BACKGROUND: Inflammatory bowel disease (IBD) care and education might differ around Europe. Therefore, we conducted this European Variation In IBD PracticE suRvey (VIPER) to investigate potential differences between countries. METHODS: This trainee-initiated survey, run through SurveyMonkey®, consisted of 47 questions inquiring basic demographics, IBD training, and clinical care. Results were compared according to gross domestic product (GDP) per capita, for which countries were divided into 2 groups (low/high income, according to the World Bank). RESULTS: The online survey was completed by 1,285 participants from 40 European countries, with a majority of specialists (65.3%) working in academic institutions (50.4%). Significant differences in IBD-specific training (55.9% vs. 38.4%), as well as availability of IBD units (58.4% vs. 39.7%) and multidisciplinary meetings (73.2% vs. 40.1%), were observed between respondees from high and low GDP countries (p < 0.0001). In high GDP countries, IBD nurses are more common (85.9% vs. 36.0%), also mirrored by more nurse-led IBD clinics (40.6% vs. 13.7%; p < 0.0001). IBD dieticians (33.4% vs. 16.5%) and psychologists (16.8% vs. 7.5%) are mainly present in high GDP countries (p < 0.0001). In the current COVID era, telemedicine is available in 73.2% versus 54.1% of the high/low GDP countries, respectively (p < 0.0001). Treat-to-target approaches are implemented everywhere (85.0%), though access to biologicals and small molecules differs significantly. CONCLUSION: Much variability in IBD practice exists across Europe, with marked differences between high and low GDP countries. Further work is required to help address some of these inequalities, aiming to improve and standardize IBD care and training across Europe.

1st Propedeutic Department of Internal Medicine Aristotle University of Thessaloniki AHEPA Hospital Thessaloniki Greece

Clinic for Gastroenterology and Hepatology Clinical Center of Serbia School of Medicine Belgrade University Belgrade Serbia

Clinic of Gastroenterology Nephrology and Surgery Institute of Clinical Medicine Faculty of Medicine Vilnius University Vilnius Lithuania

Department of Chronic Diseases and Metabolism TARGID IBD KU Leuven Leuven Belgium

Department of Digestive Tract Diseases Faculty of Medicine Medical University of Lodz Lodz Poland

Department of Gastroenterology and Hepatology Inflammatory Bowel Disease Center Radboud University Medical Center Nijmegen The Netherlands

Department of Gastroenterology and Hepatology University Hospital Zurich Zurich Switzerland

Department of Gastroenterology and Hepatology University Hospitals Leuven KU Leuven Leuven Belgium

Department of Gastroenterology Harvey PR Russells Hall Hospital Dudley UK

Department of Gastroenterology Hillingdon Hospital Uxbridge UK

Department of Gastroenterology Hospital de Galdakao Biocruces Bizkaia Health Research Institute Galdakao School of Medicine Deusto University Bilbao Spain

Department of Gastroenterology Hospital Parc Tauli Sabadell Spain

Department of Gastroenterology IBD Referral Center Careggi University Hospital Florence Italy

Department of Gastroenterology Marmara University School of Medicine Istanbul Turkey

Department of Gastroenterology Royal Victoria Hospital Belfast UK

Department of Gastroenterology Saint Antoine Hospital AP HP Paris France

Department of Gastroenterology Tartu University Hospital Tartu Estonia

Department of Gastroenterology Tsaritsa Yoanna University Hospital Medical University of Sofia Sofia Bulgaria

Department of Gastroenterology UHC Rijeka and UH Merkur Rijeka Croatia

Department of General and Colorectal Surgery Department of Biochemistry Faculty of Medicine Medical University of Lodz Lodz Poland

Department of Hepatogastroenterology Institute for Clinical and Experimental Medicine Prague Czechia

Department of Internal Medicine 1 University Medical Center Schleswig Holstein Campus Kiel Kiel Germany

Department of Internal Medicine and Hematology Semmelweis University Budapest Hungary

Department of Internal Medicine and Pediatrics Ghent University Ghent Belgium

Department of Internal Medicine Riga Stradins University Riga Latvia

Department of Pathophysiology and Transplantation University of Milan Milan Italy

Department of Surgery №1 Bogomolets National Medical University Kyiv Ukraine

Department of Surgery Oncology and Gastroenterology Gastroenterology Unit University of Padova Azienda Ospedaliera di Padova Padova Italy

Division of Gastroenterology and Hepatology Department of Internal Medicine Medical University of Graz Graz Austria

Division of Gastroenterology Mater Dei Hospital Msida Malta

Division of Gastroenterology Rabin Medical Center Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel

Gastroenterology Department Grigore T Popa University of Medicine and Pharmacy Lași Romania

Gastroenterology Department Hospital Senhora da Oliveira Guimarães Portugal

Gastroenterology Division Surgery Department Hospital Beatriz Ângelo Loures Portugal

Gastroenterology Unit Copenhagen University Hospital Hvidovre Hvidovre Denmark

IBD Department Moscow Clinical Scientific Centre Loginov Moscow Russian Federation

Institute of Clinical Molecular Biology University Medical Center Schleswig Holstein Campus Kiel Kiel Germany

Out patient Department Medical Center Medeor Chelyabinsk Russian Federation

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