Gastroenterology in developing countries: Issues and advances

Kate L. Mandeville, Justus Krabshuis, Nimzing Gwamzhi Ladep, Chris J.J. Mulder, Eamonn M.M. Quigley, Shahid A. Khan

Research output: Contribution to journalReview article

73 Scopus citations

Abstract

Developing countries shoulder a considerable burden of gastroenterological disease. Infectious diseases in particular cause enormous morbidity and mortality. Diseases which afflict both western and developing countries are often seen in more florid forms in poorer countries. Innovative techniques continuously improve and update gastroenterological practice. However, advances in diagnosis and treatment which are commonplace in the West, have yet to reach many developing countries. Clinical guidelines, based on these advances and collated in resource-rich environments, lose their relevance outside these settings. In this two-part review, we first highlight the global burden of gastroenterological disease in three major areas: diarrhoeal diseases, hepatitis B, and Helicobacter pylori. Recent progress in their management is explored, with consideration of future solutions. The second part of the review focuses on the delivery of clinical services in developing countries. Inadequate numbers of healthcare workers hamper efforts to combat gastroenterological disease. Reasons for this shortage are examined, along with possibilities for increased specialist training. Endoscopy services, the mainstay of gastroenterology in the West, are in their infancy in many developing countries. The challenges faced by those setting up a service are illustrated by the example of a Nigerian endoscopy unit. Finally, we highlight the limited scope of many clinical guidelines produced in western countries. Guidelines which take account of resource limitations in the form of "cascades" are advocated in order to make these guidelines truly global. Recognition of the different working conditions facing practitioners worldwide is an important step towards narrowing the gap between gastroenterology in rich and poor countries.

Original languageEnglish (US)
Pages (from-to)2839-2854
Number of pages16
JournalWorld Journal of Gastroenterology
Volume15
Issue number23
DOIs
StatePublished - Jun 21 2009

Keywords

  • Developing countries
  • Gastrointestinal diseases
  • Health care delivery
  • Helicobacter pylori
  • Practice guidelines

ASJC Scopus subject areas

  • Gastroenterology

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