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Copyright ©2009 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Jun 21, 2009; 15(23): 2839-2854
Published online Jun 21, 2009. doi: 10.3748/wjg.15.2839
Gastroenterology in developing countries: Issues and advances
Kate L Mandeville, Justus Krabshuis, Nimzing Gwamzhi Ladep, Chris JJ Mulder, Eamonn MM Quigley, Shahid A Khan
Kate L Mandeville, Centre for Infectious Diseases Epidemiology, Department of Primary Care and Population Sciences, University College London, Hampstead Campus, Royal Free Hospital, London NW3 2PF, United Kingdom
Justus Krabshuis, Highland Data, Les Charleix, 24390 Tourtoirac, Dordogne, France
Nimzing Gwamzhi Ladep, Department of Medicine, University of Jos and Jos University Teaching Hospital, Jos, Plateau State, P.M.B. 2076, Nigeria
Chris JJ Mulder, Department of Gastroenterology, VU University Medical Center, Amsterdam 1081 HV, Holland
Eamonn MM Quigley, World Gastroenterology Organisation and Department of Medicine, National University of Ireland, Cork University Hospital Clinical Sciences Building Wilton, Cork, Ireland
Shahid A Khan, Department of Hepatology and Gastroenterology, Faculty of Medicine, Imperial College London, St Mary’s Campus, London W2 1NY, United Kingdom
Author contributions: Mandeville KL and Khan SA developed the structure of the paper; Mandeville KL wrote the manuscript; Quigley EMM, Mulder CJJ, Krabshuis J, Ladep NG and Khan SA contributed sections to the paper and reviewed the manuscript.
Correspondence to: Kate L Mandeville, MBBS, Centre for Infectious Diseases Epidemiology, Department of Primary Care and Population Sciences, University College London, Hampstead Campus, Royal Free Hospital, Rowland Hill Street, London NW3 2PF, United Kingdom.
Telephone: +44-20-78302239
Fax: +44-20-77941224
Received: February 3, 2009
Revised: April 21, 2009
Accepted: April 28, 2009
Published online: June 21, 2009

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.

Keywords: Helicobacter pylori, Developing countries, Gastrointestinal diseases, Health care delivery, Practice guidelines