Management of patients with functional GI disorders (FGIDs) is one of the most challenging areas of gastroenterology and medicine, and diagnosis is accomplished using the symptom-based Rome criteria. However, with treatment, this is not enough; we must also rely on the totality of the patient experience, and that is hard to capture using diagnostic criteria alone.
Here are five things clinicians need to know about the multi-dimensional approach to patient care:
- The FGIDs, like IBS, now expanded under Rome IV to include the definition of disorders of gut-brain interaction, are truly biopsychosocial disorders because patient symptoms are derived from several factors (the diagnosis based on diagnostic criteria, clinical modifiers, the impact of the illness or quality of life, and psychosocial and physiological influences). All of these relate to characterize the unique profile of the patient’s clinical status. This biopsychosocial profile determines the varying but specific methods of treatment. These methods can differ among a patient with the same diagnosis if they have infrequent and mild IBS-D to another with IBS-C having severe pain, emotional distress and physiological disturbance.
- In order to help clinicians use a multi-dimensional approach in their practice, members of the Board of Directors of the Rome Foundation, created The Rome Foundation Multi-Dimensional Clinical Profile, an intuitive learning model that incorporates how good clinicians approach treatment of these disorders. The world’s leading experts designed the MDCP by organizing the key factors into a simple and logical 5-component framework. Using this information, the MDCP provides a treatment plan uniquely targeted to the patient. This is demonstrated with 72 clinical cases that cover the full spectrum of the FGIDs, from mild to severe. After completion of these case exercises, the reader will be well prepared to address the full spectrum of treatment options available to help our patients.
- This is an excellent and unique learning tool for all clinicians working in functional GI disorders (FGIDs) to develop a more biopsychosocial patient centered approach to care, and I highly recommend the MDCP for students, practitioners in gastroenterology and primary care, health care extenders, or anyone who treats patients with FGIDs.
- Five MDCP Categories:
- Category A is diagnosis, which can be made using traditional symptom-based criteria like the Rome diagnostic criteria, but may also include physiologic criteria.
- Category B is the clinical modifiers that are not part of the diagnostic criteria such as IBS-C (constipation); IBS-D (diarrhea); IBS-M (mixed); postinfective IBS; sphincter of Oddi dysfunction I, II, or III; or FODMAP (fermentable, oligosaccharides, disaccharides, monosaccharides, and polyols) sensitivity.
- Category C is essentially a single quality of life question: “How do your symptoms interfere with life?” that results in a rating of mild, moderate, or severe. Category D is psychosocial modifiers or comorbidities. They may be categorical like a DSM 5 diagnosis of anxiety or depression, dimensional like a Rome psychosocial red flag, or patient reported such as a history of abuse. All of these can impact outcome and symptom presentation.
- Category E is physiologic modifiers, like motility, that can alter the clinical expression of the condition, and also will include validated biomarkers that will allow clinicians to subspecify patients for a particular type of treatment.
- We have presented two webinars introducing and further explaining how the MDCP can help in clinical practice. You can access them here: