The burden of chronic digestive diseases

The burden of chronic digestive diseases
Talking about your digestive health with your doctor is central to establishing earlier diagnosis, but many people are put off from doing so by the stigma surrounding conditions such as liver disease and IBD

UEG’s Professor Markus Peck considers how Europe can rise to the challenge of chronic digestive diseases, following on from the launch of the MEP Digestive Health Group.

Europe is currently failing to manage the increasing burden inflicted by chronic digestive diseases. This is the warning of a new report from United European Gastroenterology (UEG), which also highlights the enormous challenges posed by poor nutrition and heavy alcohol consumption.

Published to coincide with the launch of the MEP Digestive Health Group, ‘Digestive Health Across Europe: Issues, challenges and inequalities’ reveals a number of surprising statistics, among them:

  • 59% of men and 45% of women in the EU aged 18 and above are overweight;
  • Digestive cancers represent 28% of all cancer-related deaths in the EU; and
  • One in four deaths from gastrointestinal diseases can be directly attributed to alcohol.

UEG and the MEP Digestive Health Group are thus calling on policymakers and the scientific community to take urgent steps to improve awareness of chronic digestive diseases, put digestive health firmly on the EU agenda, and reverse the current trend in obesity.
UEG’s Professor Markus Peck explains more in conversation with Health Europa Quarterly.

What are the main aims of the European Parliament Interest Group on Digestive Health?

The main aim of the group is to raise awareness among policymakers of the importance of digestive health and the high burden of digestive diseases. The fact is, this is a disease area which affects a lot of people, including a great number of young people, and which leads to a tremendous loss in productivity, but is nonetheless getting very little attention.

We also want to improve awareness because in order to tackle diseases such as these, we need to improve our understanding of them, and that will require a lot more research. At the moment, digestive diseases are not being studied to the same extent that cardiovascular disease (CVD), diabetes, pulmonary disease and cancer are, for example.

Given the high burden of chronic digestive diseases, why has this issue been neglected on the policy agenda?

Digestive diseases have likely been neglected because they’re not necessarily killing people or putting people into hospital. As a result, they’re considered minor issues, even if they aren’t really minor in terms of population health. Healthcare systems are more geared towards battling major diseases like cancer and CVD. But even if no one dies of discomfort in their stomach, it does affect their daily functioning, it can cause considerable suffering, and it does lead to substantial amounts of sick leave and significant losses in productivity.

Digestive health also isn’t talked about much. Bowel diseases, for instance, often lead to problems with a person’s stool habits, which isn’t exactly considered a polite topic of conversation. Other chronic digestive diseases are stigmatised. Liver disease, for instance, is often associated with alcohol abuse, but oftentimes that isn’t the cause at all. Nonetheless, the stigma remains, and attempts to do something about liver disease will often attract comments from non-involved people such as: ‘Well, people should just stop drinking.’

These issues combined are contributing to the fact that digestive health is going largely unaddressed on the policy agenda.

What can be done to encourage the earlier diagnosis of functional gastrointestinal disorders and inflammatory bowel diseases (IBD)?

To establish earlier diagnosis, it is very important that we try to talk about these diseases more. The problem with IBD in particular is that it often gets diagnosed very late because it is considered to be merely a functional disorder. Oftentimes, people don’t see a doctor because they don’t think their condition is serious enough or because people around them dismiss their discomfort as ‘just a bit of tummy ache’.

Doctors themselves don’t always prescribe invasive procedures like a colonoscopy to patients, because they think the condition is not that severe and don’t want their patients, particularly the younger ones, to have to undergo such a procedure. In other words, they want to protect the patient, but unfortunately they go about it in the wrong way. As a result, it takes a long time to establish a diagnosis.

To encourage earlier diagnosis of chronic digestive diseases, then, probably the most important thing we can do is talk publicly about digestive health and diseases. It’s vital that we do this because, even though many of these conditions will turn out to be benign, others won’t.

What can be done to reduce the various inequalities in the prevalence and mortality rates for digestive diseases across Europe?

Health is one of the very few issues that the EU does not dare address in a comprehensive way. Instead, they leave health to the individual member states themselves. As a result, different European countries have very different levels of medical care and medical systems, which leads to grave inequalities. In order to reduce disease prevalence and mortality rates, it is therefore very important that we focus on prevention.

In this regard, we have a very good case for screening for colorectal cancer, because there is a disease that can be detected early in a pre-malignant stage, or at a stage where you still have localised disease and can remove it, thereby preventing the development of cancer completely. In order for this to be effective, you need to have a system in place that makes sure that the people at risk are actually getting screening and surveillance. At the moment, close to 70% of people in some countries have access to screening, while in other countries, less than 5% of the at-risk population do. That is something that we need to improve if we believe in a common Europe in which everyone has access to, if not the same standard of healthcare, then at least a similar level. In much the same way, we also need to improve access to treatment and to develop a system that leads to the more consistent delivery of care. But there is still a lot of work to do there.

How could European citizens be better empowered to take charge of their own digestive health?

In order to empower citizens to take charge of their own healthcare, we need to give them information. In addition to having great inequalities between countries in Europe, we also have great inequalities within countries. Some sections of the population are very well informed and do a lot to take care of themselves. They also have easy access to healthcare services and treatment should they develop a disease. Other sections of the population are not so fortunate. The difference is education but also access to education. It is therefore very important that we get straightforward, easy-to-understand information to people who are perhaps from less-educated backgrounds so that they can think for themselves about their own health and communicate with their physicians in order to make sure that they’re receiving the services and support they should be.

Prevention also requires lifestyle modification, which is notoriously difficult because people tend to enjoy the particular way they live and they don’t want to make any changes. Again, to change this we need to give people information, and we need to keep giving it to them, because, in a lot of cases, the first time a person hears something they don’t really think about it or they assume it doesn’t relate to them. It can take a long time for the information to sink in. We know this approach works, however, because it has already worked for a number of public health issues such as smoking.

Today, everybody knows that smoking is bad for you, even if some people still choose to do it. I’m not convinced that everybody knows how important it is to undergo colorectal cancer screening at age 50, however.

Professor Markus Peck
Chair, Public Affairs Committee
United European Gastroenterology

This article will appear in issue 6 of Health Europa Quarterly, which will be published in August.


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