Gastrointestinal Pathology: A Continuing Challenge (Special Section--Insights and Controversies in Gastrointestinal Pathology) (Report‪)‬

In most nations, digestive diseases represent a heavy burden on health care, and gastrointestinal pathology is a major part of the daily work load of surgical pathologists. Worldwide, enteric infections rank third among all causes of intestinal diseases and are responsible for between 1.7 and 2.5 million deaths per year, mostly among young children and infants living in developing countries. (1) Usually, no biopsy diagnosis is available to initiate treatment, if it is available. The pathology is different in the developed world, where chronic inflammatory disorders and neoplasias are far more common. In 2004, 35 ambulatory care visits per 100 US residents were related to digestive disorders. In the same time frame, digestive diseases were reported as the primary first or secondary diagnosis of 13.5 million hospital discharges. Gastroesophageal reflux disease is by far the most frequently listed digestive condition. More surprisingly, the prevalence of gluten-sensitive enteropathy has been reevaluated and recent findings estimate that about 2 000 000 people in the United States have celiac disease or, as in Europe, about 1 in 133 individuals. Finally, in the United States, chronic inflammatory bowel diseases (IBDs) are responsible for 221 000 hospital discharge diagnoses and 18 342 000 ambulatory care visits per year. (2,3) A rising trend in the incidence and prevalence of IBDs is also noted in Asia. (4)