Abstract
One of the remits of UEG is to raise the political and public awareness of gastrointestinal disorders throughout Europe. To provide an evidence base for future discussions, a research team from Swansea University and the UEG Future Trends Committee of UEG are conducting a comprehensive survey of digestive health across Europe.
The main aims of this survey include investigating the impact of gastrointestinal diseases on patient mortality, morbidity and quality of life across Europe, assessing the health care costs and other economic implications, and assessing the organisation and delivery of gastroenterology services across Europe. In addressing these aims, the project comprises three main components, namely the burden of gastrointestinal disorders, the economic impact and burden of gastrointestinal disorders and the organisation and delivery of gastroenterology services, including disease screening and prevention.
The project methodology being used includes systematic reviews, meta analyses, geographical information systems mapping and forecasting of future trends in gastrointestinal diseases across Europe up to 2025. Major information sources include Medline, Embase, Cochrane Library, Sigle, grey literature, international and national reports, websites and data sources covering the different European countries, gastrointestinal specialties, oncology and communicable diseases. The survey is utilising contacts with UEG national representatives as well as international experts and authors of major publications on gastrointestinal diseases.
The survey covers the 28 member states of the EU, along with Norway, Switzerland, Liechtenstein and Russia, and focuses on regional differences across Europe as well as the European region as a whole. The review is prioritising the most important gastrointestinal diseases that have a high burden on patient mortality, morbidity, quality of life, healthcare expenditure and service delivery. The focus of the review is primarily on the recent ten year period since 2003 and, secondly, on the preceding years since 1990.
To date, many of the reviews and data collection on the burden of gastrointestinal diseases have covered major disorders including upper gastrointestinal bleeding, peptic ulcer, helicobacter pylori infection, inflammatory bowel disease, coeliac disease, alcoholic liver disease, non-alcoholic fatty liver disease, primary biliary cirrhosis, hepatitis B and C, haemochromatosis, acute and chronic pancreatitis, gallstones and malignancies of the colon, stomach, oesophagus, pancreas and liver. These reviews have covered disease incidence, prevalence, hospital admissions, mortality and cancer survival, with the results of meta analyses mapped across Europe.
The reviews and data collection on the organisation and delivery of gastroenterology services to date include an overview of gastroenterology and health care systems across Europe, colorectal screening programmes, inflammatory bowel disease services, organ donation policies and services, and alcohol services and public health policy. These reviews are prioritising major surgical, diagnostic and therapeutic procedures including liver transplantation, colectomy and endoscopy.
The reviews and data collection on the economic burden of gastrointestinal diseases are currently focusing on a series of national studies of the individual European countries, with comparisons across Europe to follow. These include overviews of the national health economies, health technology assessments and the cost burden and quality of life burden of gastrointestinal disorders. To date, this part of the project has identified approximately 150 studies for inclusion in the quantitative economic meta analyses.
Some of the important interim findings to date include the following:
For acute pancreatitis, interim meta analyses and mapping have identified both highest incidence rates and ratios of alcoholic vs gallstone aetiology in some eastern and northern European countries compared with other regions of Europe. For upper gastrointestinal bleeding, interim meta analyses and mapping show a less clear pattern across the regions of Europe for both hospital admissions and mortality. For Crohn's disease, meta analyses and mapping show that incidence rates tend to be higher in northern and western European countries compared with eastern and southern Europe. For ulcerative colitis incidence, the pattern is quite similar, although less pronounced than for Crohn's disease and with highest incidence mostly in northern Europe. Meta analyses of mortality in population based cohorts of patients with Crohn's disease and ulcerative colitis across Europe show levels of mortality – in most countries – that are comparable with those in the corresponding national general populations, but with modestly increased or decreased mortality in some cohorts. Interim findings on disease forecasting up to 2025 for the major gastrointestinal malignancies show a pattern of increasing prevalence over time in northern and western Europe, reductions over time in prevalence in eastern Europe and stability in southern Europe. For the major gastrointestinal malignancies, survival rates are often highest in western European countries such as Austria, Belgium, France, Germany and Switzerland.
The reviews will be extended to other priority areas over the next few months and will lead to a comprehensive report covering digestive health across Europe with policy recommendations.