Major survey reveals changing trends and inequalities in healthcare provision for gastrointestinal disorders across Europe

A major pan-European survey into the burden of gastrointestinal (GI) disorders and the delivery of care has revealed changing trends in many important GI and liver diseases and worrying inequalities in the provision of healthcare services across the continent. The results of the survey, which was commissioned by United European Gastroenterology (UEG), have led to calls for greater political and public awareness of the burden of GI disorders across Europe and for more funding to be made available to improve service provision and support Europe-wide research. "This extensive survey has highlighted major differences between countries in terms of both the risk of developing GI disorders and their long-term health outcomes," said UEG President, Professor Michael Farthing. "We are particularly concerned about the increasing incidence of most major GI disorders across Europe and the clear differences in outcomes for patients between Eastern and Western nations."

Survey of Digestive Health Across Europe^1,2

The Survey of Digestive Health Across Europe was commissioned by UEG in the spring of 2013 at the request of its own Future Trends Committee. An experienced research group from Swansea University in Wales, UK, initiated a detailed assessment of digestive health across Europe, focussing on the clinical and economic burden of disease and the organisation and delivery of gastroenterology services across 28 European Union (EU) member states, Norway, Switzerland, Liechtenstein and Russia. The aim of the survey was to draw together all the available evidence and provide up-to-date information on the human health consequences and public health burden of GI disorders.

"Gastroenterology is a medical specialty that gets relatively little attention from a policy perspective compared with other specialties and attracts minimal independent research funding," said Professor Farthing. "We wanted to take a long, hard look at the situation today across Europe in order to ensure we prioritise our efforts where it is needed most."

Changing trends in GI disorders

The Digestive Health survey revealed a number of evolving trends in terms of the incidence and prevalence of GI disorders. According to the survey results, many European countries have witnessed increases in the incidence of major GI disorders such as upper GI bleeding, inflammatory bowel disease [IBD], coeliac disease, alcoholic liver disease, gallstone disease, and colorectal and oesophageal cancer, with disease rates highest amongst older people. Incidence or prevalence rates were found to be higher in many Eastern European countries compared with other regions in Europe, with mortality from GI disorders (other than cancer and infectious diseases) highest in Eastern and North Eastern countries and lowest in parts of Scandinavia and the Mediterranean Islands.

GI cancer is now the leading cause of cancer death in Europe, and while mortality rates for colorectal cancer (CRC) have fallen for several decades in almost all Western, Northern and Central European countries, rates continue to rise in many parts of Eastern Europe and some parts of Southern Europe. "We need to look more closely at the reasons behind these worrying statistics and find ways to overcome the regional differences observed and reduce the growing burden of GI cancers," said Professor Farthing.

Inequalities in healthcare provision

The survey identified major inequalities in healthcare provision across Europe. While CRC screening programmes are now well established in most European countries, participation rates vary widely and there is no standardised approach to screening. Upper GI bleeding is managed variably across Europe, with a lack of consensus on best practice. Endoscopy services are patchy and not currently viewed as a priority by policymakers, which could have serious implications for meeting future service demands. Training of medical students in gastroenterology varies between countries and is poorly documented.

"This survey was wide-ranging and has highlighted some areas of good practice, but many areas that require attention at both a national and European level," said Professor Farthing. "Our hope is that, ultimately, the survey and the reports generated will help to improve care and health outcomes and reduce inequalities across the continent."