AGA Abstracts M1249 Do We Know What Patients Want? the Communication/Understanding Gap Between Patients with Functional Gastrointestinal Disorders (FGIDs) and Gastroenterologists Edwina Farrall, Joanne Collins, Deborah A. Turnbull, Gerald Holtmann, David J. Hetzel, Jane M. Andrews Introduction: Patients with FGIDs often consult Gastroenterologists (GEs). The reason(s) for this is often unclear to the GE consulted. Meeting patients' expectations at this time may be critical in modifying health care utilisation. Integral to this is ensuring patient and doctor have a common understanding. We therefore assessed patients' perceived needs/expectations and compared them to the treating GEs understanding of each patient's expectations and understanding with respect to diagnosis and ongoing management. Methods: Twenty one patients (Pts) with a clinical diagnosis of FGID and each consulting GE independently completed matching questionnaires on symptoms, beliefs about diagnosis & expectations of the consultation process and outcome at initial consultation. Thus, concordance within Pt-GE pairs could be assessed. Results: In 12/21 cases, Pt and GE agreed there was no prior specific diagnosis. In 5 cases GEs noted an existing diagnosis while Pts did not, in 3 cases Pts noted a prior diagnosis while the GE did not, and in one case Pt and GE agreed that a previous diagnosis existed(62% concordance). Concordance was high for prior treatment history; 18 Pts' history of methods previously trialled was also noted by GEs (85%). But GEs were either, accurate (43%) or underestimated (43%) patients' perception of symptom burden, and also tended to underestimate patients' expectations of a timely diagnosis (57%) and treatment implementation (48%), whilst overestimating their ability to cope in the longer-term without a desired diagnosis or specific treatment regimen (43%). Patients viewed diet & the impact of stress & worry as prime symptom causes, and GEs were highly accurate in gauging this belief. However, while patients viewed a one-off operation, or dietary modification, as the most useful/desirable treatment (indicating an expectation of finding a specific cause that could be targeted), GEs were more focused on symptom control, and more likely to endorse medication, or improvements in stress and worry, as preferred approaches. Conclusions: There is an early communication gap between patients' and GEs' in FGIDs. While there is good concordance in “objective” information (past diagnosis and treatment history), there is poor concordance for symptom intensity, perceived causation and Pts' longer-term expectations. These discordant perceptions of disease severity and expectations are important and are likely to contribute to patients' ongoing healthcare utilisation and lessen the potential success of therapy. This communication gap between Pts and GEs deserves further study to improve satisfaction with, and efficiency of, specialist care in FGID. M1250 Development and Validation of a Disease-Specific Health-Related Quality of Life (HRQL) Questionnaire for Esophageal Achalasia (EA) Vicente Ortiz, Vicente Garrigues, Carlos Casanova, Luis Bujanda, Eduardo Moreno, Antónia Montserrat, Jordi Serra, Begoña González Suárez, Javier P. Gisbert, Manuel Rodriguez-Tellez, Miguel A. Montoro, Julio Ponce Lack of a validated specific measure of HRQL is a limitation for the evaluation of the efficacy of treatments in EA. Aim: To develop and validate a disease-specific HRQL questionnaire for EA in Spanish language. Methods: An experts' panel from 12 Spanish hospitals identified the domains and the daily activities that are altered in EA. Items were generated and evaluated according to its importance and frequency. Initial questionnaire was administered to a cohort of patients with EA to assure its comprehension and to reduce the number of items by factorial analysis and internal reliability. The final questionnaire (EAQL) was validated in an independent series of patients with EA to be treated by pneumatic dilatation or cardiomi- otomy. Before therapy, clinical evaluation was performed; Spanish version of the Short Form- 36 (SF-36) Health Survey was administered; and the EAQL was administered twice (separated by 7-14 days). Three months after therapy, clinical situation was evaluated and EAQL was administered again. Internal (Cronbach's alpha) and temporal (intraclass correlation coefficient-ICC) reliability were calculated for each domain. Also, convergent validity with the appropriate domains of SF-36 questionnaire (Pearson correlation coefficient); and dis- criminant validity comparing to the severity of EA (linear regression) were evaluated. Finally, sensitivity to change after treatment (linear regression) was analyzed. Results: Five domains: physical, psychological, social, sleep and alimentation were identified. Initial 55 items were reduced to 31 after evaluation for importance and frequency. Initial questionnaire was administered to 104 patients with EA (51% men; mean age 55 years, range 15-88 years). Factorial analysis reduced the number of domains to 4 and the items to 18: Social function and alimentation, 6 items; Physical function, 4 items; Psychological function, 4 items; Sleep, 4 items. The EAQL was validated in 67 patients (58% men; mean age 49 years, range 17- 87 years). Internal reliability (alpha>0.75 for all domains) and temporal reliability (ICC>0.80 for all domains) were good. Correlation was demonstrated between the 4 EAQL domains and the appropriate SF-36 domains. The clinical severity of the EA was associated to all the EAQL domains, except to psychological. Mean clinical improvement after treatment (69% according to both, patient and physician opinion) was associated to improvement in EAQL. Conclusion: A disease-specific questionnaire in Spanish language has been developed and validated to measure HRQL in patients with achalasia. The EAQL meets requirements of reliability, validity and sensitivity to change after therapy. M1251 Evaluation of a Multidisciplinary Consultation Service for the Management of Functional Bowel Disorders Sophie Bonarius, Ben J. Witteman, Niek J. de Wit INTRODUCTION: Functional bowel disorders (FBD) are very frequent conditions. The combination of unexplained background, ineffective treatment and irrational expectations in FBD puts the patient-doctor relationship under pressure. Therefore a more individualized, targeted, treatment approach for FBD is required, combining 'care' and 'cure' within an A-382 AGA Abstracts effective patient-doctor relationship. Based on this approach the gastroenterologists of the Gelderse Vallei Hospital Ede, a large district hospital in the Netherlands, initiated a multidisci- plinary consultation service for patients with FBD, which consists of exploring patients expectations, multidisciplinary consultation (dietician, psychotherapist, gastroenterologist, nurse practitioner, physiotherapist, hypnotherapist), adequate patient information and a personalized treatment advice. AIMS & METHODS: The objective of this study was a descriptive evaluation of the effectiveness of a multidisciplinary consultation service in the management of FBD. All patients who were referred to the consultation service between August 2006 and December 2007 completed questionnaires on symptoms (ROME III), pain intensity (VAS) and Quality of Life (IBS-QOL) before entry. In February 2008, the same patients were approached to complete these questionnaires again, together with a final evaluation form (adequate symptom relief (AR)). RESULTS: Of the 173 patients who attended the service, 107 (61.8%) returned all questionnaires and the final evaluation form, with a mean follow-up period of 8.8 (± 4) months. Of the responders 35.4% indicated adequate symptom relief (AR) after completing the FBD service. For the three main treatment groups, by dietician, physiotherapist and psychologist the percentage AR was 33.3, 52.6 and 50.0% respectively. Overall quality of life improved after attending the service. The individual dimension score for dysphoria (p=0.00), interference with activity (p=0.01), body image (p=0.00) and social reaction (p=0.00) all improved, whereas the other four dimensions (relationship; food avoidance; health worry; sexual functioning) did not change significantly. Finally the pain intensity (range 0-10) decreased significantly from 6.74 (±1.97) before consultation to 5.86 (±2.18 (p=0.00)) after consultation. CONCLUSION: The multidisciplin- ary consultation service for FBD was evaluated positively by more than 35% of the patients. Although future randomised prospective research has to confirm the effectiveness of the service, and further detail the indications of treatment, this integrative approach seems to offer potential benefit for patients with recurrent or persistent functional bowel complaints. M1252 Eating Habits and Dietary Composition of Patients with FBD: Preliminary Data from the Bingeing and Eating in Digestive Diseases Study (BEDDS) Bethany Doerfler, Laurie Keefer, Jason R. Bratten, Jennifer L. Zinke, Michael P. Jones Introduction: There are limited data on the role of nutrition in the pathogenesis and mainten- ance of FBD. Patients with FBD often try elimination diets and fiber therapy which may not be safe or effective. Eating behaviors are likely as important as nutrient composition. BEDDS is an exploratory study aimed at characterizing both the eating behaviors and dietary composition of normal weight patients with FBD. Methods: Patients with FBD and dominant symptoms of bloating were referred to a dietitian in an outpatient GI clinic. A validated eating behavior questionnaire (C-BEDS) was administered to identify eating disorders, includ- ing sub-clinical binge eating disorder (BED). Structured interviews evaluated diet and eating behaviors including meal timing, self-directed diet manipulations and body image. Typical macronutrient intakes were assessed using 2 random, non-consecutive 24 hour recalls and compared against national averages. Demographic and anthropometric data were also obtained. Results: 30 subjects (22F/8M) with Mage 40(5.6, range 23-61) and BMI 24.6 (4.8, range 17.3-34.0) participated. Average macronutrient intake of FBD patients was not significantly different from aged-matched U.S. adults. Subjects consumed more total dietary fiber than controls and this pattern was maintained even when adjusting for total calorie intake (table 1). Disordered eating in the sample was high with 7 subjects (23%) meeting full criteria for BED and 53% reporting often experiencing a loss of control when eating. Compensatory behaviors such as laxative use, vomiting and enemas were endorsed by 27% of subjects All patients reported body image distortions, particularly feeling fat due to symptoms. Subjects reported high levels of unstructured eating and self-directed dietary manipulation. 47% reported regular meal skipping and 80% reported feeling uncomfortably full after meals. Conclusions: Seemingly with little benefit, current dietary fiber intake meets national guidelines and significantly exceeds intake of age-matched controls. Macronutrient content in patients with bloating dominant FBDs did not differ from national averages and may be unrelated to symptoms. There is a high prevalence of disordered eating behaviors and body image disturbance in this population, which may occur as either a primary or compensatory event. GEs should consider assessment of eating behaviors in addition to food content in patients with FBD. Total Fiber:BEDDS vs. NHANES *=Total fiber/calories **=NHANES 2003-2004 M1253 Patients' Satisfaction with Specialist Gastroenterologist Consultation for Irritable Bowel Syndrome (IBS)and Health Care Utilisation: Exploring the Role of Patient Expectations Vikki E. Knott, Gerald Holtmann, Deborah A. Turnbull, Jane M. Andrews Introduction: Patient satisfaction is a key parameter for medical care, particularly in chronic non-life threatening conditions such as IBS. Little is known about factors that influence patient satisfaction. This study explored factors associated with patient satisfaction at the time of specialist consultation for IBS. Methods: Patients were interviewed following specialist gastroenterologist consultation at a metropolitan hospital outpatient clinic. In addition to meeting clinical diagnostic criteria for IBS, patients were recruited using a purposive sampling framework for maximum variation to ensure broad representation of those seeking outpatient gastroenterology consultation. A mixed method design was used. Quantitative assessments (e.g. Likert scale ratings {0-7} of satisfaction; pain, impact of symptoms, the extent concerns addressed) were complemented by in-depth interviews focused on a descriptive understand- ing of the nature of patient expectations, and unmet needs. Patients were also asked about