title: Integrated medical-psychiatric outpatient care in functional gastrointestinal disorders improves outcome: a pilot study.
abstract: OBJECTIVE
  Functional gastrointestinal disorders have a multifactorial etiology, including somatic and psychosocial factors. We provide multidisciplinary outpatient consultations by a gastroenterologist and a psychiatrist using an integrated approach toward somatic and psychosocial factors in complex functional gastrointestinal disorders. The aim of this study was to determine the efficacy of this approach assessing gastrointestinal and psychiatric symptoms and quality of life.
  
  
  METHODS
  All patients with complex functional gastrointestinal disorders visiting for consultation were included and treated with antidepressants, psychotherapy, or both, or given advice for treatment in their own region. Questionnaires testing gastrointestinal and psychiatric symptoms, and quality of life at first visit and after 6 and 12 months were completed.
  
  
  RESULTS
  A total of 124 patients were included (70% women, mean age 48 years): 57% were diagnosed with irritable bowel syndrome and about 80% had a psychiatric diagnosis (50% anxiety disorder, 20% mood disorder). Of the patients, 57% were treated with antidepressants and psychotherapy, 6% with psychotherapy alone, and 38% received advice for treatment in their own region. After 1 year, patients showed significant improvement in all questionnaires, with the exception of those testing gastrointestinal symptoms, although there were significant improvements in these at 6 months.
  
  
  CONCLUSIONS
  This is the first prospective study on the efficacy of an integrated medical-psychiatric outpatient care model in patients with complex functional gastrointestinal disorders, showing significant improvement in gastrointestinal and psychiatric symptoms as well as quality of life after 6 months. With the exception of improvement in gastrointestinal symptoms, improvement persisted at the 1-year follow-up. This indicates that longer follow-up focusing on gastrointestinal symptoms may be needed.
authors.affiliation: aDepartment of Internal Medicine, Division of Gastroenterology-Hepatology Departments of bPsychiatry and Psychology cMethodology and Statistics, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: Joanna
authors.initials: J
authors.lastname: Kruimel
authors.forename: Carsten
authors.initials: C
authors.lastname: Leue
authors.forename: Bjorn
authors.initials: B
authors.lastname: Winkens
authors.forename: Dagmar
authors.initials: D
authors.lastname: Marcus
authors.forename: Sam
authors.initials: S
authors.lastname: Schoon
authors.forename: Romy
authors.initials: R
authors.lastname: Dellink
authors.forename: Jim
authors.initials: J
authors.lastname: van Os
authors.forename: Ad
authors.initials: A
authors.lastname: Masclee
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000458:organization & administration*; D000928:Antidepressive Agents / Q000627:therapeutic use; D001008:Anxiety Disorders / Q000150:complications / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D005762:Gastroenterology; D005767:Gastrointestinal Diseases / Q000523:psychology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000150:complications / Q000628:therapy*; D010348:Patient Care Team / Q000458:organization & administration; D010865:Pilot Projects; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011570:Psychiatry; D011613:Psychotherapy; D011788:Quality of Life; D012017:Referral and Consultation; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents