Foreword The Burden of Digestive Diseases
Joel J. Heidelbaugh, MD Consulting Editor
Digestive, liver, and pancreatic diseases result in greater than 100 million outpatient visits and 13 million hospitalizations annually at a cost of $141.8 billion.1 A report published in 2009 by the National Institute of Diabetes and Digestive and Kidney Diseases highlighted the 10 most costly digestive diseases in the United States in both direct and indirect costs: 1. Digestive cancers: $24.1 billion a. $9.5 billion cost of colorectal cancer b. $4.3 billion cost for pancreatic cancer 2. Liver disease: $13.1 billion 3. Gastroesophageal reflux disease (GERD): $12.6 billion 4. Gallstones: $6.2 billion 5. Abdominal wall hernia: $6.1 billion 6. Diverticular disease: $4.0 billion 7. Pancreatitis: $3.7 billion 8. Viral hepatitis (A, B, C): $3.3 billion 9. Peptic ulcer disease: $3.1 billion 10. Appendicitis: $2.6 billion. It’s very easy to be intimidated by these statistics relative to expenditures, as well as seemingly increasing incidences of most of these disorders. As obesity becomes more prevalent, its association with acute and chronic gastrointestinal disorders becomes a greater burden on primary care, gastroenterology, and society. While cancer screening remains a salient point of primary care, evidence-based guidelines exist for colorectal cancer screening, yet there are no acceptable provisions for pancreatic cancer screening. Deaths related to digestive diseases gradually declined between 1979 and 2004 (236 million cases), largely attributable to a decrease
Prim Care Clin Office Pract 38 (2011) xi–xii doi:10.1016/j.pop.2011.06.002 primarycare.theclinics.com 0095-4543/11/$ – see front matter Ó 2011 Elsevier Inc. All rights reserved.
in colorectal cancer mortality due to increased screening rates through primary care. Chronic liver disease and cirrhosis ranks twelfth in mortality with an age-adjusted mortality rate of 9.2%.2 The incidences of alcoholic cirrhosis, viral hepatitis (especially hepatitis C), and non-alcoholic fatty liver disease are all increasing. As we see more and more cases of liver disease, the primary care clinician will be required to know more about identification, etiology, and how to coordinate the complex care of the liver transplant patient. Upper gastrointestinal disorders, including GERD and peptic ulcer disease, continue to be significant sources of distress for our patients, comprising the majority of referrals to gastroenterologists for management and endoscopic evaluation. Pharmaceutical costs of anti-secretory therapy (mainly proton pump inhibitors) exceeds $1.6 billion annually, plus the costs of over-the-counter medications.3 This volume of Primary Care: Clinics in Office Practice spans an enormous range of gastrointestinal disorders that affect our patients. Dedicated articles to common diseases of the upper and lower segments, solid organs, and relationship to obesity and transplantation offer up-to-date reviews of guidelines and pertinent trials. I sincerely thank Drs Winger and Michelfelder, as well as their dedicated authors, for compiling an evidence-based and practical collection of reviews on common topics in gastroenterology. This volume will serve primary care clinicians well in their daily practices, providing the necessary statistics, diagnostic algorithms, and treatment plans to help minimize the burden of such chronic gastrointestinal diseases. Joel J. Heidelbaugh, MD Departments of Family Medicine and Urology University of Michigan Medical School Ann Arbor, MI Ypsilanti Health Center 200 Arnet Street, Suite 200 Ypsilanti, MI 48198, USA E-mail address: [email protected]
1. Everhart JE, editor. The burden of digestive diseases in the United States. US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. Washington, DC: US Government Printing Office; 2008. NIH Publication No. 09–6443. 2. Kochanek KD, Xu J, Murphy S, et al. National Vital Statistics Report. Deaths: Preliminary Data for 2009;59(4). March 16, 2011. 3. Pharmacy Facts and Figures. Drug Topics [Web site]. Available at: http://drugtopics. modernmedicine.com/drugtopics/data/articlestandard//drugtopics/252010/674961/ article.pdf. Accessed on June 11, 2011.