National survey evaluating the provision of gastroenterology dietetic services in England

Rej, Anupam; Buckle, Rachel Louise; Shaw, Christian Charles; Trott, Nick; Urwin, Heidi; McGough, Norma; Aziz, Imran; Sanders, David S.

doi:10.1136/flgastro-2020-101493

Cited by 12 publications

(11 citation statements)

References 23 publications

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“…Furthermore, their implementation requires specialized and extensive dietetic input, which incurs a substantial burden on healthcare services. Indeed, even within countries with highly established healthcare systems (eg, United Kingdom and United States), there is inequity of GI dietetic services available across regions 26 and a failure to correctly implement a LFD despite it frequently being recommended and prescribed. 27 Because IBS is a global condition, then arguably countries with less established healthcare systems may be falling even shorter of optimally delivering a LFD.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Acceptability of Dietary Therapies in Non-Constipated Irritable Bowel Syndrome: A Randomized Trial of Traditional Dietary Advice, the Low FODMAP Diet, and the Gluten-Free Diet

Rej

Sanders

Shaw

et al. 2022

Clinical Gastroenterology and Hepatology

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Section: Discussionmentioning

confidence: 99%

Efficacy and Acceptability of Dietary Therapies in Non-Constipated Irritable Bowel Syndrome: A Randomized Trial of Traditional Dietary Advice, the Low FODMAP Diet, and the Gluten-Free Diet

Rej

Sanders

Shaw

et al. 2022

Clinical Gastroenterology and Hepatology

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“…Within the UK, there is a broad range of follow-up provision, 17 and a recent study highlighted the allocated time for clinics to be insufficient compared with time advocated in guidelines. 33 Rather than guidance for a standard follow-up system for all adults with CD, we propose a system whereby patients who are not adhering to a GFD engage in a telephone clinic every 6 months, until adherence is sustained. Economic analysis of telephone clinics would be highly beneficial; there would be initial cost implications in areas where current provision is minimal, however, long-term savings due to reduced morbidity associated with gluten ingestion by patients with CD.…”

Section: Discussionmentioning

confidence: 99%

Telephone clinic improves gluten-free dietary adherence in adults with coeliac disease: sustained at 6 months

Muhammad

Reeves

Ishaq

et al. 2020

Frontline Gastroenterol

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BackgroundA gluten-free (GF) diet is the only treatment for coeliac disease (CD), non-adherence to the diet is associated with greater morbidity. The study aimed to examine the effect of a telephone clinic, designed to increase GF dietary knowledge and adherence, in adults with CD.MethodsA prospective study of 125 patients with histologically confirmed CD. Patients, not adhering to a GF diet (n=30), engaged in a personalised telephone clinic. Validated questionnaires were used to assess GF dietary adherence (Coeliac Disease Adherence Test; CDAT), knowledge of GF foods and CD-related quality of life (QoL). GF dietary adherence was assessed up to 12 months post telephone clinic. The control group completed the questionnaires only.ResultsGF dietary adherence (CDAT) median scores significantly improved at 3 and 6 months after the telephone clinic compared with baseline (16, 13 and 13, respectively, p<0.01). Reassuringly, the dietary burden QoL score remained similar to baseline values. No change in CDAT scores were observed in the control group. Change in GF dietary knowledge score was associated with improved GF dietary adherence CDAT score (r=−0.22; p=0.039). At 9 and 12 months, CDAT scores were similar to baseline values.ConclusionsTelephone clinics have a positive impact on dietary knowledge and GF dietary adherence in adults with CD, promoting health-benefitting behaviours in those previously not adhering to a GF diet. The study highlights the need for patients to have regular follow-up, with targeted reviews for those not adhering to a GF diet.

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“…The majority of dietary advice given currently is physician-led, with only a minority of gastroenterologists referring to registered dietitians for IBS management [ 60 ]. In addition, there is a lack of dietitians available to deliver dietetic therapies, with a recent UK study highlighting an inequity of dietetic services across England [ 80 ]. In view of this, further research is required to assess the efficacy of a physician led approach in IBS.…”

Section: Discussionmentioning

confidence: 99%

“…In view of this, further research is required to assess the efficacy of a physician led approach in IBS. In addition, although novel methods of dietetic delivery, such as group sessions and webinars require further assessment, they may offer a more efficient method for delivering dietary therapies with scare resources [ 80 – 82 ]. There appears to be evidence for the use of dietetic therapies (TDA, LFD and GFD) to manage patients with IBS at short-term follow-up, with further research required on assessing the long-term efficacy of these approaches.…”

Section: Discussionmentioning

confidence: 99%

Diet and irritable bowel syndrome: an update from a UK consensus meeting

Rej

Avery

Aziz

et al. 2022

BMC Med

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There has been a renewed interest in the role of dietary therapies to manage irritable bowel syndrome (IBS), with diet high on the agenda for patients. Currently, interest has focussed on the use of traditional dietary advice (TDA), a gluten-free diet (GFD) and the low FODMAP diet (LFD). A consensus meeting was held to assess the role of these dietary therapies in IBS, in Sheffield, United Kingdom.Evidence for TDA is from case control studies and clinical experience. Randomised controlled trials (RCT) have demonstrated the benefit of soluble fibre in IBS. No studies have assessed TDA in comparison to a habitual or sham diet. There have been a number of RCTs demonstrating the efficacy of a GFD at short-term follow-up, with a lack of long-term outcomes. Whilst gluten may lead to symptom generation in IBS, other components of wheat may also play an important role, with recent interest in the role of fructans, wheat germ agglutinins, as well as alpha amylase trypsin inhibitors. There is good evidence for the use of a LFD at short-term follow-up, with emerging evidence demonstrating its efficacy at long-term follow-up. There is overlap between the LFD and GFD with IBS patients self-initiating gluten or wheat reduction as part of their LFD. Currently, there is a lack of evidence to suggest superiority of one diet over another, although TDA is more acceptable to patients.In view of this evidence, our consensus group recommends that dietary therapies for IBS should be offered by dietitians who first assess dietary triggers and then tailor the intervention according to patient choice. Given the lack of dietetic services, novel approaches such as employing group clinics and online webinars may maximise capacity and accessibility for patients. Further research is also required to assess the comparative efficacy of dietary therapies to other management strategies available to manage IBS.

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National survey evaluating the provision of gastroenterology dietetic services in England

Cited by 12 publications

References 23 publications

Efficacy and Acceptability of Dietary Therapies in Non-Constipated Irritable Bowel Syndrome: A Randomized Trial of Traditional Dietary Advice, the Low FODMAP Diet, and the Gluten-Free Diet

Efficacy and Acceptability of Dietary Therapies in Non-Constipated Irritable Bowel Syndrome: A Randomized Trial of Traditional Dietary Advice, the Low FODMAP Diet, and the Gluten-Free Diet

Telephone clinic improves gluten-free dietary adherence in adults with coeliac disease: sustained at 6 months

Diet and irritable bowel syndrome: an update from a UK consensus meeting

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