Dr Eamonn Quigley looks at the reasons behind the success of World Digestive Health Day, which this year focuses on inflammatory bowel disease and falls on 29 May
The World Gastroenterology Organisation (WGO; formerly known as OMGE, its French and Spanish acronym) is a global organisation whose membership is composed of 110 national societies of gastroenterology from all four continents.
The mission of WGO is ‘to promote, to the general public and healthcare professionals alike, an awareness of the worldwide prevalence and optimal care of digestive disorders through the provision of high quality, accessible and independent education and training’.
While WGO serves all corners of the globe, its programmes and activities have a special emphasis on emerging nations. Its educational and training goals are promoted through 14 training centres in Latin America, Africa, South East Asia, Oceania, Europe and Asia and a unique modular programme, Train-the-Trainers (TTT).
The former endeavours to provide training at various levels to young doctors that is appropriate to their local needs, but which promotes the highest standards in the care of digestive disorders; TTT focuses entirely on education and brings together those involved in the education and training of the next generation of gastroenterologists to hone their educational skills.
Through its Global Guidelines, WGO provides medical practitioners and healthcare workers with practical guidance on the management of truly global digestive health problems and in a manner that can be applied anywhere in the world, regardless of resources. These guidelines are updated regularly and are available to view or download in multiple languages on the WGO website: www.worldgastroenterology.org/global-guidelines.html.
A key element of the WGO mission is to reach the general public and all who participate in the care of digestive disorders. Mindful of the success of days, months and years assigned to a variety of diseases and disorders – and realising that there was no area in the calendar dedicated to digestive complaints despite their prevalence worldwide (to illustrate: digestive cancers collectively are the most common cancers; irritable bowel syndrome affects 5-20 per cent of any population) – our then Secretary General and now Vice President, Prof Henry Cohen, from Montevideo, Uruguay, suggested that we should initiate a World Digestive Health Day (WDHD).
Little did we realise how successful this concept would become. WDHD was launched in 2004 and every year since then, the WGO and its member national societies have celebrated 29 May (the anniversary of the official incorporation of WGO in 1958) as World Digestive Health Day; such has been the success of this programme that events now extend throughout the entire year.
Each year, we launch a campaign to promote public awareness and programmes throughout the world around a particular topic or discipline in the field of gastroenterology. These topics are chosen carefully so that they represent problems that are truly global; recent topics have included nutrition, hepatitis, irritable bowel syndrome and Helicobacter pylori. Each year has seen an exponential escalation in the amount of public awareness and educational activities that these topics generate.
Public education
The topic provides a focus for public education, updating of medical and other healthcare practitioners as well as an opportunity for WGO and national societies of gastroenterology to communicate directly with the general public.
Media exposure has been tremendous, from front-page headlines in national newspapers to magazine, television and radio appearances, as well as a great variety of public events and more formal educational activities.
From a bicycle run in India to highlight the prevention of hepatitis to a city square informational tent on irritable bowel syndrome in Uruguay, we never cease to be amazed by the ingenuity of our member societies in reaching out to and engaging the public on vital health issues.
IBD focus
This year, the WDHD topic is inflammatory bowel disease (IBD). IBD a global issue? Surely not. We have been taught to regard IBD as a disease of often-affluent Caucasians from Western Europe and North America and have assumed that it simply did not exist elsewhere. How wrong we were!
Not only is IBD increasing in prevalence worldwide, but the manner of its presentation in the developing world and some of the clinical dilemmas that it presents there, provide us all with much food for thought.
I had the privilege to listen in on the deliberations of the WGO multi-national task force on IBD at the recent Digestive Diseases Week in New Orleans, Louisiana, USA and a very different picture of the global prevalence and presentation of IBD emerged.
Chaired by Prof Charles Bernstein, an eminent clinical researcher in IBD and world authority on the epidemiology of IBD (and an old friend of Irish gastroenterology), this group has been asked to develop a global map of IBD and to highlight differences, similarities and challenges in the diagnosis and management of IBD worldwide. This session was followed by a press conference on global issues in IBD.
While I do not wish to pre-empt their conclusions, some initial conclusions deserve emphasis and serve to underline the importance and, more importantly, relevance, of such a global approach.
While IBD continues to increase in prevalence worldwide, the pattern of its emergence is most interesting: initially the IBD wave is comprised of ulcerative colitis (UC) alone; later, after an interval of one or two decades, Crohn’s disease appears. Eventually, one arrives at the situation that exists here in Ireland, where colitis and Crohn’s are either equally common or Crohn’s begins to outstrip UC.
Why this pattern and what can we learn of the pathogenesis of these related disorders from this fascinating natural experiment? The differentiation of Crohn’s from tuberculosis, an everyday dilemma reported by colleagues from India, Malaysia, Pakistan and the Phillipines, has now emerged in the era of powerful biologics, such as infliximab, as a critical issue for us in the West; our colleagues from less developed nations may well be able to guide us here.
Cost prohibitive
These same biologics throw into sharp relief an issue which, perhaps, most dramatically divides the West from emerging nations: access to the latest in diagnostics and therapeutics. The sheer cost of diagnostic approaches such as computerised tomography or magnetic resonance enterography or of therapeutic modalities such as anti-tumour necrosis factor alpha (anti-TNF) antibodies precludes their use in many poorer nations. It was most encouraging to hear that, reflecting the rapid emergence of that nation as an economic powerhouse, the agents are available in Brazil, fully reimbursed by the government.
Available online
Cost of therapies and access to optimal care were two of the issues that Prof Bernstein and his team had to grapple with in developing the WGO Global Guideline on IBD, which has just been released to coincide with WDHD events (available online at: www.worldgastroenterology.org/inflammatory-bowel-disease.html). They succeeded, indeed, in developing a range of approaches (referred to as cascades) that are effective and available regardless of resources.
Ireland has not lagged in its support of WDHD events; already this year, a special open forum on IBD, for patients and the public, as well as the medical profession, is planned to take place at the Brookfield Health Sciences Centre on the UCC campus in Cork on the evening of 14 June, featuring national and international speakers and I am sure that there will be more events throughout the year.
So remember: this is the year of IBD; participate and watch this space!
l Eamonn M M Quigley,
MD FRCP FACP FACG FRCPI,
Professor of Medicine and Human Physiology,
UCC; Past President, WGO
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