Helen Dumpleton

Investigating the effectiveness of dietary advice for IBS within Cambridgeshire.

Dietitian Recognition Award for Improvement in Patient Care Winner

“An Audit of the Effectiveness of IBS Dietary Advice in Cambridgeshire Community Setting.”

The purpose of this audit was to investigate the effectiveness of dietary advice for IBS within Cambridgeshire by looking at the effectiveness of first line and second line (low FODMAP) dietary advice. The project not only gave the team the perfect opportunity to determine whether their present treatment pathways are as effective as it could be, it also allowed them to highlight areas where they could look to improve future treatment.

“I carried out a retrospective review of the notes of 387 patients with IBS who were identified as having received dietetic input during the period from January 2018 until August 2019 and checked them against key markers. These included whether they were tested for Coeliac Disease prior to dietary advice, if we were recording the IBS sub type, and whether we were using a validated tool to assess IBS symptoms and stool form. Finally, we examined how the IBS subcategories responded to dietary advice.”

The primary outcome measure was an assessment of relief of functional gut symptoms. Individual symptoms were assessed using the Gastrointestinal Symptom Rating Scale (GSRS). Stool consistency was assessed using the Bristol Stool Form Scale (BSC) whilst stool frequency was assessed on a 7-point scale.

The audit showed some very positive results, including that 100% of patients had been screened for Coeliac Disease (reducing missed diagnosis) and that validated assessment tools for IBS symptoms (GSRS) and stool form (BSC) were used and working well.

It also highlighted the effectiveness of an individualised dietetic service, with 72% of patients who received a tailored first line dietary advice achieving good relief from their gut symptoms – significantly higher than reported in the literature (54%). These results meant improved health outcomes, reduction of GP visits, reduced medication usage, reduced need for further unpleasant tests and a positive impact on quality of life for many.

Additionally, second line dietary advice (the low FODMAP diet) given by Dietitians at CPFT for patients with IBS, was in line with effectiveness reported in the literature, with 60% of those who received training on the low FODMAP diet achieved good relief from their gut symptoms. IBS sub-categories appeared to respond equally to first line dietary advice although further research into how the different IBS sub-categories respond to second line (the low FODMAP diet) is needed and will improve patient experience. Finally, we determined that staff training following this audit, on IBS-subcategories and IBS-C dietary advice will help improve patient experiences.

Why did you choose to do this Audit?

“I have always had a particular interest in IBS. It affects so many people (2 in 10 of the UK adult population) yet, with the provision of individualised care plans it is often very treatable. It is vital then, to ensure that patients are receiving an effective treatment plan and from that, the correct dietary advice and support.”

"There is nothing more important than making a real impact on people’s quality of life, so it is an honour to win this award. Just as importantly, I feel the award reflects the fantastic work that has already been done by the team. My task was the simplest one – which was to analyse the work and bring out the conclusions. This award gives me confidence to push further into investigating and improving treatments."

- Helen Dumpleton

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