Journal Article

FP50 The development of a functional GI MDT

Coleman, Nicholas, Stammers, Matthew, Hollingworth, Thomas, Beja, Maria, Price, Cathy, Wood, Rachael, George, Beth

2025

Overview

IntroductionThere is an increasing prevalence of patients presenting with complex disorders of gut brain interaction (DGBI). Anecdotally there has been an increase in patient distress associated with their symptoms and consequent requests for escalation in treatments. Current evidence supports a bio-psycho-social model for the management of DGBIs, acknowledging the impact of psychological and social factors on the development of symptoms. Concurrent psychiatric co-morbidities including anxiety and depression or eating disorders can further complicate the presentation in this group of patients.Management of DGBIs benefits from multi-disciplinary team (MDT) involvement including physicians, dietitians, psychologists, psychiatrists and pain management clinicians (Basnayake et al 2022). The aim of this strategy is to improve patient’s symptom management whilst reducing iatrogenic harm. To support this approach, we developed a ‘Functional GI MDT’ (FGI MDT) with core MDT members from the specialties described above. This provides a regular forum to discuss holistic patient management.The aim of this study was to outline the demographics and diagnoses and the referral source of patients discussed in the FGI MDT alongside the clinician perceived benefit of the FGI MDT.MethodsRetrospective data was collected for all patients discussed at the FGI MDT between 01/11/2023 – 01/11/2024 including age, gender, diagnosis and the presence of psychiatric co-morbidities. A questionnaire was sent to all core members of the MDT and all clinicians that had referred a patient to the FGI MDT within this time frame.Results146 MDT discussions took place in 78 patients. 4 patients were discussed >5 times, 3 patients were discussed 4 times. The average age was 28.4 with a range 17-68. 92% were female. The DGBI’s discussed included: functional dyspepsia (43.6%), abdominal pain (15.4%), IBS (10.3%), cyclical vomiting syndrome (5.1%), constipation (3.8%), functional nausea and vomiting syndrome (2.6%) and other (19.2%). 82.1% had a co-existent mental health diagnosis. 53.4% referrals were from a gastroenterologist, 35.6% from a dietitian and 11% from a pain specialist.Feedback was received from 13 clinicians who attended the MDT. 100% of respondents found the MDT helpful, felt that it improved patient care and reduced medical interventions. Further feedback included: ‘Group opinions on complex cases empowers and supports the treating clinician in managing these patients’, ‘I feel the MDT substantially contributes to the reduction in stress managing functional GI patients which helps at a number of levels’, ‘The MDT empowers clinicians to pursue safe, evidence based multi-modality treatments in patients with DGBIs’.ConclusionsA significant proportion of patients discussed at the FGI MDT were female with a co-existent mental health disorder. This likely represents the patient cohort presenting with more complex DGBIs. A significant number of patients present with functional dyspepsia with significant foregut symptoms. Alongside the need for MDT management f, there is commonly self-doubt about missed pathology and how best to manage this group of patients. The FGI MDT has been perceived by clinicians to improve patient care whilst also providing a supportive environment that supports and empowers decision making whilst reducing iatrogenic harm. We hope that this model of care can be expanded to support local trusts in the management of complex DGBIs.

• Publisher: BMJ Publishing Group LTD
• Subject: Constipation / Decision making / Diagnosis / Dyspepsia / Eating disorders / Empowerment / Evidence-based practice / Feedback / Foregut / Iatrogenesis / Irritable bowel syndrome / Management / Mental disorders / Mental health / Pain / Patients / Social factors / Symptom management / Vomiting