Gastroenterology in developing countries: Issues and advances

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.

Evolution of gastroenterology training

“…This issue has not been addressed. The reasons for this are multifactorial [17] . By way of illustration, intestinal infectious disease was the fifth leading cause of death in South Africa, a developing country, in 2006.…”

Bioengineered probiotics, a strategic approach to control enteric infections

“…1 Children under 5 y of age are most susceptible and the disease burden is the greatest in developing countries. 7 There are over 200 known microbial, chemical, or physical agents that can cause foodborne illness.…”

Challenges of Gastrointestinal Endoscopy in Resource-Poor Countries

“…Around a third of medical graduates from Nigerian medical schools migrate within 10 years of graduation to Canada, the UK and the USA (Ihekweazu 2005). Nurses, who commonly bear the brunt of health-care delivery in sub-Saharan Africa are also not left out in the brain drain (Labonte 2006, Mandeville 2009 …”