Leigh E Wagner, Kristina M Bridges, Jill M Hinman, Jianghua He, Daniel Buckles, Winnie Dunn, Jeanne Drisko, Debra K Sullivan, Susan E Carlson
Journal: JGH open : an open access journal of gastroenterology and hepatology 2024;8(1):e13022
PMID: 38268959
Functional bowel disorders (FBDs), including irritable bowel syndrome (IBS), are conditions without a physically identifiable cause and as a result, are difficult to treat, require more physician time and impact patients' quality of life. They are linked to disordered gut-brain interactions, and diagnosis is based on patient-reported gastrointestinal symptoms in the absence of detectable physical abnormalities. The holistic approach of integrative medicine (IM) presents an interesting avenue for FBD management. This retrospective review assessed the outcome of 57 IM clinic patients, who were diagnosed with FBDs (constipation or diarrhoea-dominant IBS, mixed IBS, functional diarrhoea/constipation/ bloating). Characteristic of IM approaches the interventions were tailored specifically to the individual needs, deploying a group of therapies, including elimination diets, vitamin or mineral supplementation, magnesium supplementation, GI-related supplementation, fermented foods, hydration, non-diet lifestyle modification, referrals and GI-related medication. Symptoms were measured using a medical symptom questionnaire (MSQ). Post-intervention (average 8.75 months) most patients (75.4%) experienced an improvement in digestive symptoms. The most common intervention was an elimination diet (predominantly gluten, grains, dairy or casein), followed by supplementation. The findings suggest that IM interventions, particularly dietary changes, can effectively alleviate symptoms in FBD patients, especially for diarrhoea-dominant conditions. They also showed that less strict elimination diets may be equally effective and easier to adhere to than a low FODMAP diet. Limitations of the study included its retrospective nature, small sample size, and difficulty in comparing interventions due to their individualised nature. In addition, self-paying patients may have been more motivated to comply. A small number of patients did not experience changes and possible reasons are discussed, acknowledging that organic GI diseases were not ruled out. Future research should explore the effectiveness of dietary interventions further and consider using more IBS-specific measuring tools, as an interdisciplinary approach may be beneficial in managing FBDs effectively.
BACKGROUND AND AIM
Functional bowel disorders (FBDs), including irritable bowel syndrome (IBS) and others, are conditions without a physically identifiable etiology that, as a result, are difficult to treat. Alternatives to traditional medical interventions are needed because IBS patients require more of physician time and higher healthcare spending. The goal of this study was to determine the efficacy of alternative lifestyle interventions for patients with FBDs seen in an integrative medicine (IM) clinic at an academic medical center.
METHODS
We performed a retrospective chart review to determine whether patients with FBDs had improvement in symptoms following predominantly nutrition-based IM interventions that included recommendations for dietary supplements and elimination diets. We measured symptoms before and after intervention (average time between measurements 8.75 months) using a medical symptoms questionnaire (MSQ) commonly used to quantify symptom change in IM clinics.
RESULTS
Digestive tract symptoms, as measured by the MSQ, improved significantly in patients ( = 57) with FBDs following IM intervention. The MSQ Digestive Tract subtotal for FBD patients decreased from 10.2 (SD, 5.4) to 7.2 (SD, 5.2) ( < 0.001) after IM intervention.
CONCLUSIONS
Patients in an IM clinic had improved digestive tract symptoms scores following IM intervention. Because nutrition-based interventions were the primary intervention recommended by IM providers, primary care physicians and gastroenterologists may wish to consider referring FBD patients to registered dietitian-nutritionists (RDNs) skilled in implementing elimination diets.
© 2024 The Authors. JGH Open published by Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.
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