India is facing a serious shortage of Gastro Intestinal (GI) experts with only 700 specialists serving 40 per cent of the 1.1 billion Indian population affected with GI disorders. This is because GI has not received the same status as a separate specialty. It is considered as part of general medicine. There is also no single super specialty centre in the country which can treat GI disorders that account for 40 per cent of the total cases at hospitals in the country.

Along with the shortage of specialists, the country is also facing a situation of imbalance with regard to availability of such experts across the country. While New Delhi has 130 GI specialists, Chennai has 60 and Hyderabad has 80. Whereas cities like Mumbai, Kolkatta and Bangalore have less than 20 specialists. The government hospitals and medical colleges have very low number of GI experts.

"There is a serious need to ensure that the GI specialists are evenly distributed across the country especially in smaller towns and remote districts so that patients can be diagnosed and treated faster", said Dr Naresh Bhat, organizing chairman, Indian Society of Gastroenterology Conference and a consultant to Bangalore Hospital.

While specialties like cardiology and neurology have received faster recognition, GI on the contrary was slow to take off despite the high disease prevalence. Even dedicated GI departments in many hospitals are created recently. Educated population is aware about the morbidity of the diseases but rural people have no knowledge and specialists in the cities are approached in the last stages of the disease. Another situation is that the patient who has consulted a GI specialist for a particular condition like ulcer does not revert for hepatitis as he does not know that the same specialist could treat the condition, stated Dr Bhat.

In such a scenario, public education is critical component along intensive four month training for resident doctors (MD- General Medicine) to be able to diagnose and treat GI disorders, he averred.

The World Organization of Gastroenterology (WOG) has issued the 2007 guidelines highlighting appropriate country specific treatment for GI. This is vital because GI diseases like IBS in developed world are not common in the developing countries where diarrhoea is more prevalent. WOG will also organize 'train the trainers' workshop worldwide to augment the number of specialists, pointed out Dr Bhat.

GI is a not capital intensive specialty as compared to cardiology. Only a good lab supported with clinical expertise can save scores of patients with faster diagnosis and treatment. Therefore training of general physicians at district hospitals and primary health centres in the country will help control GI conditions.

GI diseases cover functional disorders like ulcers, diarrhoea, Irritable Bowel Syndrome (IBS) and mal absorption syndrome. Among the liver diseases are viral hepatitis and cirrhosis. Over 70 per cent of the hospital admissions are liver disorder cases and cirrhosis cases top the list. Cases of Pancreatitis are also on the rise. However there is a five per cent increase in Amoebiasis, which is the third leading cause of morbidity and mortality due to parasitic disease in humans. The high incidence is reported because of resistance to metronidazole which was the drug of choice.

The GI drug market size is estimated at Rs 3,000 with a growth rate of 15 per cent. Leading players are Ranbaxy, Nicholas Piramal, Wockhardt, Glaxo, Wyeth and Micro Labs to name a few.