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  • 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

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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
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  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

https://doi.org/10.1136/gut.2006.117598

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    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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    Footnotes

    • Competing interests: This was an independent study undertaken by the School of Medicine of the University of Wales Swansea, in collaboration with colleagues at the University of Glamorgan and University of Wales Bangor. Professor John Williams, Dr Mike Hellier, Dr Alistair McIntyre, and Dr Roland Valori are practising gastroenterologists and members of the British Society of Gastroenterology. Dr Hellier is currently president of the Society (2004–05). Dr Faiz Ali is a trainee in gastroenterology.

    • All rights reserved. No part of the publication may be reproduced, stored on retrieval system or transmitted in any form or by any means, electronic, mechanical photocopying, recording or otherwise, without the prior permission of the copyright, except for brief, acknowledged quotations embodied in critical articles or reviews. ©University of Wales Swansea.

      Published by the Centre for Health Information, Research and Evaluation, School of Medicine, University of Wales Swansea, SA2 8PP. ISBN – 1-85987-017-1

      Team roles

      Professor John Williams led the project throughout, devised the original research proposal, wrote some sections and edited the report. Professor Ian Russell and Professor David Cohen provided invaluable advice and guidance on the development of research methodology, and wrote or edited some sections.

      Dr Helen Snooks was responsible for the day-to-day management of the project, provided methodological input and analyses, and wrote some sections. Dr Adrian Edwards and Mrs Margot Greer gave advice on the systematic literature search. Dr Hayley Hutchings and Dr Wai-Yee Cheung provided methodological and statistical input. Dr Stephen Roberts, Dr Faiz Ali, and Dr Barry Ip provided methodological input and analyses, reviewed the literature and wrote various sections. Working with Professor David Cohen, Ms Mirella Longo carried out economic analyses, reviewed the health economics literature and wrote the health economics sections.

      Mrs Gaynor Demery and Mrs Judy Williams provided clerical support. Mrs Anne Seagrove proof read the report. Mrs Kymberley Thorne assisted with the appraisal of the research literature.