Resolving the Global Burden of Gastrointestinal Illness: A Call to Action, 2002

Executive Summary

The American Academy of Microbiology convened a colloquium to consider the global burden of gastrointestinal disease. The colloquium, held February 14-16, 2002, in Galway, Ireland, brought together an international group of scientists—researchers and public health specialists—to discuss the current state of knowledge in the field and appropriate future directions for the clinical arena, research, education, disease prevention, and communication.

In the next 15 seconds, a child somewhere in the world will die from diarrheal disease. Globally, it is estimated that 6-60 billion cases of gastrointestinal illness occur annually. These illnesses are not limited to minor, uncomfortable cases of stomach upset. They are a scourge of humanity and are largely the result of fecal contamination of the environment.

The sum total of the incidence, severity, and duration of gastrointestinal disease are known as the global burden of these illnesses. Grasping these facts is critical to understanding the threat these diseases pose to public health and to appropriately allocating resources and efforts to curb them. Currently, however, there are a number of obstacles to overcome. They include the use of non-standardized definitions of disease and symptoms; failure to identify a causative agent in many, if not most, cases of disease; failure to report episodes to health authorities; and the existence of incompatible reporting systems. There are a number of modes of transmission that contribute to the burden of gastrointestinal disease, and the relative significance of each changes with economic development.

Colloquium participants discussed the routine clinical data issues central both to the question of global burden of gastrointestinal diseases and to matters of public health. Several key weaknesses in the current systems for collecting and processing clinical data were identified. Recommendations were developed, including a shift from passive reporting systems to active surveillance and reporting systems, epidemiological training for clinicians and environmental health specialists, improved data collection during outbreaks, improved surveillance and specimen collection and laboratory testing for public health purposes, more thorough investigation of the agents responsible for incidents of gastrointestinal disease, and the careful consideration of the employment of new diagnostic techniques for clinical testing. Advances in the clinical setting can lead to more thorough reporting of disease, and hence, to better management of important routes of transmission and the diseases themselves.

Progress in research and education has always been critical to improving public health. In many ways, efforts in these areas can be honed to better address needs related to gastrointestinal disease. Through establishment of standard definitions of the parameters related to gastrointestinal disease, scientists can ensure that their studies can more easily be related to the results of other work. By coordinating funding programs and encouraging interdisciplinary efforts, research programs and collaborations can more effectively address unanswered questions in the field. Improved efforts in systematic data review and peer review in the relevant journals could help synthesize the current body of knowledge andlend more credibility to findings in the field. Finally, three specific areas of research were identified as critical to progress in battling gastrointestinal disease: validation of intervention techniques, quantitative evaluation of gastrointestinal disease, and exploring the role of the host and the dose-response relationship in the development of disease.

In terms of preventing gastrointestinal illness, by far the greatest advances can be made by providing adequate sanitation—or excreta disposal— facilities to poor and developing nations.Worldwide, it is estimated that sanitation, combined with appropriate hygiene practices, could end 90% of gastrointestinal disease. Further inroads could be made by using the results of research to drive successful interventions and training of health professionals in public health, epidemiology, and hygiene promotion. Finally, communicating the risks and priorities related to gastrointestinal disease is critical to gaining recognition of these issues among the public and policy makers. On a related note, there is a great need to adequately educate and train the scientists of tomorrow. These are both key issues in addressing gastrointestinal diseases today and in the future.