P0537 - Missed Opportunity for Effective Triage of Patients With Irritable Bowel Syndrome to Dietary Therapy

Bhavana Tetali, MD, William D. Chey, MD, FACG, Stacy B. Menees, MD, MS
University of Michigan, Ann Arbor, MI

Introduction: Dietary interventions are a cornerstone of treating patients with irritable bowel syndrome (IBS). Despite this, dietary therapies are not routinely utilized by gastroenterologists. The aim of this study was to investigate patient characteristics that may influence referral to a gastroenterology (GI) dietitian, and assess the impact of discussions about food triggers on therapeutic recommendations.

Methods: This is a retrospective analysis of index GI clinic visits for adult patients with IBS between 01/2016–12/2019 at an academic tertiary care center. Patients previously seen in the GI department were excluded. Patients were divided into two groups: those referred to a dietician and those not referred to a dietician. Differences in demographics and co-morbidities were analyzed. Subgroup analyses were performed for patients with food triggers, without food triggers, and patients in whom food triggers were not discussed to assess for differences in therapeutic recommendations.

Results: We reviewed IBS patient records consecutively to include 250 patients referred to a GI dietician and 250 patients not referred to a GI dietician (N=500). We found no demographic differences between the groups (Table 1). Patients referred to a GI dietician had a higher likelihood of co-morbid dyspepsia (OR 2.08 [1.27-3.43], p=0.002), and were less likely to have somatic pain syndromes (OR 0.56 [0.32-0.99], p=0.025) and IBS-constipation (OR 0.56 [0.36-0.86], p=0.004) (Table 1). Dietary triggers were discussed in 63% of all clinic visits, and there were significant differences in therapeutic recommendations depending on whether food triggers were discussed and identified (p< 0.001) (Figure 1). Patients with dietary triggers (n=183) were more likely to be referred for GI dietary counseling and less likely to be prescribed pharmacotherapy compared to patients without food triggers (n=65) and patients in whom food triggers were not discussed (n=148). However, across all groups, pharmacotherapy (37%-61%) was more likely to be recommended as primary treatment than referral to GI dietician (9-21%).

Discussion: Although IBS patients with food triggers may be best treated with dietary modifications, referral to a GI dietician remains underutilized overall, including in patients with identified food triggers. This study highlights a potential missed opportunity to discuss dietary triggers and utilize dietary therapies for patients with IBS.




Disclosures:


Bhavana Tetali, MD, William D. Chey, MD, FACG, Stacy B. Menees, MD, MS. P0537 - Missed Opportunity for Effective Triage of Patients With Irritable Bowel Syndrome to Dietary Therapy, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.