Digestive Health

Across Europe
Issues, challenges
and inequalities
2 EUROPEAN PARLIAMENT INTEREST GROUP ON DIGESTIVE HEALTH

CONTENTS

An Introduction to Chronic Digestive Diseases Across Europe 4

MEP Group Vision 5

Nutrition, Obesity and Digestive Diseases 6

Digestive Cancers 8

Alcohol and Digestive Diseases 10

Functional Gastrointestinal (GI) Disorders 12

Paediatric Digestive Diseases 14

Inflammatory Bowel Diseases (IBD) 16

Liver Disease 17

Summary 18

The secretariat of the European Parliament Interest Group on Digestive Health is run by United European Gastroenterology
(UEG). UEG will support the group’s logistics and provide content-related inputs to the group’s activities. UEG is a professional
non-profit organisation combining all the leading European and national societies concerned with digestive health.
EUROPEAN PARLIAMENT INTEREST GROUP ON DIGESTIVE HEALTH 3

“The healthcare and socio-economic impact that is inflicted by digestive diseases

continues to grow across Europe. In the case of digestive cancers and obesity, our
society fails and the burden is only going to become greater. Digestive cancers are
the leading cause of cancer-related death in the continent and the current outlook for
young people’s health is extremely alarming, with childhood obesity rates expected to
almost double by 2025.

For many years, I have worked with colleagues from across the European Parliament
to fight against digestive diseases and, in particular, digestive cancers. I believe that a
platform to unify our efforts is essential to coordinate our actions and help to deliver
improved patient outcomes throughout our continent.

The mission of the European Parliament Interest Group on Digestive Health is to raise
awareness of chronic digestive diseases and promote policy initiatives relating to
tackling these diseases, such as the prevention and treatment of digestive cancers,
the importance of healthy nutrition and the reduction of alcohol-related harm.

Promoting a greater understanding of digestive diseases amongst political

stakeholders is imperative to facilitate positive change for the benefit of patients.
Comprehensive proposals, actions and policies must be prioritised on both an EU and
Member State level to help the prevention and treatment of digestive diseases.

We now have the opportunity to strengthen the digestive health community and
improve public health across our continent to ensure the lifelong health and
wellbeing of our citizens.

”MEP Pavel Poc

Vice-Chair of the Environment, Public Health and Food Safety (ENVI) Committee
Chair – European Parliament Interest Group on Digestive Health
4 EUROPEAN PARLIAMENT INTEREST GROUP ON DIGESTIVE HEALTH

AN INTRODUCTION TO CHRONIC DIGESTIVE DISEASES ACROSS EUROPE

“
Chronic digestive diseases encompass a wide range of long-term
health conditions, including digestive cancers, liver diseases,
inflammatory bowel disease, coeliac disease and functional
gastrointestinal disorders, such as irritable bowel syndrome.

Many chronic digestive diseases, such as digestive cancers, are strongly age-related and
the ageing European population will therefore pose a difficult challenge to healthcare
systems in the years to come. The incidence of other conditions, including inflammatory
bowel disease and chronic liver disease, is increasing in the younger generation and
there is an urgent need for investment in paediatric digestive health treatments and
services.
This, coupled with the alarming levels of rising obesity and heavy alcohol consumption
across Europe, has major implications for future healthcare provision throughout our
continent. Inequalities in the prevalence and mortality rates for digestive diseases also
vary greatly across the EU, with varied diagnoses, treatments and patient outcomes
dependent on location. Despite their considerable prevalence and impact, many chronic
digestive diseases unfortunately remain poorly understood, attract little attention and can
be extremely underfunded.
United European Gastroenterology welcome the European Parliament Interest Group on
Digestive Health and look forward to close collaboration in achieving the group’s mission
to tackle the burden of chronic digestive diseases across Europe.

”
Markus Peck
Chair – UEG Public Affairs Committee
EUROPEAN PARLIAMENT INTEREST GROUP ON DIGESTIVE HEALTH
MEP GROUP VISION
The European Parliament Interest Group
on Digestive Health brings together MEPs
who are interested in, and passionate
about, promoting improvements in
all elements of digestive health and
associated EU policy initiatives aimed
at tackling these diseases across the
European continent.
The group’s overarching mission is to ensure that
continually improving digestive health becomes and
remains an integral part of the EU health agenda;
serving as a platform of exchange between the
scientific community and policy makers.
The group will raise awareness of the need for
better prevention, improved treatment and a greater
understanding of the causes of digestive diseases.
It will also draw attention to the real-life impact of
digestives diseases, the socio-economic cost burden
that such diseases cause, and the importance of
improving the digestive health literacy of European
citizens so that they may better manage their own
digestive health.
5
Aims
• To ensure European citizens have equitable access
to effective prevention programmes and high-quality
treatment
• To encourage the mitigation of alcohol-related harm
across Europe
• To lobby for the implementation of quality-controlled
digestive cancer screening programmes and for
higher standards in cancer care and treatment across
Europe
• To raise awareness amongst policy makers of the
social and economic costs of (chronic) digestive
diseases and the cost-benefits of tackling digestive
diseases
• To encourage increased funding into digestive
health; its causes, prevention strategies and
improved treatments
• To improve public education on the importance
of nutrition and lifestyle factors in the prevention
of obesity
• To promote the importance of tackling digestive
diseases in children to improve lifelong health and
reduce the socio-economic cost burden
6 EUROPEAN PARLIAMENT INTEREST GROUP ON DIGESTIVE HEALTH

NUTRITION, OBESITY AND DIGESTIVE DISEASES

Weight problems and obesity are increasing at

a frightening rate in the majority of EU Member
59% OF MEN IN
States, with estimates that over half of the EU’s THE EU AGED 18
population aged 18 and above were overweight AND ABOVE ARE
in 2014.1 OVERWEIGHT7
Obesity is a serious public health concern and is a key factor in the
development of many gastrointestinal conditions, including digestive
cancers, inflammatory bowel disease, gastro-oesophageal reflux 45% OF WOMEN
disease and coeliac disease. Obesity is a health risk that is quickly IN THE EU
overtaking tobacco as the leading preventable cause of cancer2 and it AGED 18 AND
threatens the sustainability of public healthcare systems. ABOVE ARE
Obesity has been estimated to cost the EU €70 billion annually OVERWEIGHT7
through healthcare costs and loss of productivity, which adds to the
urgency of reversing this alarming trend.3
Several lifestyle actions can be taken to reduce the risk of becoming IN EUROPE, ONE IN
overweight or obese, including participation in regular physical EVERY THREE CHILDREN
activity and following a healthy, balanced diet. AGED 6-9 YEARS IS
There is evidence that many dietary choices can increase or decrease OVERWEIGHT OR OBESE8
the risk of developing gastrointestinal diseases. For example, a high
consumption of salt is linked to an increased risk of gastric cancer4,
processed meat is linked to an increased risk of colorectal cancer5
and a diet high in fibre has been associated with a reduced risk of UP TO 10% OF
colorectal cancer.6 HEALTHCARE COSTS ARE
SPENT TREATING OBESITY
RELATED DISORDERS IN
DEVELOPED NATIONS9
EUROPEAN PARLIAMENT INTEREST GROUP ON DIGESTIVE HEALTH 7

% of Population Overweight or Obese10

61

57.6

57.4

56.8

56.7

56.6

56.5

56.5

55.8

55.7

55.6

55.2

54.7

54.7

54.2

54

53.9

53.6

52.4

52.1

49.9

49.4

49.3

49.3

48.3

48

48

47.7

47.2

44.9
DENMARK
CZECH REPUBLIC

TURKEY

HUNGARY

PORTUGAL

GERMANY

NETHERLANDS

NORWAY

CYPRUS

ITALY
MALTA

CROATIA

SLOVENIA

LATVIA

ROMANIA

LITHUANIA

SLOVAKIA

BULGARIA

ESTONIA

BELGIUM

AUSTRIA
ICELAND

GREECE

IRELAND

POLAND

FINLAND

SPAIN

SWEDEN

LUXEMBOURG

FRANCE
“
We now have a prime opportunity to create change and
improve public health across the EU by encouraging
“
With growing evidence on the link between early
nutrition, lifestyle and obesity, we must prioritise
improved nutrition to help combat levels of obesity. research and strategies that focus our resources on
Tackling obesity must be a priority in public health policy preventing obesity in the first place, especially in
and action, both at an EU and Member State level. children. The economic burden of treating obesity is

”
simply too great for the EU and priorities must change
urgently.

”
Thomas Seufferlein
UEG Public Affairs Committee
MEP Michèle Rivasi
Co-chair - European Parliament Interest Group on Digestive Health
8 EUROPEAN PARLIAMENT INTEREST GROUP ON DIGESTIVE HEALTH

DIGESTIVE CANCERS

The five most common digestive cancers

in the EU are colorectal, gastric, pancreatic, DIGESTIVE CANCERS ARE
liver and oesophageal cancer11. RESPONSIBLE FOR 28% OF
CANCER-RELATED DEATHS
Combined, these five cancers are responsible for IN THE EU11
over 365,000 deaths per year in the EU, representing
almost one in three cancer-related deaths.11 Of these,
approximately 40% and 20% of deaths are represented
by colorectal cancer and pancreatic cancer respectively. SURVIVAL RATES FOR
If current population trends continue, the estimated PANCREATIC CANCER
number of deaths from these digestive cancers across
HAVE NOT IMPROVED
the EU per year will be over 515,000 people by 2035.12
FOR 40 YEARS15
Approximately half of all cancers are preventable and
their significant burden could be reduced by addressing
lifestyle factors, such as alcohol consumption,
smoking, diet and exercise, as well as the widespread COLORECTAL
implementation of screening programmes.13 CANCER COSTS THE
Screening is in place for colorectal cancer throughout EU €13.1 BILLION
Europe and there is strong evidence that these PER YEAR16
programmes reduce incidence and mortality rates
through early detection and prevention. However, there
are vast differences in programme types and stark
inequalities in participation rates, which range from less OVER 590,000
than 1% in Hungary to 65% in the Netherlands.14 DIGESTIVE CANCER
Further research is required to find reliable, safe and CASES EACH YEAR IN
cost-effective screening techniques and programmes to THE EU11
aid early detection of other digestive cancers.
EUROPEAN PARLIAMENT INTEREST GROUP ON DIGESTIVE HEALTH 9

EU Incidence and Mortality Figures - Digestive Cancers11

Colorectal 345,346
cancer 152,046

Gastric 81,592
cancer 58,485 Incidence
Mortality
Pancreatic 79,331
cancer 78,669

Liver 51,785
cancer 48,452

Oesophageal 34,777
cancer 29,858
0 50,000 100,000 150,000 200,000 250,000 300,000 350,000 400,000

“
Digestive cancers are one of the EU’s biggest killers.
The outlook for pancreatic cancer patients, for example,
“Policy makers at both EU and Member State level have
has not improved considerably for 40 years, yet
pancreatic cancer receives less than 2% of overall cancer
research funding in Europe. We urgently need more
research, more awareness, and a policy supporting
quicker diagnosis and treatment for patients.
a critical role to play in promoting cancer prevention,
early diagnosis and improving cancer treatments.
The implementation of population-based colorectal
cancer screening programmes in all European countries
is vital and will help to decrease the burden of digestive
cancers. Another challenge is the lack of funding for

”
cancer patient care and one example is in pancreatic
cancer research and prevention. More action in this area
Eric Van Cutsem is urgently needed to improve patient survival.

”
European Digestive Cancer Expert

MEP Marian-Jean Marinescu

Co-chair - European Parliament Interest Group on Digestive Health
10 EUROPEAN PARLIAMENT INTEREST GROUP ON DIGESTIVE HEALTH

ALCOHOL AND DIGESTIVE DISEASES

The European region has the highest level of

alcohol consumption in the world and, as a result, ALCOHOL-RELATED HARM
the highest proportion of total ill health and RESULTS IN €74 BILLION OF
premature death linked directly to alcohol.17 LOST ANNUAL PRODUCTIVITY
ACROSS THE EU21
One fifth of the European population aged 15 and above is
drinking heavily at least once per week17 and the primary
issue is how deeply embedded alcohol consumption is within
European society. Young people who begin drinking before 1-4 DRINKS PER DAY
15 years are six times more likely to develop excessive alcohol INCREASES THE RISK
consumption in later life, in comparison to those who begin OF COLORECTAL AND
drinking at 21.18
OESOPHAGEAL CANCER22
Alcohol consumption is a risk factor in over 60 types of diseases,
with nearly 25% of deaths from gastrointestinal diseases directly
attributed to alcohol.19 These include liver cirrhosis, chronic
pancreatitis and digestive cancers. However, as many as 9 in 10 MORE THAN 4 DRINKS PER
people are unaware that alcohol increases their risk of cancer.20 DAY INCREASES THE RISK
A change in public attitude towards alcohol is urgently required OF PANCREATIC, GASTRIC
and prevention strategies must be put in place on an EU and AND LIVER CANCER22
Member State level to reduce alcohol-related harm. Strategies
to restrict access to alcohol include enforcing a minimum
legal drinking age, applying regulations on the labelling of
alcoholic beverages, placing excise taxes on alcoholic drinks, ALCOHOL ABUSE
implementing national awareness campaigns and reducing ACCOUNTS FOR UP TO
exposure to alcohol through advertising and sponsorship. HALF OF ALL LIVER CANCER
CASES IN EUROPE23
EUROPEAN PARLIAMENT INTEREST GROUP ON DIGESTIVE HEALTH 11

Alcohol Consumption per Capita24

10
9
8
7
6
Litres of alcohol

5
4
3
2
1
0
Africa Americas South East Asia Europe Eastern Mediterranean Western Pacific

“There is strong evidence that policies affecting the price

of alcohol, such as minimum unit pricing, lead to an
immediate reduction in alcohol-related disease and
mortality. Research on the effects of alcohol is also vital
to help develop strategies and political action in the
future.
“
Excessive European drinking is an extremely serious
public health issue that inflicts huge socio-economic
damage on the EU. A regulatory approach on alcohol
labelling is needed to ensure consumers can make
informed purchasing decisions. This, together with a
tightening of regulations on the marketing of alcohol, are

”
actions to tackle the current burden across Europe.

Helena Cortez-Pinto
UEG Public Affairs Committee
”
MEP Nessa Childers
Co-chair - European Parliament Interest Group on Digestive Health
12 EUROPEAN PARLIAMENT INTEREST GROUP ON DIGESTIVE HEALTH

FUNCTIONAL GASTROINTESTINAL (GI) DISORDERS

Functional GI disorders (FGIDs) are defined by

a group of chronic or recurrent gastrointestinal IBS AFFECTS
conditions where symptoms and treatments are MORE THAN
not easily identifiable. The most prevalent FGIDs ONE IN TEN
are irritable bowel syndrome (IBS), constipation PEOPLE28
and functional dyspepsia and patients often
suffer from multiple FGIDs.25
JUST ONE IN THREE PEOPLE
FGIDs are extremely common, can be disabling for patients WITH SYMPTOMS OF IBS
and inflict a major social and economic burden.26 The costs of OR CONSTIPATION CONSULT
treating and managing IBS in Germany alone, for example,
THEIR PHYSICIAN29,28
is estimated to be over €3.2 billion per year.25 FGIDs are also
associated with educational and occupational absenteeism. It
is estimated that IBS patients record school or work absences
of up to 13 days per year, compared with just five days for the
general population.25 FUNCTIONAL DYSPEPSIA
Difficulty often lies in diagnosing FGIDs, with a third of IBS
PREVALENCE RANGES FROM
sufferers reporting that they visit their medical professional 11-24% IN EUROPE30
more than five times to receive a diagnosis.27 To improve
the lives of people with FGIDs, there needs to be greater
recognition of the disorders and advancement of scientific
understanding to optimise patient outcomes.
HIGHER
PREVALENCE OF
FGIDS IN FEMALES
THAN IN MALES
EUROPEAN PARLIAMENT INTEREST GROUP ON DIGESTIVE HEALTH 13

Highest Estimated International Prevalence of IBS (% of population)28

Iceland
Croatia
Greece
Finland
Sweden
Romania
Spain
Germany
Turkey
Norway
Italy
Netherlands
France
0 5 10 15 20 25 30 35

“
Even though functional GI disorders are common, many
patients are, unfortunately, negatively stigmatised and
labelled. As well as dedicating resources to improve the
physical elements of living with functional GI disorders,
care and investment must be committed to providing
psychological and emotional support for patients.
“
The fact that the majority of IBS and constipation
sufferers do not seek medical advice should be of great
worry to European public health authorities. We need
greater public awareness of gastrointestinal disorders
if we are to improve the health and wellbeing of our
citizens.

”
Hans Törnblom
UEG Public Affairs Committee
”
MEP Nessa Childers
Co-chair - European Parliament Interest Group on Digestive Health
14 EUROPEAN PARLIAMENT INTEREST GROUP ON DIGESTIVE HEALTH

PAEDIATRIC DIGESTIVE DISEASES

Many digestive health conditions, such

as inflammatory bowel disease (IBD), are 25% OF IBD CASES
commonly diagnosed during childhood or ARE DIAGNOSED IN
adolescence, presenting a variety of challenges CHILDHOOD AND
for both the patient and the health practitioner. ADOLESCENCE35

A number of digestive health conditions are on the increase

in children. For example, chronic liver disease is becoming
increasingly common in young people, whilst non- GLOBALLY, OVERWEIGHT
alcoholic fatty liver disease (NAFLD) has become the most UNDER-FIVES WILL RISE
common cause of chronic disease among young people in FROM 41 MILLION TO 70
Western countries, with cases documented in children as MILLION BY 202534
young as three years old.31 Paediatric IBD, coeliac disease
and inflammation of the GI tract caused by food allergy
(eosinophilic oesophagitis for example) are also increasing
in many European countries.32 BEING OVERWEIGHT
Childhood obesity presents a major risk factor in numerous CAN CAUSE EXTREME
paediatric digestive diseases, including inflammatory bowel ANXIETY AND
disease, coeliac disease, functional gastrointestinal disorders DEPRESSION IN CHILDREN
and liver cirrhosis. The prevalence of NALFD is estimated to
be between 3-10% of the global population, but can affect
up to 80% of obese children.33
Obesity and weight problems in young people are increasing
OVER HALF OF IBD
at an alarming rate. It is estimated that, by 2025, the global PATIENTS FEEL THAT IBD
number of overweight children under five will rise from NEGATIVELY AFFECTS
41 million (in 2016) to over 70 million if current trends THEIR EDUCATION36
continue.34
EUROPEAN PARLIAMENT INTEREST GROUP ON DIGESTIVE HEALTH 15

15 Year Olds Overweight or Obese (% of population)37

35
Boys Girls
30

25

20

15

10

0
Italy

Hungary

Germany

Czech Republic

Norway

Denmark
Malta

Greece

Bulgaria

Wales

Slovenia

Spain

Finland

Croatia

Iceland

Sweden

Estonia

Poland

Ireland

Scotland

Luxembourg

Portugal

Romania

Slovakia

Austria

Latvia

Belgium

England

Lithuania

France

Netherlands
“
Improving paediatric digestive health services across
the continent, such as providing improved support
“ The economic burden of treating obesity is simply too
great for the European region to handle. National and
as patients move from paediatric to adult care and European strategies for prevention and early intervention
facilitating educational programmes for children and are needed now more than ever, especially for in
parents to reduce levels of childhood obesity, will help children. The rise in chronic digestive diseases is a
to minimise the impact of paediatric digestive diseases. consequence of our modern way of eating and as such,
Children are among the most vulnerable members of improving our dietary habits from a young age is an
our society and we must act accordingly to improve their important step in mitigating this burden.

”
quality of life.

”
Gigi Veereman
UEG Public Affairs Committee
Deirdre Kelly
Chair of the ESPGHAN Public Affairs Committee
16 EUROPEAN PARLIAMENT INTEREST GROUP ON DIGESTIVE HEALTH

INFLAMMATORY BOWEL DISEASES

Inflammatory bowel diseases (IBD)
represent a group of chronic intestinal
disorders that cause continued
inflammation of the digestive tract.
The two most common diseases that
fall under the IBD umbrella are Crohn’s
disease and ulcerative colitis, both of
which are chronic relapsing conditions
with variable spells of remission in
between acute or severe flare-ups.
“
Inconsistent diagnostic strategies and treatment
practices contribute to impaired quality of life and high
levels of complications, ultimately resulting in poor
outcomes for IBD patients across Europe. Paediatric
IBD is increasing in incidence and severity, thus service
provision must be enhanced to improve the lives of
young IBD patients, most of whom suffer from their
disease into adulthood and throughout their lives.
”
Axel Dignass
UEG Vice President

The causes of IBD are not fully known although research

strongly suggests that both genetic and environmental
factors play a significant role. IBD leads to an increased
risk of developing colorectal cancer and, whilst
symptoms may develop at any age, the peak age of IBD
onset is during adolescence or early adulthood.32 IBD
also causes complications outside of the digestive tract,
such as joint pain and skin conditions.
IBD DIAGNOSIS OFTEN
Approximately 3 million people in Europe are TAKES UP TO FIVE
affected by IBD, which has a direct healthcare cost YEARS
of up to €5.6 billion per year.38
DIRECT HEALTHCARE
COST OF IBD IS UP TO €5.6
BILLION PER YEAR38
EUROPEAN PARLIAMENT INTEREST GROUP ON DIGESTIVE HEALTH 17

LIVER DISEASE

Chronic liver disease has been estimated to
affect almost 30 million people in the EU.32
Alcohol consumption has reached hazardous levels
in many European countries and this is commonly
regarded as the leading cause of liver disease across
the continent although, in some regions, hepatitis B
and C infections are also major causes. In addition, liver
disease is fuelled by Europe’s rising levels of obesity,
which is the most prevalent risk factor for non-alcoholic
“
Most liver diseases need a lifetime of care which
carries a significant drain on healthcare systems.
European policy makers are in a strong position to
drive transformation and improvements in hepatology,
such as developing strategies that strive towards the
goal of eliminating hepatitis by 2030 or committing
to educational campaigns that convey the dangers of
excessive alcohol consumption and its impact on the
liver.

”
fatty liver disease (NAFLD). Direct medical costs treating
NAFLD in Germany, France, Italy and the United
Laurent Castera
Kingdom are estimated to be €35 billion per year.39 European Liver Disease Expert
Prognosis following hospitalisation for liver disease
and cirrhosis is usually dismal and has not improved
substantially over the last 50 years. Mortality varies
strongly according to the aetiology of liver disease,
with the highest lethality often associated with
alcoholic causes.
13.3 MILLION PEOPLE IN THE

HBV
WHO EUROPEAN REGION ARE
INFECTED WITH HEPATITIS B40

15 MILLION PEOPLE IN THE

WHO EUROPEAN REGION ARE

HCV CHRONICALLY INFECTED WITH

HEPATITIS C40
18 EUROPEAN PARLIAMENT INTEREST GROUP ON DIGESTIVE HEALTH

SUMMARY

Chronic digestive diseases, poor nutritional choices, increasing levels of obesity and high levels of
alcohol consumption are placing a significant healthcare and socio-economic burden throughout
Europe. Current predictions, trends and attitudes demonstrate that this challenge is only going to
become greater and urgent action is required to reduce this burden and improve health outcomes in
generations to come.

A number of steps are required to facilitate change and mitigate the threat of chronic digestive diseases to
European public health:

• To enhance political stakeholder understanding of chronic digestive diseases

• To increase investment and funding in paediatric health treatment and services

• To provide equal access to digestive disease prevention programmes, such as colorectal cancer
screening

• To implement strategies that improve public understanding of chronic digestive diseases and their
associated risk factors to ensure early diagnosis and intervention

• To further research into digestive diseases to influence the policies that limit the burden of these
diseases

• To ensure that tackling obesity is, and remains, a priority in public health policy

• To tighten regulations on alcohol marketing, unit-pricing and the labelling of alcoholic beverages to
mitigate alcohol-related harm
EUROPEAN PARLIAMENT INTEREST GROUP ON DIGESTIVE HEALTH
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