Introduction/Background In the last decade, Neurogastroenterology & Motility (N&M) has become a major clinical speciality in both paediatric and adult gastroenterology, encompassing gastrointestinal (GI) conditions from classic motility disorders, such as achalasia and intestinal pseudo-obstruction, to functional GI disorders (FGID). The latter represents one of the most challenging and common groups of disorders managed by both primary care practitioners and GI specialists. Appropriate transition is particularly challenging due to the complexity of this group of patients and a holistic approach, including dietetic, psychology, psychiatry, social work, physiotherapy and occupational therapy, is characteristically required. In the last year, a formal transition pathway has been developed between GOSH and UCLH N&M services.
Aim We aimed to review the clinical features and the complex needs of a group of young people transitioned from a paediatric to adult N&M.
Method All patients aged 13–24 transitioned to the UCLH N&M service over a period of 6 months were retrospectively reviewed. Demographic data, diagnosis, diet, biopsychosocial complexities, including multiple speciality involvement, polypharmacy, and known psychiatric and/or neurodevelopmental disorders were reported.
Results Ninety-two patients (70.7% Female) under the neuro-gastroenterology adolescent and young-adult service were included into the analysis, of which 72.8% were 13–18 years of age, 23.9% 19–22 years of age and 3.3% 22–24 years of age. Twenty-seven patients (29.3%) were diagnosed with an underlying motility disorders, 59 (64.1%) with FGID and 8 (8.7%) with GI-allergy. The majority of patients (80.5%) were under one or more additional medical specialities, with 28.3% under 3 or more medical specialities. Polypharmacy was common within this cohort, with 61% of patients being on 3 or more medications, whilst only 1.1% of patients required no medication to manage the symptoms. The majority of patients (56.5%) had mental health or developmental needs, such as anxiety (25%), depression (12%), eating disorders (5.4%), and learning difficulties (14.1%). Psychological interventions were necessary in 69% of the patients, whilst dietetic interventions in 76% of patients.
Summary/Conclusion Our study confirms the need for multidisciplinary support from the specialist adolescent medicine team to provide medical and psychological care when highly demanding complex patients are transitioned between a paediatric and an adult N&M services. Our data strongly supports a specialist adolescent transition hub model to ensure the delivery of developmentally appropriate healthcare, which has been shown to improve long-term health outcomes for young people with complex conditions. Although N&M expertise at GOSH lies in caring for patients up to 18 years, adolescent expertise is limited, as it is nationally. Conversely, UCLH has a unique expertise in complex and specialist adolescent care, which could assist the transition planning for those children with the most complex needs. Based on our data, children with motility and functional-GI disorders commonly require a transition plan spanning multiple adult services and require the expertise of the adolescent MDT including psychology, social work, youth work, psychiatry, physiotherapy and occupational therapy. A commissioned joint transition service between GOSH and UCLH would facilitate best practice and provide an exemplar of clinical care for young people with complex health problems.
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