What Are the Most Challenging Aspects of Inflammatory Bowel Disease? An International Survey of Gastroenterologists Comparing Developed and Developing Countries

Inflamm Intest Dis. 2021 May;6(2):78-86. doi: 10.1159/000512310. Epub 2021 Feb 5.

Richard B Gearry 1, Andrew M McCombie 1, Morten Vatn 2, David T Rubin 3, Flavio Steinwurz 4, Edward V Loftus 5, Wolfgang Kruis 6, Curt Tysk 7, Jean-Frederic Colombel 8, Siew C Ng 9, Gert Van Assche 10, Charles N Bernstein 11


Author information

  • 1Department of Medicine, University of Otago, Christchurch, New Zealand.
  • 2Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
  • 3Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, Illinois, USA.
  • 4Department of Gastroenterology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil.
  • 5Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
  • 6Department of Internal Medicine, University of Cologne, Cologne, Germany.
  • 7Department of Gastroenterology, Orebro University Hospital, Orebro, Sweden.
  • 8Icahn School of Medicine at Mount Sinai, New York, New York, USA.
  • 9Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Diseases, LKS Institute of Health Science, Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, Hong Kong, China.
  • 10Division of Gastroenterology, G UZ Gasthuisberg, Leuven, Belgium.
  • 11Section of Gastroenterology, Max Rady School of Medicine and University of Manitoba IBD Clinical and Research Centre, Winnipeg, Manitoba, Canada.


Background and aims: As inflammatory bowel disease (IBD) becomes more prevalent, the challenges that gastroenterologists face in managing these patients evolve. We aimed to describe the most important challenges facing gastroenterologists from around the world and compare these between those working in developed and developing countries.

Methods: An online questionnaire was developed, and a link distributed to gastroenterologists. Data were analyzed descriptively using Friedman and Wilcoxon matched-pair signed rank tests to compare rankings for responses. Mann-Whitney U tests were used to compare rankings between responses from gastroenterologists from developed and developing countries. Lower scores reflected greater challenges.

Results: Of 872 who started, 397 gastroenterologists (45.5%) completed the survey. Respondents represented 65 countries (226 [56.9%] from developed countries). Overall, the challenge ranked most important (smallest number) was increasing IBD prevalence (13.6%). There were significant differences in mean ranking scores for many simple aspects of care for those from developing countries compared to providers from developed countries, such as access to simple IBD treatments (5.52 vs. 6.02, p = 0.01), access to anti-TNF drugs including dose escalation (3.33 vs. 3.93, p < 0.01), access to good stoma care (2.57 vs. 3.03, p < 0.001), access to therapeutic drug monitoring (1.47 vs. 1.84, p < 0.001), and access to care for people from low socioeconomic status (2.77 vs. 3.37, p < 0.001).

Conclusions: Increasing IBD prevalence is seen by gastroenterologists as the greatest challenge facing them. There are significant differences between the IBD challenges facing gastroenterologists from developed and developing countries that reflect inequities in access to health care.



© Copyright 2013-2024 GI Health Foundation. All rights reserved.
This site is maintained as an educational resource for US healthcare providers only. Use of this website is governed by the GIHF terms of use and privacy statement.