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Gut 2007;56:1-113 doi:10.1136/gut.2006.117598
  • Supplement

Gastroenterology services in the UK. The burden of disease, and the organisation and delivery of services for gastrointestinal and liver disorders: a review of the evidence

  1. J G Williams14,
  2. S E Roberts11,
  3. M F Ali1,
  4. W Y Cheung2,
  5. D R Cohen3,
  6. G Demery4,
  7. A Edwards5,
  8. M Greer6,
  9. M D Hellier7,
  10. H A Hutchings8,
  11. B Ip9,
  12. M F Longo10,
  13. I T Russell12,
  14. H A Snooks13,
  15. J C Williams15
  1. 1Dr Faiz Ali, specialist registrar in gastroenterology/research fellow, Centre for Health Information, Research and EvaLuation (CHIRAL), School of Medicine, University of Wales Swansea.
  2. 2Dr Wai‐Yee Cheung, senior lecturer in health service research, Centre for Health Information, Research and Evaluation (CHIRAL), School of Medicine, University of Wales Swansea.
  3. 3Professor David Cohen, professor of health economics, School of Care Sciences, University of Glamorgan.
  4. 4Mrs Gaynor Demery, personal assistant to Professor John Williams, School of Medicine, University of Wales Swansea.
  5. 5Dr Adrian Edwards, reader in primary care, Centre for Health Information, Research and Evaluation (CHIRAL), School of Medicine, University of Wales Swansea.
  6. 6Mrs Margot Greer, library and information services manager, National Public Health Service.
  7. 7Dr Mike Hellier, president, British Society of Gastroenterology.
  8. 8Dr Hayley Hutchings, statistician, Centre for Health Information, Research and Evaluation (CHIRAL), School of Medicine, University of Wales Swansea.
  9. 9Dr Barry Ip, research officer, Centre for Health Information, Research and Evaluation (CHIRAL), School of Medicine, University of Wales Swansea.
  10. 10Mrs Mirella Longo, research fellow, School of Care Sciences, University of Glamorgan.
  11. 11Dr Stephen Roberts, lecturer of epidemiology, Centre for Health Information, Research and Evaluation (CHIRAL), School of Medicine, University of Wales Swansea.
  12. 12Professor Ian Russell, professor of public health and director of Institute of Medical and Social Care Research, University of Wales Bangor.
  13. 13Dr Helen Snooks, senior lecturer in health and social care research, Centre for Health Information, Research and Evaluation (CHIRAL), School of Medicine, University of Wales Swansea.
  14. 14Professor John Williams, Project leader, consultant gastroenterologist/professor of health services research, Centre for Health Information, Research and Evaluation (CHIRAL), School of Medicine, University of Wales Swansea.
  15. 15Mrs Judy Williams, clerical officer, Centre for Health Information, Research and Evaluation (CHIRAL), School of Medicine, University of Wales Swansea.
  1. Correspondence to:
    Dr S E Roberts
    Swansea Clinical School, University of Wales, Singleton Park, Swansea SA2, UK; stephen.e.roberts{at}swansea.ac.uk
  • Accepted 11 December 2006

1. EXECUTIVE SUMMARY

Purpose of report

This document has been commissioned by the British Society of Gastroenterology. It is intended to draw together the evidence needed to fill the void created by the absence of a national framework or guidance for service provision for the management of patients with gastrointestinal and hepatic disorders. It sets out the service, economic and personal burden of such disorders in the UK, describes current service provision, and draws conclusions about the effectiveness of current models, based on available evidence. It does not seek to replicate existing guidance, which has been produced for upper and lower gastrointestinal cancers, hepatobiliary and pancreatic disorders, and many chronic disorders of the gut. It does, however, draw on evidence contained in these documents. It is intended to be of value to patient groups, clinicians, managers, civil servants, and politicians, particularly those responsible for developing or delivering services for patients with gastrointestinal disorders.

Methods used

A systematic review of the literature was undertaken to document the burden of disease and to identify new methods of service delivery in gastroenterology. This systematic review was supplemented by additional papers, identified when the literature on incidence, mortality, morbidity, and costs was assessed.

Routine data sources were interrogated to obtain additional data on burden of disease, the activity of the NHS, and costs, in relation to gastrointestinal disorders.

The views of users of the service were sought, through discussions with the voluntary sector and through a workshop held at the Royal College of Physicians in December 2004.

The views of professionals were obtained by wide dissemination of the document in a draft form, seeking feedback on the content and additional material.

Main findings

The burden of gastrointestinal and liver disease is heavy for patients, the NHS, and the economy, with gastrointestinal disease the third most common cause of death, the leading cause of cancer …

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