Phenotyping and treatment of primary health care IBS patients

IBS is a functional gastrointestinal (GI) condition, which is strongly associated with dietary and psychosocial factors. Management of IBS remains challenging for healthcare systems. IBS shares long-term associations with psychosocial health problems, urogenital symptoms and infections, musculoskeletal symptoms and other somatic symptoms in primary care. Many doctors consider contact with IBS patients demanding and difficult. They may feel unsure how to manage conditions without clear structural findings, since this is how physicians are trained traditionally. Furthermore, they may not fully be aware of the complexity of factors involved in understanding the pathophysiology, which adheres to a brain-gut biopsychosocial model.

The treatment comprises of pharmacological, dietary and psychological treatment. However, at the group level, none of these treatments has been shown to be superior in comparison to each other. There are only a few studies, which investigated the phenotype of the patients with a subsequent treatment trial, in order to investigate which treatment will work for which patients.

Our aim is to comprehensively phenotype primary care IBS patients, randomize them into 2 different groups and then to apply different treatments on each group and to identify baseline phenotypical predictors of treatment response. This type of studies is currently lacking and it is well-acknowledged that they are needed in the context of IBS research. This study will provide data on effective and individualized treatment for IBS patients, which will be useful for physicians in everyday clinical practice to provide more effective treatment for IBS.

The aim of the current project is to perform a comprehensive phenotyping of irritable Bowel Syndrome (IBS) patients, inclusive biological samples, within the primary health care in Region Örebro. Following this phenotyping, we will perform a prospective study using two different treatments as described below. Subsequently, we want to identify baseline phenotype characteristics see whether the presence of a certain phenotype can predict the efficacy of different treatments. The results of this study will be implemented in the primary care as a guideline for the general physician providing a tool for phenotyping an IBS patient as well as a simple treatment algorithm.

The study plan is structured into 4 major areas:

1. Phenotyping of primary care IBS patients. To investigate the correlation between the different psychometric parameters and IBS symptom severity and Quality of Life.
2. The effect and outcome of internet-based cognitive behavioral therapy on IBS patients in primary health care.
3. The effect and outcome of low FODMAP diet on IBS patients in primary health care.
4.  Comparison of psychological and dietary treatment in IBS patients and identify baseline phenotypic characteristics predicting treatment outcome for both these treatments.