A Collaborative Health Care Model for the Treatment of Irritable Bowel Syndrome

Background & Aims: There have been few reports of successful treatment of chronically symptomatic patients with irritable bowel syndrome. We performed a preliminary single center study to evaluate a new collaborative treatment model that used both gastroenterologist and psychologist working together, compared to medical treatment or psychological treatment alone. A second goal was to determine the sample size that would be necessary to definitively demonstrate efficacy of such a collaborative treatment program. Methods: Forty-one patients with irritable bowel syndrome, seen in a tertiary setting, were randomly assigned to the 3 treatment groups. The research design was weighted toward collaborative treatment, which consisted of 3 biweekly visits. A series of questionnaires, including a 2-week daily diary as well as measures of quality of life, anxiety, depression, and relationships, were administered before treatment, after treatment, and again 3 months later. At termination of the study, patients completed a global assessment scale. Results: Sixteen patients completed the collaborative program, 8 completed medical treatment directed at gastrointestinal function, and 6 completed psychological therapy. Eleven patients dropped out of the study; 2 had organic disease. Intent to treat and per protocol analyses showed that global self-assessment improved significantly at long-term follow-up in the collaborative treatment group (P < 0.0002). Abdominal pain, diarrhea, and constipation also improved significantly in the collaborative treatment group (P < 0.001). Collaborative treatment was statistically superior to medical treatment alone (P < 0.05). The psychological treatment group had 50% improvement in global score. There was no significant improvement in the medically treated group. Conclusions: We have demonstrated that short-term treatment with gastroenterologist and psychologist working together is more effective than medical treatment in relieving symptoms in patients with chronic irritable bowel syndrome. Attributes of a collaborative approach are discussed. These pilot data suggest that collaborative treatment programs should be explored in further studies, and they show the importance of dealing with both mind and body in these patients.