S867 Using the Tools of Functional Medicine Improves the Multi-Disciplinary Model of Care of the IBD Patient

Abstract

Introduction: Inflammatory Bowel Disease (IBD) is a chronic, multifaceted disease that often coexists with extra-intestinal manifestations (EIMs) and persistent GI symptoms despite remission. Functional medicine is a patient-centered, complementary approach to care that focuses on diet and modifiable lifestyle factors (MLF). An individualized functional medicine program was developed for IBD patients at a tertiary care IBD center with the goal of supporting traditional IBD care and improving symptoms and quality of life. Methods: Between December 2020 and April 2022, clinically stable IBD patients with persistent GI symptoms or EIMs were offered access to our IBD functional medicine clinic (FMC), where they had individual appointments with a dietician, functional medicine provider, and social worker. They received education on nutrition and techniques to address stress, sleep quality, and other MLFs. Prior to each visit, the following patient-reported outcome (PRO) surveys were administered: the SIBDQ (Short Inflammatory Bowel Disease Questionnaire), FSS (Fatigue Severity Scale), PSQI (The Pittsburgh Sleep Quality Index), and MSQ (Medical Symptoms Questionnaire). Statistical analysis was performed with Wilcoxon matched-pairs signed-rank test. (Figure) Results: 40 patients were consented. Of those, 27 patients attended FMC and completed PRO surveys at least twice (21 CD, 5 UC, 1 indeterminate; 9 men, 18 women). The range of disease length was 0-35 years. 16 of 27 indicated they were extremely ready to make diet and MLF changes. Median SIBDQ increased from 52 to 58 with statistical significance. There was a trend towards improvement in MSQ, FSS, and PSQI, although without statistical significance. The MSQ subsets of joint and weight symptoms showed significant improvement. Patients who indicated readiness for change significantly improved their SIBDQ, MSQ and PSQI. (Table) Conclusion: In patients with stable IBD, persistent symptoms may be related to dietary or psychosocial triggers, which are the key targets of functional medicine care. A previous retrospective design looked at the functional medicine approach to care in a shared medical appointment standardized program and found improvement in areas of sleep, fatigue, and medical symptoms. This prospective study of an individualized functional medicine IBD program showed that patients who were ready for change improved in MSQ and PSQI compared to the entire cohort, while the entire cohort significantly improved their SIBDQ regardless of readiness for change.Figure 1.: SIBDQ, MSQ, and PSQI significantly improved in patients who indicated readiness for change Table 1. - Median PROs Showed Trends Towards Improvement, with Significant Improvement in SIBDQ First score median (range) Last score median (range) p-value SIBDQ 52 (27-65) 58 (34-68) < 0.05 MSQ 51 (10-120) 37 (1-130) 0.2 FSS 39 (15-57) 35 (17-63) 0.5 PSQI 3 (0-13) 2 (0-5) 0.15