Burden of Gastrointestinal Disease in the United States

2012 Update

Anne F. Peery; Evan S. Dellon; Jennifer Lund; Seth D. Crockett; Christopher E. Mcgowan; William J. Bulsiewicz; Lisa M. Gangarosa; Michelle T. Thiny; Karyn Stizenberg; Douglas R. Morgan; Yehuda Ringel; Hannah P. Kim; Marco Dacosta Dibonaventura; Charlotte F. Carroll; Jeffery K. Allen; Suzanne F. Cook; Robert S. Sandler; Michael D. Kappelman; Nicholas J. Shaheen


Gastroenterology. 2012;143(5):1179-1187. 

In This Article

Abstract and Introduction


Background & Aims: Gastrointestinal (GI) diseases account for substantial morbidity, mortality, and cost. Statistical analyses of the most recent data are necessary to guide GI research, education, and clinical practice. We estimate the burden of GI disease in the United States.
Methods: We collected information on the epidemiology of GI diseases (including cancers) and symptoms, along with data on resource utilization, quality of life, impairments to work and activity, morbidity, and mortality. These data were obtained from the National Ambulatory Medical Care Survey; National Health and Wellness Survey; Nationwide Inpatient Sample; Surveillance, Epidemiology, and End Results Program; National Vital Statistics System; Thompson Reuters MarketScan; Medicare; Medicaid; and the Clinical Outcomes Research Initiative's National Endoscopic Database. We estimated endoscopic use and costs and examined trends in endoscopic procedure.
Results: Abdominal pain was the most common GI symptom that prompted a clinic visit (15.9 million visits). Gastroesophageal reflux was the most common GI diagnosis (8.9 million visits). Hospitalizations and mortality from Clostridium difficile infection have doubled in the last 10 years. Acute pancreatitis was the most common reason for hospitalization (274,119 discharges). Colorectal cancer accounted for more than half of all GI cancers and was the leading cause of GI-related mortality (52,394 deaths). There were 6.9 million upper, 11.5 million lower, and 228,000 biliary endoscopies performed in 2009. The total cost for outpatient GI endoscopy examinations was $32.4 billion.
Conclusions: GI diseases are a source of substantial morbidity, mortality, and cost in the United States.


Gastrointestinal (GI) diseases affect an estimated 60 to 70 million US citizens annually.[1] In 2004, there were an estimated 4.6 million hospitalizations, 72 million ambulatory care visits, and 236,000 deaths attributable to GI disease.[1] Spending on GI diseases in the United States has been estimated at $142 billion per year in direct and indirect costs.[1]

Current descriptive statistics describing the toll of GI diseases are necessary to guide research, education, and resource allocation. Reports detailing the burden of GI disease have been published and are frequently utilized for these endeavors.[1–6] With the availability of recent data and additional resources, an updated report is needed.

Our objective was to summarize from large national databases the most recent data on GI morbidity, mortality, and cost in adults in the United States. We compiled the most recent statistics on GI symptoms, quality of life, outpatient diagnoses, hospitalizations, cost, cancer, and mortality. Because GI endoscopy makes a major contribution to the diagnosis, management, and treatment of most GI symptoms and diseases, we also generated estimates for the current utilization and cost of GI endoscopies in the United States. We assessed trends in endoscopic utilization and compiled indications for common GI endoscopic procedures.