IDDF2018-ABS-0206 The impact and effectiveness of ibs clinical pathway in outpatient management of irritable bowel syndrome in a tertiary centre

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Abstract

Background

Irritable bowel syndrome (IBS) is a chronic gastrointestinal disorder consisting of abdominal pain and altered bowel habit with either diarrhoea, constipation or both which has a significant impact on patient‘s quality of life. To date, there have been no published studies on the efficacy of a clinical pathway in treating IBS. The IBS Clinical Pathway (CP) consists of an algorithm that delivers standardised care and prompt intervention to IBS patients. We aim to assess the effectiveness of IBS clinical pathway in improving symptoms and severity of IBS.

Methods

This was a non-randomised prospective study in Universiti Kebangsaan Malaysia Medical Centre (UKMMC) from June 2017 to May 2018. We included all patients that fulfilled the diagnosis of IBS based on Rome III criteria. The patients from CP group and non-CP group had their baseline IBS severity scoring system (IVS-SSS), Euro quality of life 5-dimension 5-levels (EQ-VAS) and hospital anxiety and depression scale (HADS) score calculated at baseline and the end of the study. CP followed a strict algorithm from diagnosis consisting of dietary counselling for low FODMAP diet during each visit, close biopsychosocial assessment and those with moderate to severe HADS scores were referred to psychiatry for appropriate intervention.

Results

101 patients were recruited under CP and 84 patients for the non-CP group. At the end of the study, the CP group demonstrated a statistically significant improvement in their IBS Severity Score: 20 participants (19.8%) showed significant IBS Severity Score improvement in CP group whereas only 7 participants (8.3%) in non-CP group (p=0.006) demonstrated an improvement. For EQ-VAS score, both groups showed significant improvement in the level of health at the end of the study (p value<0.05). There was a significant improvement in IBS symptoms with prompt psychiatry referral in CP groups (p=0.024) but not in non-CP group (p=0.171). In relation between IBS severity improvement and low FODMAP diet, there were no significant difference in both groups (p>0.05).

Conclusions

IBS Clinical Pathway is effective in improving IBS severity and symptoms and should be incorporated into clinical practice.

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