‘It takes a village’ to manage IBS
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This month’s cover story focuses on the integrated, team-based approach to managing patients with irritable bowel syndrome.
I see some analogies in our evolution of the management of patients with Crohn’s disease and ulcerative colitis — it really does take a village, coming at the problem from multiple angles, to reach a solution.
The days of “increase your fiber intake” and “take some dicyclomine” should be waning. We need to up our IBS game. The continued lack of mechanistic biomarkers in IBS can be challenging, but it doesn’t absolve us from offering good, evidence-based treatments.
The cover story highlights the importance of introducing dietary measures early on — perhaps this should be one of our first interventions. The evidence for the benefit of a low FODMAP diet continues to grow. As William D. Chey, MD, FACG, mentions, this doesn’t necessarily mean a lifetime of low FODMAP, but if the patient sees clinical improvement, then over time the diet can be gradually liberalized.
Having a gastroenterology-focused dietitian available is a huge plus. The comments by Kate Scarlata, MPH, RDN, remind us of the deepening level of knowledge we have accumulated on dietary interventions and how dietitians can thoughtfully implement a strategy based not only on evidence but also on patient-specific factors.
Similarly, a psychologist/therapist embedded within the GI team can be enormously helpful and can potentially prevent the stigma some patients feel when they’re referred to psychology or psychiatry (the unspoken implication being “it’s all in your head”). GI psychologists can offer a range of options, from apps to cognitive behavioral therapy, as outlined by Laurie Keefer, PhD. Let’s employ specialists who can help dissect that complex interaction between the brain and the gut.
By integrating the gastroenterologist, dietitian, psychologist and physiotherapist, one can achieve better outcomes than with the gastroenterologist alone, as witnessed in the MANTRA study: Patients with IBS receiving multidisciplinary care saw a higher rate of symptom score reductions than those receiving usual care.
As Chey points out, this multidisciplinary approach offers the patient a wider range of treatment options, and, perhaps most importantly, offers options that resonate with the patient — and therefore increases the chance of adherence.
- Reference:
- Basnayake C, et al. Lancet Gastroenterol Hepatol. 2020;doi:10.1016/S2468-1253(20)30215-6.
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