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Gastroenterology involves many disciplines, including physicians, surgeons, radiologists, pathologists, nurses, dieticians, clinical scientists and general practitioners, who need to work together closely to deliver the best care. Gastrointestinal and liver disorders are common, but the specialty is poorly understood and has attracted little attention from a policy perspective. Thus, it has no National Service Framework, was not included in the “Quality and Outcome Framework” for general practice and does not attract significant charitable research funding, in comparison with many other disciplines. Yet the burden of disease relating to gastroenterology and hepatology is very considerable. Gastrointestinal disease is the third most common cause of death, and cancer of the gastrointestinal tract is the leading cause of cancer death. Including day case investigations, gastrointestinal disorders account for as many hospital admissions as respiratory illnesses, and both are second only to circulatory disorders. In the past few decades there have been increases in the incidence of most gastrointestinal diseases that have major implications for future healthcare needs. These include hepatitis C, acute and chronic pancreatitis, alcoholic liver disease, gallstone disease, upper gastrointestinal haemorrhage, diverticular disease, Barrett’s oesophagus and oesophageal and colorectal cancers. The impairment of quality of life is substantial in terms of symptoms, activities of daily living and employment. Conditions with a particularly high level of disruption to the lives of sufferers include gastro-oesophageal reflux disease, dyspepsia, irritable bowel syndrome, anorectal disorders, gastrointestinal cancers and chronic liver disease.
The evidence underpinning …
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