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  1. Goh KL
    J Dig Dis, 2007 Nov;8(4):179-85.
    PMID: 17970873
    The new millennium has seen distinct changes in the pattern of gastrointestinal disease in the Asia-Pacific region. These changes are important as more than half of the world's population come from the region and therefore impact significantly on the global disease burden. The highest incidence of gastric cancer (GCA) has been reported from Asia and GCA remains a very important cancer. However time-trend studies have shown a decrease in GCA incidence in several countries in Asia. A rise in cardio-esophageal cancers as seen in the West has not been reported. On the other hand, colorectal cancer has been steadily increasing in Asia with age-standardized incidence rates of some countries approaching that of the West. The pattern of acid-related diseases has also changed. Gastroesophageal reflux disease is a fast emerging disease with an increasing prevalence of reflux esophagitis and reflux symptoms. The prevalence of peptic ulcer disease has at the same time declined in step with a decrease in H. pylori infection. Many of the changes taking place mirror the Western experience of several decades ago. Astute observation of the epidemiology of emerging diseases combined with good scientific work will allow a clearer understanding of the key processes underlying these changes. With rapid modernization, lifestyle changes have been blamed for an increase in several diseases including gastroesophageal reflux disease, nonalcoholic fatty liver disease and colorectal cancer. A worrying trend has been the increase in obesity among Asians, which has been associated with an increase in metabolic diseases and various gastrointestinal cancers. Conversely, an improvement in living conditions has been closely linked to the decrease in GCA and H. pylori prevalence.
    Matched MeSH terms: Gastrointestinal Diseases/epidemiology*
  2. Traub RJ, Pednekar RP, Cuttell L, Porter RB, Abd Megat Rani PA, Gatne ML
    Vet Parasitol, 2014 Sep 15;205(1-2):233-8.
    PMID: 25139393 DOI: 10.1016/j.vetpar.2014.06.037
    A gastrointestinal parasite survey of 411 stray and refuge dogs sampled from four geographical and climactically distinct locations in India revealed these animals to represent a significant source of environmental contamination for parasites that pose a zoonotic risk to the public. Hookworms were the most commonly identified parasite in dogs in Sikkim (71.3%), Mumbai (48.8%) and Delhi (39.1%). In Ladakh, which experiences harsh extremes in climate, a competitive advantage was observed for parasites such as Sarcocystis spp. (44.2%), Taenia hydatigena (30.3%) and Echinococcus granulosus (2.3%) that utilise intermediate hosts for the completion of their life cycle. PCR identified Ancylostoma ceylanicum and Ancylostoma caninum to occur sympatrically, either as single or mixed infections in Sikkim (Northeast) and Mumbai (West). In Delhi, A. caninum was the only species identified in dogs, probably owing to its ability to evade unfavourable climatic conditions by undergoing arrested development in host tissue. The expansion of the known distribution of A. ceylanicum to the west, as far as Mumbai, justifies the renewed interest in this emerging zoonosis and advocates for its surveillance in future human parasite surveys. Of interest was the absence of Trichuris vulpis in dogs, in support of previous canine surveys in India. This study advocates the continuation of birth control programmes in stray dogs that will undoubtedly have spill-over effects on reducing the levels of environmental contamination with parasite stages. In particular, owners of pet animals exposed to these environments must be extra vigilant in ensuring their animals are regularly dewormed and maintaining strict standards of household and personal hygiene.
    Matched MeSH terms: Gastrointestinal Diseases/epidemiology
  3. Ngui R, Lee SC, Yap NJ, Tan TK, Aidil RM, Chua KH, et al.
    Acta Parasitol, 2014 Oct;59(4):737-44.
    PMID: 25236287 DOI: 10.2478/s11686-014-0306-3
    To estimate the current prevalence of gastrointestinal (GI) parasites in dogs and cats, a total of 105 fresh faecal samples were collected from rural areas in Peninsular Malaysia. Each faecal sample was examined for the presence of GI parasites by microscopic examination after formalin-ether concentration technique and for protozoa, trichrome and Ziehl-Neelsen staining were employed. The overall prevalence of GI parasitic infection was 88.6% (95% CI = 82.5-94.7) in which 88.3% of dogs and 89.3% of cats were infected with at least one parasites species, respectively. There were 14 different GI parasites species (nematodes, cestodes and protozoa) detected, including Ancylostoma spp. (62.9%), Toxocara spp. (32.4%), Trichuris vulpis (21.0%), Spirometra spp. (9.5%), Toxascaris leonina (5.7%), Dipylidium caninum (4.8%), Ascaris spp. (2.9%), Hymenolepis diminuta (1.0%) and others. General prevalence of GI parasites showed a significant difference between helminth (84.4%) and protozoa (34.3%) infections. Monoparasitism (38.1%) was less frequent than polyparasitism (46.7%). As several of these GI parasites are recognized as zoonotic agents, the results of this investigation revealed that local populations may be exposed to a broad spectrum of zoonotic agents by means of environmental contamination with dogs and cats faeces and this information should be used to mitigate public health risks. Prevention and control measures have to be taken in order to reduce the prevalence rates especially in socioeconomically disadvantaged communities where animals live in close proximity to people, poor levels of hygiene and overcrowding together with a lack in veterinary attention and zoonotic awareness.
    Matched MeSH terms: Gastrointestinal Diseases/epidemiology
  4. Bursey CR, Goldberg SR, Grismer LL
    Acta Parasitol, 2014 Oct;59(4):643-52.
    PMID: 25236275 DOI: 10.2478/s11686-014-0299-y
    Two new nematode species, Bakeria schadi sp. nov. and Falcaustra malaysiaia sp. nov. from the gastrointestinal tract of McGuire's rock gecko, Cnemaspis mcguirei (Sauria: Gekkonidae) collected in Peninsular Malaysia are described. The two species now assigned to Bakeria are separated on the bases of male bursa type and location of the excretory pore: type II in B. schadi sp. nov. and type I in B. bakeri; location of excretory pore, anterior to nerve ring in B. schadi sp. nov. and posterior to nerve ring in B. bakeri. Falcaustra malaysiaia sp. nov. is most similar to F. chabaudi, F. concinnae, F. condorcanquii, F. barbi, F. dubia, and F. tchadi in that these 7 species possess 1 pseudosucker, 1 median papilla plus 10 pairs caudal papillae, and spicules with lengths between 1 and 2 mm. F. barbi and F. tchadi lack adcloacal papillae; the remaining 5 species possess 1 pair of adcloacal papillae. Falcaustra chabaudi is known from Nearctic salamanders; F. concinnae from Nearctic turtles; F. condorcanquii from Neotropical frogs, F. dubia from Oriental frogs, and F. malaysiaia sp. nov. from Oriental geckos. Two additional species of Nematoda were found, Cosmocerca ornata and Meteterakis singaporensis. Cnemaspis mcguirei represents a new host record for Cosmocerca ornata and Meteterakis singaporensis.
    Matched MeSH terms: Gastrointestinal Diseases/epidemiology
  5. Sperber AD, Bangdiwala SI, Drossman DA, Ghoshal UC, Simren M, Tack J, et al.
    Gastroenterology, 2021 01;160(1):99-114.e3.
    PMID: 32294476 DOI: 10.1053/j.gastro.2020.04.014
    BACKGROUND & AIMS: Although functional gastrointestinal disorders (FGIDs), now called disorders of gut-brain interaction, have major economic effects on health care systems and adversely affect quality of life, little is known about their global prevalence and distribution. We investigated the prevalence of and factors associated with 22 FGIDs, in 33 countries on 6 continents.

    METHODS: Data were collected via the Internet in 24 countries, personal interviews in 7 countries, and both in 2 countries, using the Rome IV diagnostic questionnaire, Rome III irritable bowel syndrome questions, and 80 items to identify variables associated with FGIDs. Data collection methods differed for Internet and household groups, so data analyses were conducted and reported separately.

    RESULTS: Among the 73,076 adult respondents (49.5% women), diagnostic criteria were met for at least 1 FGID by 40.3% persons who completed the Internet surveys (95% confidence interval [CI], 39.9-40.7) and 20.7% of persons who completed the household surveys (95% CI, 20.2-21.3). FGIDs were more prevalent among women than men, based on responses to the Internet survey (odds ratio, 1.7; 95% CI, 1.6-1.7) and household survey (odds ratio, 1.3; 95% CI, 1.3-1.4). FGIDs were associated with lower quality of life and more frequent doctor visits. Proportions of subjects with irritable bowel syndrome were lower when the Rome IV criteria were used, compared with the Rome III criteria, in the Internet survey (4.1% vs 10.1%) and household survey (1.5% vs 3.5%).

    CONCLUSIONS: In a large-scale multinational study, we found that more than 40% of persons worldwide have FGIDs, which affect quality of life and health care use. Although the absolute prevalence was higher among Internet respondents, similar trends and relative distributions were found in people who completed Internet vs personal interviews.

    Matched MeSH terms: Gastrointestinal Diseases/epidemiology*
  6. Chew KS, Em JM, Koay ZL, Jalaludin MY, Ng RT, Lum LCS, et al.
    Pediatr Neonatol, 2021 01;62(1):49-54.
    PMID: 32891528 DOI: 10.1016/j.pedneo.2020.08.009
    BACKGROUND: Functional gastrointestinal disorders (FGIDs) are common in children. The prevalence of FGIDs varies across the world but is unknown in Malaysia. We aimed to investigate the prevalence of FGIDs in healthy Malaysian infants.

    METHODS: This was a cross-sectional study involving healthy infants younger than 12 months of age who attended a well-baby clinic. A universal sampling method was adopted. Children with congenital disorders potentially affecting gastrointestinal functions, chronic debilitating diseases and hypothyroidism were excluded. Rome IV criteria were used to define FGIDs.

    RESULTS: Of the total 534 infants recruited (54% males), 92% were born at term; 85% had normal birth weight [range 2.5-4.0 kg], and the mean (±S.D.) age at interview was 6.8 (±3.4) months. Thirty-six percent were breastfed, 29% were formula-fed, and 35% had mixed feeding. Prevalence of infant regurgitation and rumination syndrome was 10.5% and 1.7%, respectively. Prevalence of infant colic was 1.9% (3/160) (infant 

    Matched MeSH terms: Gastrointestinal Diseases/epidemiology*
  7. Kwan AC, Bao T, Chakkaphak S, Chang FY, Ke M, Law NM, et al.
    J Gastroenterol Hepatol, 2003 Jul;18(7):796-802.
    PMID: 12795751 DOI: 10.1046/j.1440-1746.2003.03081.x
    BACKGROUND: It has been unclear as to whether the Rome II criteria could be applied to patients in the Asia region with functional gastrointestinal (GI) diseases. The aim of the present study was to determine if symptoms of Asian patients with functional gastrointestinal disorders formed groups which corresponded to the Rome II diagnostic criteria.

    METHODS: A modified English version of Talley's bowel disease questionnaire was developed in collaboration with various research teams in accordance with the Rome II criteria. This instrument was translated into the local languages of the following nine Asian regions: China, Hong Kong, Indonesia, Korea, Malaysia, Singapore, Taiwan, Thailand and Vietnam. From September to December 2001, newly enrolled outpatients attending 14 GI or medical clinics in these regions were invited to complete the questionnaire. From these respondents, patients with functional gastrointestinal disorders fulfilling the '12 weeks out of 12 months' criteria were separated for further analysis. Principal component factor analysis with varimax rotation was used to identify symptom clusters or factors. These factors were compared with the existing classification of functional GI diseases derived from the Rome II criteria.

    RESULTS: Factor analysis of symptoms from 1012 functional GI patients supported the Rome II classification of the following groups of functional GI disorders: diarrhea-predominant irritable bowel syndrome, functional constipation, functional dyspepsia, functional abdominal pain syndrome, functional heartburn, and functional vomiting. Functional diarrhea was combined with functional anorectal disorders, and globus merged with functional dysphagia into one factor. Some of the functional dyspepsia, abdominal bloating and belching symptoms were loaded into one factor.

    CONCLUSIONS: Factor analysis of symptoms from a sample of Asian patients with functional GI disorders partially supported the use of the Rome II classification.
    Matched MeSH terms: Gastrointestinal Diseases/epidemiology
  8. Sunoto
    PMID: 7163834
    Diarrhoea up till now is still a major problem in Southeast Asia with high morbidity and mortality, particularly among children under 5 years of age, with the peak in children between 6 - 24 months. In Indonesia, in 1981, it was estimated that there are 60 million episodes with 300,000 - 500,000 deaths. In the Philippines, diarrhoea ranks as a second cause of morbidity (600 per 100,000 in 1974) and second cause of infant mortality (5 per 1,000 in 1974). In Thailand, in 1980, the morbidity rate was 524 per 100,000 and the mortality rate 14 per 100,000. In Malaysia, in 1976, diarrhoea was still ranking number 5 (3.1%) as a cause of total admission and number 9 (2.2%) as a cause of total deaths. In Singapore, diarrhoea still ranks number 3 as a cause of deaths (4% of total deaths). In Bangladesh, the overall attack rates imply a prevalence of 2.0% for the entire population, with the highest for under 5 groups i.e. 4.1%. The diarrhoea episode in rural population is 85.4%, 39% of them are children under 5. The most common enteropathogens found in all countries are rotavirus followed by Enterotoxigenic E. coli, Vibrio spp., Salmonella spp., Shigella spp. and Campylobacter. Malnutrition and decline of giving breast-feeding play an important role in causing high morbidity, besides socio-economic, socio-cultural and poor environmental sanitation.
    Matched MeSH terms: Gastrointestinal Diseases/epidemiology
  9. Mohammed K, Abba Y, Ramli NS, Marimuthu M, Omar MA, Abdullah FF, et al.
    Trop Anim Health Prod, 2016 Jun;48(5):1013-20.
    PMID: 27038194 DOI: 10.1007/s11250-016-1049-y
    The prevalence of gastrointestinal (GI) nematodes and total worm burden of Damara and Barbados Blackbelly cross sheep was investigated among smallholder farms in Salak Tinggi district of Selangor, Malaysia. A total of 50 sheep raised in smallholder farms comprising of 27 Damara cross and 23 Barbados Blackbelly cross were categorized based on their age into young and adults. Fecal samples were collected and examined for strongyle egg count by using modified McMaster technique. Severity of infection was categorized into mild, moderate, and heavy, based on egg per gram (EPG). Five sheep were randomly selected and slaughtered to examine the presence of adult gastrointestinal (GI) nematodes through total worm count (TWC). Faffa Malan Chart (FAMACHA) score was used for investigation of worm load based on the degree of anemia. The study revealed an overall EPG prevalence of 88 %, of which 84.1 % had mild infection. There was a significant difference (p = 0.002) in EPG among the two breeds. Based on age, significant difference (p = 0. 004) in EPG was observed among Barbados Blackbelly cross, but not for Damara cross (p = 0.941). The correlation between severity of infection and the FAMACHA score was significant (r = 0.289; p = 0.042). Haemonchus spp. were the most predominant nematode found in the gastrointestinal tract, followed by Trichostrongylus and Oesophagostomum spps. EPG and TWC for Haemonchus were positively correlated, but not significant (r = 0.85, p = 0.066). From regression analysis, 73 % of the variability in TWC for Haemonchus could be explained by EPG. Thus, it can be concluded that FAMACHA score correlates well with severity of infection of a nematode and can be used to assess the strongyle nematode burden in the different sheep crosses.
    Matched MeSH terms: Gastrointestinal Diseases/epidemiology
  10. Koh JC, Loo WM, Goh KL, Sugano K, Chan WK, Chiu WY, et al.
    J Gastroenterol Hepatol, 2016 Aug;31(8):1405-13.
    PMID: 27010240 DOI: 10.1111/jgh.13385
    The incidence of obesity is increasing in Asia, with implications on gastrointestinal (GI) and liver diseases. The Gut and Obesity in Asia Workgroup comprises regional experts with the aim of studying relationship between obesity and the GI and liver diseases in Asia. Through literature review and the modified Delphi process, consensus statements examining the impact of obesity on esophageal, gastric, pancreatic, colorectal, and liver diseases, exploring relationship between gut microbiome and obesity, and assessing obesity therapies have been produced by the Gut and Obesity in Asia Workgroup. Sixteen experts participated with 9/15 statements having strong consensus (>80% agreement). The prevalence of obesity in Asia is increasing (100% percentage agreement in brackets), and this increased prevalence of obesity will result in a greater burden of obesity-related GI and liver diseases (93.8%). There was consensus that obesity increases the risk of gastric cancer (75%) and colorectal neoplasia (87.5%). Obesity was also associated with Barrett's esophagus and esophageal adenocarcinoma (66.7%) and pancreatic cancer (66.7%) in Asia. The prevalence of non-alcoholic fatty liver disease (NAFLD) in Asia is on the rise (100%), and the risk of NAFLD in Asia (100%) is increased by obesity. Obesity is a risk factor for the development of hepatocellular carcinoma (93.8%). Regarding therapy, it was agreed that bariatric surgery was an effective treatment modality for obesity (93.8%) but there was less agreement on its benefit for NAFLD (62.5%). These experts' consensus on obesity and GI diseases in Asia forms the basis for further research, and its translation into addressing this emerging issue.
    Matched MeSH terms: Gastrointestinal Diseases/epidemiology*
  11. Nur Atiqah NA, Lim CB
    Med J Malaysia, 2001 Dec;56(4):414-7.
    PMID: 12014759
    A total of 97 children aged 1 month to 16 years (mean 6.6 years) had upper endoscopies performed in Paediatric Institute, Kuala Lumpur Hospital between January 1997 and December 1999 for various gastrointestinal symptoms. Of these 70 children were tested for Helicobacter pylori. The four most common indications for upper endoscopy were recurrent abdominal pain, upper gastrointestinal bleeding, epigastric pain and vomiting. The overall prevalence of this infection in this heterogenous group of symptomatic children was 10% (7/70). This study shows that H.pylori positivity in a routine endoscopy population is low and does not appear to be associated with specific symptoms.
    Matched MeSH terms: Gastrointestinal Diseases/epidemiology*
  12. Lim TO, Looi HW, Harun K, Marzida
    Med J Malaysia, 1991 Sep;46(3):239-46.
    PMID: 1839919
    Using computerized in-patients' discharge records, a descriptive analysis was carried out of all medical admission in 1987 in a general hospital. The survey found that there were a total of 4053 admissions in 1987. A wide range of medical disorders were seen reflecting the lack of subspecialization. Cardiovascular disorders topped accounting for 25.6% of all admissions, followed by gastrointestinal and hepatobiliary disorders 12.8% and respiratory disorders 10.7%. The commonest specific medical disorders seen were hypertension 13.8%, diabetes mellitus 10.2%, ischaemic heart disease 7% and asthma 4.5%. The age, sex, ethnic and geographical distributions of the common medical disorders seen appear to conform to two broad pattern; hypertension, diabetes, ischaemic heart disease and cerebrovascular disease affected the older patients, had even ethic distribution and predominantly urban. Malaria, non-specific fever, viral hepatitis and acute gastroenteritis affected the younger patients, predominantly rural and Malay. Information from such surveys may be useful for planning and organization of medical services.
    Matched MeSH terms: Gastrointestinal Diseases/epidemiology
  13. Goh KL
    J Clin Gastroenterol, 2017 Jul;51(6):479-485.
    PMID: 28591070 DOI: 10.1097/MCG.0000000000000847
    Colorectal cancer (CRC), gastroesophageal reflux disease (GERD), inflammatory bowel disease (IBD), and nonalcoholic fatty liver disease are considered important emerging diseases in the Asia Pacific (AP) region. The incidence rate of CRC is the highest among gastrointestinal cancers in the region surpassing that of gastric cancer. However, population CRC screening is limited by availability of adequate health resources and financing. GERD is a highly prevalent disease in AP with the prevalence of GERD symptoms and reflux esophagitis reported to be increasing. The usage of proton pump inhibitors has also been reported to be high. The incidence and prevalence of IBD is not as high as in the west but is now an increasingly recognizable disease in the AP region. Being a complicated disease, IBD will pose a huge financial burden with the increasing use of expensive biological drugs. In tandem with the exponential increase in obesity and diabetes mellitus in AP, nonalcoholic fatty liver disease will become the most important liver disease in the region in the coming years. These emerging diseases reflect the continued fast-paced socioeconomic development in the region with marked lifestyle changes and increasing affluence.
    Matched MeSH terms: Gastrointestinal Diseases/epidemiology*
  14. Ross IN, Nair S, Jayakumar CR
    Singapore Med J, 1985 Jun;26(3):271-8.
    PMID: 4048988
    The results of 2449 investigations of the upper gastrointestinal tract were analysed to determine the incidence of disease. Abnormalities were detected in 53% of patients who had endoscopy, but were found in only 24% of patients who had barium studies (p <= 0.001). Altogether 916 patients had abnormal findings. Duodenal ulcer accounted for 42% of cases, gastric ulcer 16% and gastric cancer 9%. The prevalence of perforated ulcer was 13%. The annual incidence/1000 in males and females (>14 years) were respectively, for duodenal ulcer 1.66 and 0.42, for gastric ulcer 0.57 and 0.25, for perforated ulcer 0.36 and 0.05, and for gastric cancer 0.29 and 0.14. Most types of gastro-duodenal disease were less common in Malays than expected (p = <0.001). However oesophageal cancer and varices were more common in Indians compared to Malays and Chinese (p = <0.001). This study showed that the pallern of perforating ulcers was not the same as that of non-peforating ulcers, suggesting a differing pathogenesis. Identification of the factors causing a different prevalence of disease between the three ethnic groups would help in the understanding of the causes of upper gastrointestinal disease.
    Matched MeSH terms: Gastrointestinal Diseases/epidemiology*
  15. Al-Jashamy K, Murad A, Zeehaida M, Rohaini M, Hasnan J
    Asian Pac J Cancer Prev, 2010;11(6):1765-8.
    PMID: 21338230
    Colorectal cancer (CRC) is the second most common cause of cancer mortality among men and women worldwide; the risk of its occurrence has been shown to be increased by chronic bacterial infections. A case control study was therefore carried out at Hospital Universiti Sains Malaysia (HUSM) to determine the incidence of colorectal cancer associated with S. bovis infection. A total of 166 stool specimens were collected from diseased patients and healthy individuals and S. bovis isolates were identified. Suspected colon tumor and cancer cases were diagnosed and confirmed. It was found that overall prevalence of S. bovis was 41 (24.7%) out of 166 cases studied. Some 41(48.6%) of these S. bovis isolates was found in patients with colonic polyps, adenocarcinomas, inflammatory bowel disease (IBD) and chronic gastrointestinal tract (GIT). It was also found that colorectal cancer incidence was 24.7%, adenocarinomas accounting for 51% with the highest incidence in the sigmoid part of the colon. Among the IBD and chronic GIT cases, ulcerative colitis featured in the majority of cases (41.4%). In conclusion, there is a high incidence of colorectal cancer associated with S. bovis.
    Matched MeSH terms: Gastrointestinal Diseases/epidemiology
  16. Chan WK, Treeprasertsuk S, Imajo K, Nakajima A, Seki Y, Kasama K, et al.
    Aliment Pharmacol Ther, 2018 Mar;47(6):816-825.
    PMID: 29333610 DOI: 10.1111/apt.14506
    BACKGROUND: The Gut and Obesity Asia (GO ASIA) workgroup was formed to study the relationships between obesity and gastrointestinal diseases in the Asia Pacific region.

    AIM: To study factors associated with nonalcoholic steatohepatitis (NASH) and advanced fibrosis, and medical treatment of biopsy-proven nonalcoholic fatty liver disease (NAFLD) patients.

    METHODS: Retrospective study of biopsy-proven NAFLD patients from centres in the GO ASIA Workgroup. Independent factors associated with NASH and with advanced fibrosis on binary logistic regression analyses in a training cohort were used for the development of their corresponding risk score, which were validated in a validation cohort.

    RESULTS: We included 1008 patients from nine centres across eight countries (NASH 62.9%, advanced fibrosis 17.2%). Independent predictors of NASH were body mass index ≥30 kg/m2 , diabetes mellitus, dyslipidaemia, alanine aminotransferase ≥88 U/L and aspartate aminotransferase ≥38 U/L, constituting the Asia Pacific NASH risk score. A high score has a positive predictive value of 80%-83% for NASH. Independent predictors of advanced fibrosis were age ≥55 years, diabetes mellitus and platelet count <150 × 109 /L, constituting the Asia-Pacific NAFLD advanced fibrosis risk score. A low score has a negative predictive value of 95%-96% for advanced fibrosis. Only 1.7% of patients were referred for structured lifestyle program, 4.2% were on vitamin E, and 2.4% were on pioglitazone.

    CONCLUSIONS: More severe liver disease can be suspected or ruled out based on factors identified in this study. Utilisation of structured lifestyle program, vitamin E and pioglitazone was limited despite this being a cohort of biopsy-proven NAFLD patients with majority of patients having NASH.

    Matched MeSH terms: Gastrointestinal Diseases/epidemiology*
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