Gone is the time when people believed that medicine could cure all known illnesses and the doctor was the high priest of the arcane rites. The advent of the internet has meant that patients may be as informed about their diseases as their doctor and the medical consultation is more a dialogue between experts than a trip to the Oracle. It’s more about containment and management than cure. Popular acceptance of the healing arts practiced by alternative and complementary therapists has led to a greater understanding of the core relationship between mind and body in the achievement of well being. 

By far the greatest demand for gastroenterological services comes from patients with recurrent or chronic symptoms of dyspepsia, abdominal discomfort and bowel upset and long term conditions such as Irritable Bowel Syndrome, Chronic Liver Disease, Inflammatory Bowel Disease, Coeliac Disease and Barrett’s Oesophagitis. A modern GI service will not only need to respond rapidly to gastrointestinal emergencies, but also to monitor and facilitate  the self care of long term gastrointestinal conditions. 

In the future, more patients will be encouraged to care for themselves while their condition is monitored with simple blood and stool tests in their local health centre. There will be greater emphasis of self help groups, which could  be facilitated by specially trained health care professionals; practice nurses, dietitians and counsellors, and resourced by the third sector; the patient charities (e.g., Core, Coeliac UK, CC(UK) and The IBS Network). The IBS Network, for example, publishes its own self management plan, operates a telephone helpline and offers medical advice by email.

Patients with long term gastrointestinal conditions crave the confidence of a consistent, responsive and reliable service. This may well be better supplied within the patients’ locality, avoiding unnecessary referrals to hospital and allowing gastroenterologists to focus on the increasingly sophisticated and complex diagnostic and therapeutic procedures required for the more life threatening and complicated conditions. 

Freed up from day to day management of chronic conditions, it could be that specialists will adopt a more supervisory and educational role, monitoring the test results of patients with chronic life threatening GI illness through shared websites, responding to email enquiries from local health services, training local health care professionals, advising patient charities, and  preparing educational videos to be disseminated via local television services.

There will be less separation between primary and secondary care in future.  It seems likely that the bulk of gastroenterological services, including diagnostic endoscopy, will be conducted within local hospitals and health centres, which specialists will visit to advise and consult. For example, dyspepsia could be managed in the community with a test and treat approach to H. Pylori, while health teams will be set up to tackle major public health issues such as chronic alcoholic liver disease and obesity.

Population screening will be increasingly important.  It is already here for bowel cancer and it is likely that simple, sensitive and specific biomarkers will become available for other abdominal cancers; pancreas, ovary, liver, stomach and oesophagus as well as coeliac disease, IBD and viral hepatitis.

And as always, the focus of gastrointestinal research will continue to shift with fashion, establishing evidence for changes in health care, improving outcomes, eliciting patient experience, estimating the nature of well being, developing appropriate biomarkers for screening tests, and seeking insight into the relationship between the gut, the mind and the alien within, the all consuming intestinal microbiome. The future may well be not so much orange but beige or brown!

This was the piece I was asked to write to celebrate Core’s 40th anniversary.  Core, previously the Digestive Diseases Foundation, is the charitable limb of the British Society of Gstroenterology.  

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