An international Delphi study to assess the need for multiaxial criteria in diagnosis and management of functional gastrointestinal disorders

Purpose: To assess agreement, consensus, and disagreement between experts in different domains in the evaluation of functional gastrointestinal disorders (FGIDs). Methods: We conducted a modified Delphi study using 90 purposively sampled experts using an online survey tool to develop, distribute and analyse the Delphi rounds. Experts were sent 132 items generated from a literature review examining present and proposed future FGID evaluation. The survey items examined contributory factors and were divided into four sections examining risk and contributing factors, the therapeutic relationship, domains of measurement and the pros and cons of multiaxial assessment. The consensus level was set at 75%. Key results: 36 of 68 eligible participants (52%) replied to round one and 96 items gained consensus. Using expert feedback, we used thematic analysis to generate 33 additional items for round two. 31 of 36 participants (86%) replied to rounds two and three. In round two, 19 items gained consensus, and in round three, nine items gained consensus. Agreement was high concerning systematic approaches for both physiological and psychosocial components of FGIDs (91%) using laboratory and self-reporting-findings (83%). Opinion was divided regarding physical risk factors such as previous surgery (53%) and genetic association (71%). Overall, 124 of the 167 items gained consensus. Conclusion and inferences: We have identified expert consensus and disagreement on domains of information relevant to the evaluation of FGIDs. Experts agreed there is an immediate need for multi-axial assessment. Physiological and genetic risk factors are not. fully accepted and require further study. (C) 2013 Elsevier Inc. All rights reserved.