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Alonso-Sierra M, Malagelada C, Serra J. Organization of Neurogastroenterology and Motility units with a multidisciplinary, patient-centered perspective. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2024; 116:302-304. [PMID: 38469803 DOI: 10.17235/reed.2024.10368/2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
Neurogastroenterology and Motility is a Gastroenterology subspecialty dealing with the management of gastrointestinal (GI) motor diseases and disorders of gut-brain interaction (DGBI). Both types of conditions may impair the nutritional status of patients - In the case of motility disorders, because deficient gastrointestinal motility may impair appropriate food digestion and absorption; in DGBI because development of gastrointestinal symptoms may impair appropriate patient nutrition. In both cases, different studies have shown that patients start restrictive diets on their own, without supervision of a dietician, which leads to nutritional deficits in many cases. Likewise, psychological factors like stressful situations or anxiety may trigger gastrointestinal symptoms in these patients, mainly in those with DGBI. Recent studies comparing a patient-centered approach that includes medical treatment, dietary modifications, and behavioural interventions with gastroenterologist-only standard care have shown a greater proportion of improved symptoms, psychological status, and quality of life, as well as reduced costs in patients allocated to the multidisciplinary treatment arm. In conclusion, there is growing evidence in favour of dietary and behavioural interventions by specialized professionals, coupled with appropriate medical evaluation and treatment by a gastroenterologist. Hence the importance of developing reference units in which comprehensive, individualized management may be offered. Multidisciplinary models improve clinical outcomes and patient satisfaction, which should result in a reduction of direct and indirect costs. .
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Affiliation(s)
| | | | - Jordi Serra
- Digestive System Research Unit, Hospital Universitari Vall d´Hebron, España
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Burgell RE, Hoey L, Norton K, Fitzpatrick J. Treating disorders of brain-gut interaction with multidisciplinary integrated care. Moving towards a new standard of care. JGH Open 2024; 8:e13072. [PMID: 38770352 PMCID: PMC11103762 DOI: 10.1002/jgh3.13072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 04/06/2024] [Accepted: 04/13/2024] [Indexed: 05/22/2024]
Abstract
Disorders of brain-gut interaction (DGBI) are highly prevalent in our community with a negative burden on the quality of life and function. Symptoms are frequently food-induced, and psychological disorders are commonly co-morbid and contribute greatly to symptom severity and healthcare utilization, which can complicate management. Pathophysiological contributors to the development and maintenance of DGBI are best appreciated within the biopsychosocial model of illness. Established treatments include medical therapies targeting gastrointestinal physiology, luminal microbiota or visceral sensitivity, dietary treatments including dietary optimization and specific therapeutic diets such as a low-FODMAP diet, and psychological interventions. The traditional "medical model" of care, driven predominantly by doctors, poorly serves sufferers of DBGI, with research indicating that a multidisciplinary, integrated-care approach produces better outcomes. This narrative review explores the current evidence for multidisciplinary care and provides the best practice recommendations for physicians and healthcare systems managing such patients.
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Affiliation(s)
- Rebecca Elizabeth Burgell
- Gastroenterologist Functional GI Disorders ServiceAlfred Health and Monash UniversityMelbourneAustralia
| | - Louisa Hoey
- Clinical PsychologistFunctional GI Disorders service, Alfred HealthMelbourneAustralia
| | - Kate Norton
- Clinical Nurse SpecialistFunctional GI Disorders service, Alfred Health MelbourneMelbourneAustralia
| | - Jessica Fitzpatrick
- DietitianFunctional GI Disorders service, Alfred Health and Monash UniversityMelbourneAustralia
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The Pervasive Impact of the Stigmatization of Gastrointestinal Diseases-A Patient's Perspective. Gastroenterol Clin North Am 2022; 51:681-695. [PMID: 36375989 DOI: 10.1016/j.gtc.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Stigma is a centuries-old phenomenon that pervades chronic digestive diseases, regardless of classification. Patients with gastrointestinal (GI) illness perceive others hold stigmatizing beliefs about them and their illness, including from medical professionals, and may go on to internalize or believe these negative stereotypes as true. These perceptions seem to be based on the thought that the public views GI diseases negatively. The effects of GI stigma are substantial and influence quality of life, psychological distress, treatment adherence, disease severity, and health-care utilization. These realities underscore the need for stigma to be addressed by the GI community and measures taken to mitigate its impacts.
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Melchior C, Nuzzo A, Keszthelyi D. How to raise the interest for neurogastroenterology among young gastroenterologists? United European Gastroenterol J 2021; 9:1193-1196. [PMID: 34724358 PMCID: PMC8672086 DOI: 10.1002/ueg2.12174] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Chloé Melchior
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,INSERM UMR 1073, Institute for Research and Innovation in Biomedicine, Normandy University, Rouen, France.,Rouen University Hospital, Gastroenterology Department and INSERM CIC-CRB 1404, Rouen, France
| | - Alexandre Nuzzo
- APHP.Nord, Department of Gastroenterology, IBD and Intestinal Failure, Beaujon Hospital, Clichy, France.,Université de Paris, Paris, France
| | - Daniel Keszthelyi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
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Electrogastrography Abnormalities in Pediatric Gastroduodenal Disorders: A Systematic Review and Meta-analysis. J Pediatr Gastroenterol Nutr 2021; 73:9-16. [PMID: 33797449 DOI: 10.1097/mpg.0000000000003140] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Electrogastrography (EGG) is a non-invasive method of measuring gastric electrophysiology. Abnormal gastric electrophysiology is thought to contribute to disease pathophysiology in patients with gastroduodenal symptoms but this has not been comprehensively quantified in pediatric populations. This study aimed to quantify the abnormalities in gastric electrophysiology on EGG in neonatal and pediatric patients.Databases were systematically searched for articles utilizing EGG in neonatal and pediatric patients (≤18 years). Primary outcomes were prevalence of abnormality, percentage of time in normal rhythm, and power ratio. Secondary outcomes were correlations between patient symptoms and abnormal gastric electrophysiology on EGG.A total of 33 articles (1444 participants) were included. EGG methodologies were variable. Pooled prevalence of abnormalities on EGG ranged from 61% to 86% in patients with functional dyspepsia (FD), gastro-esophageal reflux disease (GERD), and type 1 diabetes mellitus (T1DM). FD patients averaged 20.8% (P = 0.011) less preprandial and 21.6% (P = 0.031) less postprandial time in normogastria compared with controls. Electrophysiological abnormalities were inconsistent in GERD. T1DM patients averaged 46.2% (P = 0.0003) less preprandial and similar (P = 0.32) postprandial time in normogastria compared with controls, and had a lower power ratio (SMD -2.20, 95% confidence interval [CI]: -4.25 to -0.15; P = 0.036). Symptom correlations with gastric electrophysiology were inconsistently reported.Abnormalities in gastric electrophysiology were identifiable across a range of pediatric patients with gastroduodenal symptoms on meta-analysis. However, techniques have been inconsistent, and standardized and more reliable EGG methods are desirable to further define these findings and their potential utility in clinical practice.
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Duncanson K, Burns G, Pryor J, Keely S, Talley NJ. Mechanisms of Food-Induced Symptom Induction and Dietary Management in Functional Dyspepsia. Nutrients 2021; 13:1109. [PMID: 33800668 PMCID: PMC8066021 DOI: 10.3390/nu13041109] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 03/23/2021] [Accepted: 03/25/2021] [Indexed: 12/12/2022] Open
Abstract
Functional dyspepsia (FD) is a common disorder of gut-brain interaction, characterised by upper gastrointestinal symptom profiles that differentiate FD from the irritable bowel syndrome (IBS), although the two conditions often co-exist. Despite food and eating being implicated in FD symptom induction, evidence-based guidance for dietetic management of FD is limited. The aim of this narrative review is to collate the possible mechanisms for eating-induced and food-related symptoms of FD for stratification of dietetic management. Specific carbohydrates, proteins and fats, or foods high in these macronutrients have all been reported as influencing FD symptom induction, with removal of 'trigger' foods or nutrients shown to alleviate symptoms. Food additives and natural food chemicals have also been implicated, but there is a lack of convincing evidence. Emerging evidence suggests the gastrointestinal microbiota is the primary interface between food and symptom induction in FD, and is therefore a research direction that warrants substantial attention. Objective markers of FD, along with more sensitive and specific dietary assessment tools will contribute to progressing towards evidence-based dietetic management of FD.
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Affiliation(s)
- Kerith Duncanson
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia; (G.B.); (J.P.); (S.K.)
- Centre for Research Excellence, Digestive Health, Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Grace Burns
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia; (G.B.); (J.P.); (S.K.)
- Centre for Research Excellence, Digestive Health, Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Jennifer Pryor
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia; (G.B.); (J.P.); (S.K.)
- Centre for Research Excellence, Digestive Health, Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Simon Keely
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia; (G.B.); (J.P.); (S.K.)
- Centre for Research Excellence, Digestive Health, Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Nicholas J. Talley
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia; (G.B.); (J.P.); (S.K.)
- Centre for Research Excellence, Digestive Health, Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Department of Gastroenterology, John Hunter Hospital, New Lambton Heights, NSW 2305, Australia
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Carson DA, O'Grady G, Du P, Gharibans AA, Andrews CN. Body surface mapping of the stomach: New directions for clinically evaluating gastric electrical activity. Neurogastroenterol Motil 2021; 33:e14048. [PMID: 33274564 DOI: 10.1111/nmo.14048] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 10/11/2020] [Accepted: 11/03/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Gastric motility disorders, which include both functional and organic etiologies, are highly prevalent. However, there remains a critical lack of objective biomarkers to guide efficient diagnostics and personalized therapies. Bioelectrical activity plays a fundamental role in coordinating gastric function and has been investigated as a contributing mechanism to gastric dysmotility and sensory dysfunction for a century. However, conventional electrogastrography (EGG) has not achieved common clinical adoption due to its perceived limited diagnostic capability and inability to impact clinical care. The last decade has seen the emergence of novel high-resolution methods for invasively mapping human gastric electrical activity in health and disease, providing important new insights into gastric physiology. The limitations of EGG have also now become clearer, including the finding that slow-wave frequency alone is not a reliable discriminator of gastric dysrhythmia, shifting focus instead toward altered spatial patterns. Recently, advances in bioinstrumentation, signal processing, and computational modeling have aligned to allow non-invasive body surface mapping of the stomach to detect spatiotemporal gastric dysrhythmias. The clinical relevance of this emerging strategy to improve diagnostics now awaits determination. PURPOSE This review evaluates these recent advances in clinical gastric electrophysiology, together with promising emerging data suggesting that novel gastric electrical signatures recorded at the body surface (termed "body surface mapping") may correlate with symptoms. Further technological progress and validation data are now awaited to determine whether these advances will deliver on the promise of clinical gastric electrophysiology diagnostics.
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Affiliation(s)
- Daniel A Carson
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Greg O'Grady
- Department of Surgery, University of Auckland, Auckland, New Zealand.,Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Peng Du
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand.,Department of Engineering Science, University of Auckland, Auckland, New Zealand
| | - Armen A Gharibans
- Department of Surgery, University of Auckland, Auckland, New Zealand.,Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
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Chey WD, Keefer L, Whelan K, Gibson PR. Behavioral and Diet Therapies in Integrated Care for Patients With Irritable Bowel Syndrome. Gastroenterology 2021; 160:47-62. [PMID: 33091411 DOI: 10.1053/j.gastro.2020.06.099] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/08/2020] [Accepted: 06/06/2020] [Indexed: 02/06/2023]
Abstract
Irritable bowel syndrome (IBS) is a common, symptom-based condition that has negative effects on quality of life and costs health care systems billions of dollars each year. Until recently, management of IBS has focused on over-the-counter and prescription medications that reduce symptoms in fewer than one-half of patients. Patients have increasingly sought natural solutions for their IBS symptoms. However, behavioral techniques and dietary modifications can be effective in treatment of IBS. Behavioral interventions include gastrointestinal-focused cognitive behavioral therapy and gut-directed hypnotherapy to modify interactions between the gut and the brain. In this pathway, benign sensations from the gut induce maladaptive cognitive or affective processes that amplify symptom perception. Symptoms occur in response to cognitive and affective factors that trigger fear of symptoms or lack of acceptance of disease, or from stressors in the external environment. Among the many dietary interventions used to treat patients with IBS, a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols is the most commonly recommended by health care providers and has the most evidence for efficacy. Patient with IBS who choose to follow a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols should be aware of its 3 phases: restriction, reintroduction, and personalization. Management of IBS should include an integrated care model in which behavioral interventions, dietary modification, and medications are considered as equal partners. This approach offers the greatest likelihood for success in management of patients with IBS.
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Affiliation(s)
- William D Chey
- Division of Gastroenterology, Michigan Medicine, Ann Arbor, Michigan.
| | | | - Kevin Whelan
- Department of Nutritional Sciences, King's College London, London, United Kingdom
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An Y, Prince D, Gardiner F, Neeman T, Linedale EC, Andrews JM, Connor S, Begun J. Faecal calprotectin testing for identifying patients with organic gastrointestinal disease: systematic review and meta‐analysis. Med J Aust 2019; 211:461-467. [DOI: 10.5694/mja2.50384] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Yoon‐Kyo An
- Mater Hospital Brisbane Brisbane QLD
- University of Queensland Brisbane QLD
| | - David Prince
- Liverpool Hospital Sydney NSW
- South Western Sydney Clinical SchoolUniversity of New South Wales Sydney NSW
| | - Fergus Gardiner
- Royal Flying Doctor Service Canberra ACT
- National Centre for Epidemiology and Population HealthAustralian National University Canberra ACT
| | | | | | | | - Susan Connor
- Liverpool Hospital Sydney NSW
- South Western Sydney Clinical SchoolUniversity of New South Wales Sydney NSW
| | - Jakob Begun
- Mater Hospital Brisbane Brisbane QLD
- Mater Research InstituteUniversity of Queensland Brisbane QLD
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Mutsekwa RN, Canavan R, Whitfield A, Spencer A, Angus RL. Dietitian first gastroenterology clinic: an initiative to reduce wait lists and wait times for gastroenterology outpatients in a tertiary hospital service. Frontline Gastroenterol 2019; 10:229-235. [PMID: 31281623 PMCID: PMC6583570 DOI: 10.1136/flgastro-2018-101063] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 10/05/2018] [Accepted: 10/09/2018] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE The demand for outpatient gastroenterology medical specialist consultations is above what can be met within budgetary and staffing constraints. This study describes the establishment of a dietitian first gastroenterology clinic to address this issue, the patient journey and its impact on wait lists and wait times in a tertiary gastroenterology service. DESIGN A dietitian first gastroenterology clinic model was developed and a mixed-methods approach used to evaluate the impact of the service over a 21-month period. SETTING Gold Coast University Hospital, Queensland, Australia (a public tertiary hospital). PATIENTS 658 patients were triaged to the clinic between June 2016 and March 2018. INTERVENTION A dietitian first gastroenterology clinic for low-risk gastroenterology patients. MAIN OUTCOME MEASURES We examined demographic, referral, wait list, wait time and service activity data, patient satisfaction and patient journey. RESULTS At the time of audit, 399 new (67.9% female) and 307 review patients had been seen. Wait times for eligible patients reduced from 280 to 66 days and the percentage of those in breach of their recommended wait times reduced from 95% to zero. The average time from referral to discharge was 117.8 days with an average of 2.4 occasions of service. 277 patients (69.4%) had been discharged to the care of their general practitioner and 43 patients (10.7%) had an expedited specialist medical review. Patient surveys indicated a high level of satisfaction. CONCLUSION A dietitian first gastroenterology model of care helps improve patient flow, reduces wait times and may be useful elsewhere to address outpatient gastroenterology service pressures.
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Affiliation(s)
- Rumbidzai N Mutsekwa
- Gold Coast Hospital and Health Service, Nutrition and Food Service Department, Hospital Boulevard Southport, Southport, Queensland, Australia
| | - Russell Canavan
- Gold Coast Hospital and Health Service, Gastroenterology Department, Hospital Boulevard Southport, Southport, Queensland, Australia
| | - Anthony Whitfield
- Gold Coast Hospital and Health Service, Gastroenterology Department, Hospital Boulevard Southport, Southport, Queensland, Australia,Health Sciences, Griffith University, Southport, Queensland, Australia
| | - Alan Spencer
- Gold Coast Hospital and Health Service, Nutrition and Food Service Department, Hospital Boulevard Southport, Southport, Queensland, Australia
| | - Rebecca L Angus
- Gold Coast Hospital and Health Service, Nutrition and Food Service Department, Hospital Boulevard Southport, Southport, Queensland, Australia,Health Sciences, Griffith University, Southport, Queensland, Australia
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