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Digestive Diseases a Heavy Burden

More than 283 million cases cost $42 billion each year, study shows

SATURDAY, July 21, 2001 (HealthDayNews) -- Digestive diseases, which can range from gallbladder disease to diarrhea, pose a huge burden in terms of cost and suffering in the United States, a recent study by the American Gastroenterological Association says.

There are more than 283 million cases of so-called "gastrointestinal diseases" each year, with a price tag of $42 billion.

"It's pretty mind-boggling," says Dr. Mark Donowitz, chairman of the AGA's public policy committee. He served as an advisor for the study, which was presented at a recent press conference.

Although he and his colleagues expected the study to reveal a serious problem, they were amazed at the "titanic" burden of gastrointestinal diseases. And Donowitz adds that the study looked at only 17 of 300 digestives disorders, so even these results don't reflect the total burden.

The 17 diseases selected were the most common and had available data on their costs.

The study looked at national and local databases in order to assess the impact of: gastroesophageal reflux disease (GERD); gallbladder disease; irritable bowel syndrome (IBS); peptic ulcers; chronic liver disease and cirrhosis; chronic hepatitis C; chronic diarrhea; diverticular disease; diseases of the pancreas; Barrett's esophagus; ulcerative colitis; colorectal cancer; Crohn's disease; pancreatic cancer; liver cancer; food-borne illness and non-food-borne gastroenteritis.

Food-borne illness and non-food-borne gastroenteritis were the most prevalent conditions, with 135 million and 76 million cases, respectively, each year.

That high number of diarrhea cases was a surprise, Donowitz says.

He says that in developing countries people get an average of four-to-six episodes of diarrhea each year, which has a tremendous impact on the work forces in those countries.

But who would have thought that in the United States there'd be more than 200 million cases of diarrhea each year, Donowitz says. That translates into more than 200 million lost workdays at an estimated annual cost of about $75 million, he says.

The other most numerous conditions are gallbladder disease (20.5 million), GERD (18.6 million), irritable bowel syndrome (15.4 million) and peptic ulcer disease (6.7 million).

The study also looked at the costs of the diseases. GERD was first in that category at $10 billion each year, followed by gallbladder disease ($6.5 billion), colorectal cancer ($5.3 billion), peptic ulcer disease ($3.4 billion) and diverticular disease ($2.6 billion).

But Donowitz says those figures are conservative. They include direct costs -- doctor, hospital and drug costs -- and indirect costs such as time off from work. But the study's calculations don't include such things as long-term care in nursing homes or home health care. There's also no value attached to pain, suffering and diminished quality of life.

As an example, Donowitz points to Crohn's disease sufferers.

"They may not miss that much time from work and yet that's a tremendous burden. Lives are really very much compromised, and we have not put that into this equation at all," he says.

Although this study may seem like just an exercise in number crunching, Donowitz says it provides a better understanding of the scope of the problem.

"We knew that the gastroenterologists in practice were overburdened. There are so many patients demanding to be taken care of. We really didn't know why. Now we know," he says.

In practical terms, this information can be used to encourage government and scientists to direct more money and research into some of these diseases, Donowitz says. It can even serve as a recruiting tool to entice more medical students to select gastroenterology as a specialty because the numbers show the high demand and guaranteed work.

Nancy Norton, president and founder of the International Foundation for Functional Gastrointestinal Diseases, says she's "not surprised" by the study's findings. "I think the burden of illness and the cost of digestive diseases really haven't been understood."

"Digestive diseases, for the most part, are illnesses that are not necessarily perceived by the public," she says. "People [with some digestive diseases] look relatively healthy. They're sort of hidden diseases, and the costs that are associated with them are hidden as well. So a study like this points out, really, the burden of the disease as well as the costs that are associated with it."

What to Do: For more information, visit the American Gastroenterological Association Web site, or the International Foundation for Functional Gastrointestinal Disorders.

SOURCES: Interviews with Mark Donowitz, M.D., professor of medicine, Johns Hopkins University, Baltimore, and chairman, American Gastroenterological Association public policy committee; Nancy Norton, president and founder, International Foundation for Functional Gastrointestinal Disorders, Milwaukee, Wis.
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