International Delphi study to assess the need for multiaxial criteria in diagnosis and management of functional gastrointestinal disorders
Austin, Philip Daniel
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Purpose: While there are diagnostic criteria for functional gastrointestinal disorders (FGIDs), their evaluation is challenging. This is because criteria are based on symptoms, and the underlying pathophysiology is not clear; as such, there are no gold standard tests. Diagnosis is further challenged by considerable clinical overlap between different FGIDs as well as other organic diseases, while many people with FGIDs have more anxiety and depression than healthy individuals. I hypothesised that assessment of separate components of FGIDs that also indicate their effect on the patient could improve diagnosis. My aim was to investigate the evolution of opinions from experts involved in the development of FGID diagnostic criteria on the proposal for the development of multiaxial assessment criteria (MAC) for FGIDs. Methods: I conducted a web-based Delphi study using a group of purposively sampled experts identified from committees of the Rome Foundation and the International Foundation for Gastrointestinal Disorders. From a systematic search of relevant articles, I generated132 items that were sent to experts as a first round survey. The items assessed risk and contributing factors, the therapeutic relationship, areas of evaluation and the advantages and disadvantages of multiaxial assessment. Consensus on an item was reached when 75% of experts indicated that they agreed or strongly agreed with the statement. Key results: 36 of 68 eligible participants (52%) responded to the first round. Consensus was reached on 96 items. Using participant feedback, thematic analysis was used to generate 33 additional items for round two. Thirty-one of 36 participants (86%) replied to rounds two and three. In round two, 19 items gained consensus, and in round three, nine items gained consensus. Participants agreed that multiaxial assessment was needed, using a systematic approach to establish the physiological and psychosocial components of FGIDs. Participants were unable to agree on the importance of physical risk factors such as previous surgery and genetic association. Overall, 124 of the 167 items achieved consensus. Conclusion and inferences: The key finding from my study shows that experts agree that multiaxial assessment of FGIDs is needed. I also identified expert agreement on the consideration of psychological risk factors and the importance of the impact of FGID symptoms on daily life. Findings also show that experts disagreed on the impact of physical risk factors, socioeconomic status and spirituality on people with FGIDs. While experts could not agree on genetic and gender-based risk factors, they considered that these areas are important and require further research.