P0538 - Underutilization of Behavioral Health Therapy in Patients With Irritable Bowel Syndrome

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

Introduction: Irritable bowel syndrome (IBS) can be effectively treated by behavioral therapies, particularly when stress triggers are present. The aim of this study was to investigate the influence of discussions about stress triggers on therapeutic recommendations in patients with IBS.

Methods: This was a retrospective analysis of index gastroenterology clinic visits for adult patients with IBS between 01/2016–12/2019 at an academic tertiary care center. Patients previously seen in the gastroenterology department were excluded. Patients were divided into three groups: patients with stress triggers, patients without stress triggers, and patients in whom stress triggers were not discussed. Differences in demographics and therapeutic recommendations were analyzed.

Results: We reviewed 396 IBS patients’ records consecutively. Of these patients, 65 had stress triggers, 48 did not have stress triggers, and 283 did not report discussing stress triggers. Patients with stress triggers were younger (37.3 ± 15.0 years, p=0.020) and had lower body mass index (25.6 ± 5.8, kg/m², p=0.040) (Table 1). There were no differences in gender, race, or ethnicity among the groups (Table 1). Stress triggers were discussed at 29% of all clinic visits, and 5% of patients overall were referred to behavioral therapy. There were significant differences in therapeutic recommendations depending on whether stress triggers were discussed and identified (p< 0.001) (Figure 1). In 60-69% of patients, pharmacotherapy was recommended exclusively as primary treatment across all groups. Patients with stress triggers were marginally more likely to be referred to behavioral therapy (n=14, 22%) compared patients without stress triggers (n=2, 4%) and patients in whom stress triggers were not discussed (n=4, 1%). However, even among patients in whom stress triggers were identified, pharmacotherapy was more likely to be recommended as primary treatment than referral to behavioral therapy.

Discussion: Stress triggers were reported in fewer than 30% of clinic visits for patients with IBS. While the identification of stress triggers increased the likelihood of referral to behavioral therapy, pharmacotherapy continued to predominate as primary treatment. These findings highlight a gap in our current approach to the management of patients with IBS. Management of IBS could potentially be improved by more consistent screening for stress triggers and more consistent utilization of behavioral health interventions.




Disclosures:


Bhavana Tetali, MD, William D. Chey, MD, FACG, Stacy B. Menees, MD, MS. P0538 - Underutilization of Behavioral Health Therapy in Patients With Irritable Bowel Syndrome, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.