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.
The FGIDs 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
As President of the Rome Foundation, I had the honor of presenting the Rome Foundation Multi-Dimensional Clinical Profile at the American Gastroenterological Association James W. Freston Conference
Created by the world’s leading experts, members of the Board of Directors of the Rome Foundation , this intuitive learning model incorporates how good clinicians approach treatment of these disorders. The key factors are organized into a simple and logical 5-component framework. Using this information, we provide a treatment plan uniquely targeted to the patient. This is demonstrated with over 30 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
MDCP Five Categories Explained
The MDCP has five 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-IV 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.
The Rome IV diagnostic criteria, which are due out in spring 2016, try to address some of these limitations by further simplifying some of the 2006 Rome III diagnostic criteria and creating clinical algorithms that provide clinicians with a pathway leading to diagnosis and subtyping. In addition there will be the new 2nd edition of the MDCP which will have over 70 clinical cases to help guide the reader in this new method, more than twice as many as there was for the Rome III edition.
See recent coverage of my talk at the James Freston AGA conference on the MDCP, Symptom-based diagnostic criteria: A work in progress in IBS by Patrice Wendling, Internal Medicine News
ACG GI Circle and the Rome Foundation Two-Part Webinar Series: “A Multi-Dimensional Approach to Treating Functional Gastrointestinal Disorders”