followed by relaxation techniques. This group was compared to a similar group of patients who received written information covering the topics discussed during the group-consultations (group B). Severity of digestive and psychological symptoms, use of drugs and adherence to the diet were the main outcomes measured. Results: the mean age of participants was 43 (± 1.38) years, 78 % were female and 73 % had at least two functional gastrointestinal disorders. Sixty-two patients were included in group A and 17 in group B. The severity of gastrointestinal and psychological symptoms at baseline was similar in both groups. Globally, there was an improvement in all symptoms in both groups. The proportion of participants with severe baseline gastrointestinal symptoms or pathologic anxiety scores that showed improvement was significantly higher in group A (74 % vs 23 %, p = 0.005; 47 % vs 8 %, p = 0.02, respectively). Symptoms were reassessed at six and 12 months after the intervention in participants from group A who attended ≥ 80 % sessions and a sustained response was observed. Conclusions: group-consultations are useful and efficient to alleviate gastrointestinal and psychological symptoms in patients with functional gastrointestinal disorders.
Share Button
New comment
Comments

07/09/2022 23:03:04
Awarded article: José Antonio Solís Herruzo Prize, awarded by the Spanish Journal of Gastroenterology (REED) in 2022


References
1. Drossman DA, Hasler WL. Rome IV-Functional GI Disorders: Disorders of Gut-Brain Interaction. Gastroenterology. 2016; 150(6):1257-1261.
2. Sperber AD, Bangdiwala SI, Drossman DA, et al. Worldwide Prevalence and Burden of Functional Gastrointestinal Disorders, Results of Rome Foundation Global Study [published online ahead of print, 2020 Apr 12]. Gastroenterology. 2020; S0016-5085(20)30487-X. DOI: 10.1053/j.gastro.2020.04.014
3. Camilleri M, Heading RC, Thompson WG. Consensus report: Clinical perspectives, mechanisms, disgnosis and management of irritable bowel síndrome. Aliment Pharmacol Ther 2002; 16 (8): 1407-1430.
4. Almansa C, Díaz-Rubio M, Rey E. The burden and management of patients with IBS: Results from a survey in spanish gastroenterologists. Rev Esp Enferm Dig. 2011; 103(11): 570-575.
5. Vanner S, Greenwood-Van Meerveld B, Mawe G, et al. Fundamentals of Neurogastroenterology: Basic Science. Gastroenterology. 2016; 150 (6): 1280–1291.
6. Boeckxstaens G, Camilleri M, Sifrim D, et al. Fundamentals of Neurogastroenterology: Physiology/Motility - Sensation. Gastroenterology. 2016; 150 (6): 1292-1304.
7. Van Oudenhove L, Crowell MD, Drossman DA, et al. Biopsychosocial Aspects of Functional Gastrointestinal Disorders. Gastroenterology 2016; 150 (6): 1355–1367.
8. Heymann-Mönnikes I, Arnold R, Florin I, et al. The combination of medical treatment plus multicomponent behavioral therapy is superior to medical treatment alone in the therapy of irritable bowel syndrome. Am J Gastroenterol. 2000; 95(4):981-994.
9. Ramdas K, Darzi A. Adopting Innovations in Care Delivery - The Case of Shared Medical Appointments. N Engl J Med. 2017; 376(12):1105-1107.
10. Housden LM, Wong ST. Using Group Medical Visits With Those Who Have Diabetes: Examining the Evidence. Curr Diab Rep. 2016; 16(12):134.
11. Smith CE, Piamjariyakul U, Wick JA, et al. Multidisciplinary group clinic appointments: the Self-Management and Care of Heart Failure (SMAC-HF) trial. Circ Heart Fail. 2014; 7 (6): 888-894.
12. Lettieri CJ, Walter RJ. Impact of group education on continuous positive airway pressure adherence. J Clin Sleep Med. 2013; 9 (6): 537-541.
13. Everest E, Akhtar S, Sumego M, et al. Effectiveness of Shared Medical Appointments Versus Traditional Clinic Visits for Adolescents With Type 1 Diabetes. Qual Manag Health Care. 2016; 25(3):181-184.
14. Trickett KH, Matiaco PM, Jones K, et al. Effectiveness of Shared Medical Appointments Targeting the Triple Aim Among Patients With Overweight, Obesity, or Diabetes. J Am Osteopath Assoc. 2016; 116(12):780-787.
15. Paul S, Yehle KS, Wood K, et al. Implementing shared medical appointments for heart failure patients in a community cardiology practice: a pilot study. Heart Lung. 2013; 42(6):456-461.
16. Labus J, Gupta A, Gill HK, et al. Randomised clinical trial: symptoms of the irritable bowel syndrome are improved by a psycho-education group intervention. Aliment Pharmacol Ther. 2013; 37(3):304-315.
17. Ringström G, Störsrud S, Lundqvist S, et al. Development of an educational intervention for patients with Irritable Bowel Syndrome (IBS): a pilot study. BMC Gastroenterol. 2009;9:10.
18. World Medical Association General Assembly. 2013. Declaration of Helsinki. Ethical Principles for Medical Research Involving Human Subjects. Fortaleza, Brazil. Copyright, World Medical Association. All Rights Reserved. Retrieved from: https://www.wma.net/policies-post/wma-declaration-of-helsinki-ethical-principles-for-medical-research-involving-human-subjects/ Accesed 17/9/2020.
19. Staudacher HM, Whelan K. The low FODMAP diet: recent advances in understanding its mechanisms and efficacy in IBS. Gut. 2017; 66(8):1517-1527.
20. Thakur ER, Holmes HJ, Lockhart NA, et al. Emotional awareness and expression training improves irritable bowel syndrome: A randomized controlled trial. Neurogastroenterol Motil. 2017; 29(12).
21. Johannesson E, Ringström G, Abrahamsson H, et al. Intervention to increase physical activity in irritable bowel syndrome shows long-term positive effects. World J Gastroenterol. 2015; 21(2):600-608.
22. Zijdenbos IL, de Wit NJ, van der Heijden GJ, et al. Psychological treatments for the management of irritable bowel syndrome. Cochrane Database Syst Rev. 2009, Issue 1. Art. No.: CD006442.
23. Conrad A, Roth WT. Muscle relaxation therapy for anxiety disorders: it works but how? J Anxiety Disord. 2007; 21 (3): 243-264.
24. Jerath R, Crawford MW, Barnes VA, Harden K. Self-regulation of breathing as a primary treatment for anxiety. Appl Psychophysiol Biofeedback. 2015; 40 (2): 107-115.
25. Demir Doğan M. The Effect of Laughter Therapy on Anxiety: A Meta-analysis. Holist Nurs Pract. 2020; 34 (1): 35-39.
26. Drossman DA. The functional gastrointestinal disorders and the Rome III process. Gastroenterology. 2006; 130(5):1377-1390.
27. Drossman DA, Hasler WL. Rome IV-Functional GI Disorders: Disorders of Gut-Brain Interaction. Gastroenterology. 2016; 150(6):1257-1261.
28. Francis CY, Morris J, Whorwell PJ. The irritable bowel severity scoring system: a simple method of monitoring irritable bowel syndrome and its progress. Aliment Pharmacol Ther. 1997; 11(2):395-402.
29. Polese B, Nicolai E, Genovese D, et al. Postprandial Gastrointestinal Function Differs after Acute Administration of Sourdough Compared with Brewer's Yeast Bakery Products in Healthy Adults. J Nutr. 2018; 148(2): 202-208.
30. Mari A, Abu Backer F, Mahamid M, et al. Bloating and Abdominal Distension: Clinical Approach and Management. Adv Ther. 2019 May;36(5):1075-1084.
31. Staudacher HM, Lomer MCE, Farquharson FM, et al. A Diet Low in FODMAPs Reduces Symptoms in Patients With Irritable Bowel Syndrome and A Probiotic Restores Bifidobacterium Species: A Randomized Controlled Trial. Gastroenterology. 2017; 153(4): 936-947.
32. Zugasti Murillo A, Estremera Arévalo F, et al. Diet low in fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) in the treatment of irritable bowel syndrome: indications and design. Endocrinol Nutr. 2016; 63(3): 132-138.
33. Gravina AG, Dallio M, Romeo M, et al. Adherence and Effects Derived from FODMAP Diet on Irritable Bowel Syndrome: A Real Life Evaluation of a Large Follow-Up Observation. Nutrients. 2020; 12(4): 928.
34. Algera J, Colomier E, Simrén M. The Dietary Management of Patients with Irritable Bowel Syndrome: A Narrative Review of the Existing and Emerging Evidence. Nutrients. 2019; 11(9): 2162.
35. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361-370.
36. ASGE Standards of Practice Committee, Shaukat A, Wang A, Acosta RD, et al. The role of endoscopy in dyspepsia. Gastrointest Endosc. 2015; 82(2):227-232.
37. ASGE Standards of Practice Committee, Shen B, Khan K, Ikenberry SO, et al. The role of endoscopy in the management of patients with diarrhea. Gastrointest Endosc. 2010; 71(6):887-892.
38. Spiller R, Aziz Q, Creed F, et al; Clinical Services Committee of The British Society of Gastroenterology. Guidelines on the irritable bowel syndrome: mechanisms and practical management. Gut. 2007; 56(12): 1770-1798.
39. Ringström G, Störsrud S, Simrén M. A comparison of a short nurse-based and a long multidisciplinary version of structured patient education in irritable bowel syndrome. Eur J Gastroenterol Hepatol. 2012; 24(8):950-957.
40. Robinson A, Lee V, Kennedy A, et al. A randomised controlled trial of self-help interventions in patients with a primary care diagnosis of irritable bowel syndrome. Gut. 2006; 55(5):643-648.
41. Sanders KA, Blanchard EB, Sykes MA. Preliminary study of a self-administered treatment for irritable bowel syndrome: comparison to a wait list control group. Appl Psychophysiol Biofeedback. 2007; 32(2):111-119.
42. Ringström G, Störsrud S, Posserud I,et al. Structured patient education is superior to written information in the management of patients with irritable bowel syndrome: a randomized controlled study. Eur J Gastroenterol Hepatol. 2010; 22(4):420-428.
43. Lindfors P, Simren M, Tornblom H et al. Poster P1081. Structured patient group education versus structured patient education via the internet for patients with IBS: a randomized, controlled trial. At: 26th UEG Week 2018. Vienna (Austria) October 2018. United European Gastroenterol J. 2018; 6(8 Suppl): A490. doi: 10.1177/2050640618792832
44. Almansa C, García-Sánchez R, Barceló M, et al. Translation, cultural adaptation and validation of a Spanish version of the Irritable Bowel Syndrome Severity Score. Rev Esp Enferm Dig. 2011; 103(12): 612-618. doi: 10.4321/s1130-01082011001200002
Related articles

Letter

Pancreatic lipoma: diagnostic boom of a rare mesenchymal tumor

DOI: 10.17235/reed.2022.8536/2021

Letter

How is the duodenal mucosa in functional dyspepsia?

DOI: 10.17235/reed.2020.7673/2020

Special Article

Consensus document on exclusion diets in irritable bowel syndrome (IBS)

DOI: 10.17235/reed.2018.5941/2018

Letter

Dyspepsia, functional dyspepsia and Rome IV criteria

DOI: 10.17235/reed.2018.5599/2018

Letter to the Editor

A question about dyspeptic patients analyzed using psychometric scores

DOI: 10.17235/reed.2017.5401/2017

Citation tools
Tejedor M, Alcalde D, Cruces C, Hernando E, López-Martín M, Briz R, et all. Functional gastrointestinal disorders: real-life results of a multidisciplinary non-pharmacological approach based on group-consultations. 7276/2020


Download to a citation manager

Download the citation for this article by clicking on one of the following citation managers:

Metrics
This article has received 2224 visits.
This article has been downloaded 337 times.

Statistics from Dimensions


Statistics from Plum Analytics

Publication history

Received: 18/05/2020

Accepted: 14/11/2020

Online First: 29/12/2020

Published: 07/09/2021

Article revision time: 172 days

Article Online First time: 225 days

Article editing time: 477 days


Share
This article has been rated by 1 readers.
Reader rating:
Valora este artículo:




Asociación Española de Ecografía Digestiva Sociedad Española de Endoscopia Digestiva Sociedad Española de Patología Digestiva
The Spanish Journal of Gastroenterology is the official organ of the Sociedad Española de Patología Digestiva, the Sociedad Española de Endoscopia Digestiva and the Asociación Española de Ecografía Digestiva
Cookie policy Privacy Policy Legal Notice © Copyright 2023 y Creative Commons. The Spanish Journal of Gastroenterology