Inflammatory bowel diseases (IBD), including Crohn's disease and ulcerative colitis, are chronic immune-mediated diseases with a high incidence and prevalence in Europe. Since these are diseases with associated disability, they require complex management and the availability of high-quality healthcare resources. We focused on the analysis of IBD care in selected countries of Central and Eastern Europe (Croatia, the Czech Republic, Hungary, Moldova, Poland, Romania and Slovakia) targeting the availability and reimbursement of diagnostic and therapeutic modalities, the role of IBD centers and also education and research in IBD. As part of the analysis, we created a questionnaire of 73 statements organized in three topics: (1) diagnostics, follow-up and screening, (2) medications and (3) IBD centers. The questionnaire was filled out by co-authoring IBD experts from individual countries, and then the answers and comments on the questionnaire were analyzed. We identified that despite the financial burden, which still partially persists in the region, the availability of some of the cost-saving tools (calprotectin test, therapeutic drug monitoring) differs among countries, mainly due to variable reimbursement from country to country. In most participating countries, there also remains a lack of dedicated dietary and psychological counseling, which is often replaced by recommendations offered by gastroenterologists. However, there is adequate availability of most of the currently recommended diagnostic methods and therapies in each participating country, as well as the implementation of established IBD centers in the region.

1st Department of Medicine University of Szeged Faculty of Medicine Szeged Hungary

2nd Gastroenterology Department Centre of Postgraduate Medical Education Warsaw Poland

Department of Gastroenterology and Hepatology Division of Internal Medicine University Hospital Center Zagreb Zagreb Croatia

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

Department of Gastroenterology Jessenius Faculty of Medicine Comenius University Bratislava Kollárova 2 Martin 036 01 Slovakia

Department of Gastroenterology Jessenius Faculty of Medicine Comenius University Bratislava Martin Slovakia

Department of Gastroenterology Nicolae Testemitanu State University of Medicine and Pharmacy Chisinau Moldova

IBD Clinical and Research Center ISCARE a s and the 1st Faculty of Medicine Charles University Prague Czech Republic

Sf Spiridon County Clinical Emergency Hospital Iasi Romania

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Alatab S, Sepanlou SG, Ikuta K, et al.. The global, regional, and national burden of inflammatory bowel disease in 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Gastroenterol Hepatol 2020; 5: 17–30. PubMed PMC

Knowles SR, Graff LA, Wilding H, et al.. Quality of life in inflammatory bowel disease: a systematic review and meta-analyses-part I. Inflamm Bowel Dis 2018; 24: 742–751. PubMed

Zhao M, Gönczi L, Lakatos PL, et al.. The burden of inflammatory bowel disease in Europe in 2020. J Crohns Colitis 2021; 15: 1573–1587. PubMed

Gonczi L, Lakatos L, Kurti Z, et al.. Incidence, prevalence, disease course, and treatment strategy of Crohn’s disease patients from the veszprem cohort, western hungary: a population-based inception cohort study between 2007 and 2018. J Crohns Colitis 2023; 17: 240–248. PubMed

Kurti Z, Gonczi L, Lakatos L, et al.. Epidemiology, treatment strategy, natural disease course and surgical outcomes of patients with ulcerative colitis in western hungary – a population-based study between 2007 and 2018: data from the veszprem county cohort. J Crohns Colitis 2023; 17: 352–360. PubMed

Dušek L, Benešová K, Ngo O, et al.. Díl III. – Epidemiologie idiopatických strˇevních záneˇt ů v české populaci – časový vývoj a statistické predikce počtu pacientů. Gastroenterol Hepatol 2019; 73: 257–264.

Zagórowicz E, Walkiewicz D, Kucha P, et al.. Nationwide data on epidemiology of inflammatory bowel disease in Poland between 2009 and 2020. Pol Arch Intern Med 2022; 132: 16194. PubMed

Jarkovský J, Benešová K, Hejduk K, et al.. Epidemiology, hospitalization and migration of patients with IBD under specialized care in the Czech Republic. Gastroenterol Hepatol 2017; 71: 501–509.

Vegh Z, Burisch J, Pedersen N, et al.. Incidence and initial disease course of inflammatory bowel diseases in 2011 in Europe and Australia: results of the 2011 ECCO-EpiCom inception cohort. J Crohns Colitis 2014; 8: 1506–1515. PubMed

Burisch J, Pedersen N, čukovič-čavka S, et al.. East-West gradient in the incidence of inflammatory bowel disease in Europe: the ECCO-EpiCom inception cohort. Gut 2014; 63: 588–597. PubMed

Klarin I, Majnarič L, Jovanovič Z, et al.. Epidemiology and clinical presentation of inflammatory bowel disease in Zadar County, Croatia. Coll Antropol 2013; 37: 1161–1170. PubMed

Rencz F, Péntek M, Bortlik M, et al.. Biological therapy in inflammatory bowel diseases: access in Central and Eastern Europe. World J Gastroenterol 2015; 21: 1728–1737. PubMed PMC

Gregus M. The incidence and prevalence of IBD in Slovakia. Oral presentation. In: Czech and Slovak IBD conference. Prague, 2014.

Faust AH, Halpern LF, Danoff-Burg S, et al.. Psychosocial factors contributing to inflammatory bowel disease activity and health-related quality of life. Gastroenterol Hepatol 2012; 8: 173–181. PubMed PMC

Fiorino G, Lytras T, Younge L, et al.. Quality of care standards in inflammatory bowel diseases: a European Crohn’s and Colitis Organisation [ECCO] position paper. J Crohns Colitis 2020; 14: 1037–1048. PubMed

Maaser C, Sturm A, Vavricka SR, et al.. ECCO-ESGAR guideline for diagnostic assessment in IBD part 1: initial diagnosis, monitoring of known IBD, detection of complications. J Crohns Colitis 2019; 13: 144–164. PubMed

Sturm A, Maaser C, Calabrese E, et al.. ECCO-ESGAR guideline for diagnostic assessment in IBD part 2: IBD scores and general principles and technical aspects. J Crohns Colitis 2019; 13: 273–284. PubMed

Torres J, Bonovas S, Doherty G, et al.. ECCO guidelines on therapeutics in Crohn’s disease: medical treatment. J Crohns Colitis 2020; 14: 4–22. PubMed

Raine T, Bonovas S, Burisch J, et al.. ECCO guidelines on therapeutics in ulcerative colitis: medical treatment. J Crohns Colitis 2022; 16: 2–17. PubMed

Messaris E, Chandolias N, Grand D, et al.. Role of magnetic resonance enterography in the management of Crohn disease. Arch Surg 2010; 145: 471–475. PubMed

Mendoza JL, González-Lama Y, Taxonera C, et al.. Using of magnetic resonance enterography in the management of Crohn’s disease of the small intestine: first year of experience. Rev Esp Enferm Dig 2012; 104: 578–583. PubMed

Kopylov U, Yung DE, Engel T, et al.. Diagnostic yield of capsule endoscopy versus magnetic resonance enterography and small bowel contrast ultrasound in the evaluation of small bowel Crohn’s disease: systematic review and meta-analysis. Dig Liver Dis 2017; 49: 854–863. PubMed

Calabrese E, Rispo A, Zorzi F, et al.. Ultrasonography tight control and monitoring in Crohn’s disease during different biological therapies: a multicenter study. Clin Gastroenterol Hepatol 2022; 20: e711–e722. PubMed

Halpin SJ, Ford AC.Prevalence of symptoms meeting criteria for irritable bowel syndrome in inflammatory bowel disease: systematic review and meta-analysis. Am J Gastroenterol 2012; 107: 1474–1482. PubMed

Rezaie A, Gu P, Kaplan GG, et al.. Dyssynergic defecation in inflammatory bowel disease: a systematic review and meta-analysis. Inflamm Bowel Dis 2018; 24: 1065–1073. PubMed

Mao R, Xiao Y, Gao X, et al.. Fecal calprotectin in predicting relapse of inflammatory bowel diseases: a meta-analysis of prospective studies. Inflamm Bowel Dis 2012; 18: 1894–1899. PubMed

Lin J-F, Chen J-M, Zuo J-H, et al.. Meta-analysis: fecal calprotectin for assessment of inflammatory bowel disease activity. Inflamm Bowel Dis 2014; 20: 1407–1415. PubMed

Tham YS, Yung DE, Fay S, et al.. Fecal calprotectin for detection of postoperative endoscopic recurrence in Crohn’s disease: systematic review and meta-analysis. Ther Adv Gastroenterol 2018; 11: 1756284818785571. PubMed PMC

Turner D, Ricciuto A, Lewis A, et al.. STRIDE-II: an update on the Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE) initiative of the International Organization for the Study of IBD (IOIBD): determining therapeutic goals for treat-to-target strategies in IBD. Gastroenterology 2021; 160: 1570–1583. PubMed

Colombel J-F, D’haens G, Lee W-J, et al.. Outcomes and strategies to support a treat-to-target approach in inflammatory bowel disease: a systematic review. J Crohns Colitis 2020; 14: 254–266. PubMed PMC

Yang Z, Clark N, Park K.Effectiveness and cost-effectiveness of measuring fecal calprotectin in diagnosis of inflammatory bowel disease. Clin Gastroenterol Hepatol 2014; 12: 253–262.e2. PubMed PMC

Zhang W, Wong CH, Chavannes M, et al.. Cost-effectiveness of faecal calprotectin used in primary care in the diagnosis of inflammatory bowel disease. BMJ Open 2019; 9: e027043. PubMed PMC

Panaccione R, Colombel J-F, Travis SPL, et al.. Tight control for Crohn’s disease with adalimumab-based treatment is cost-effective: an economic assessment of the CALM trial. Gut 2020; 69: 658–664. PubMed PMC

Papamichael K, Cheifetz AS.Therapeutic drug monitoring in IBD: the new standard-of-care for anti-TNF therapy. Am J Gastroenterol 2017; 112: 673–676. PubMed

Fernandes SR, Bernardo S, Simões C, et al.. Proactive infliximab drug monitoring is superior to conventional management in inflammatory bowel disease. Inflamm Bowel Dis 2020; 26: 263–270. PubMed

Guidi L, Pugliese D, Tonucci TP, et al.. Therapeutic drug monitoring is more cost-effective than a clinically based approach in the management of loss of response to infliximab in inflammatory bowel disease: an observational multicentre study. J Crohns Colitis 2018; 12: 1079–1088. PubMed

Yao J, Jiang X, You JHS. A systematic review on cost-effectiveness analyses of therapeutic drug monitoring for patients with inflammatory bowel disease: from immunosuppressive to anti-TNF therapy. Inflamm Bowel Dis 2021; 27: 275–282. PubMed

Sethi S, Dias S, Kumar A, et al.. Meta-analysis: the efficacy of therapeutic drug monitoring of anti-TNF-therapy in inflammatory bowel disease. Aliment Pharmacol Ther. Epub ahead of print December 2022. DOI: 10.1111/apt.17313. PubMed DOI

Burisch J, Kiudelis G, Kupcinskas L, et al.. Natural disease course of Crohn’s disease during the first 5 years after diagnosis in a European population-based inception cohort: an Epi-IBD study. Gut 2019; 68: 423–433. PubMed

Duricova D, Pedersen N, Elkjaer M, et al.. 5-aminosalicylic acid dependency in Crohn’s disease: a Danish Crohn Colitis Database study. J Crohns Colitis 2010; 4: 575–581. PubMed

Burisch J, Bergemalm D, Halfvarson J, et al.. The use of 5-aminosalicylate for patients with Crohn’s disease in a prospective European inception cohort with 5 years follow-up – an Epi-IBD study. United Eur Gastroenterol J 2020; 8: 949–960. PubMed PMC

Zeng J, Meng Z-M, Huang X-L, et al.. Effects of 5-aminosalicylates or thiopurines on the progression of low-grade dysplasia in patients with inflammatory bowel disease: a systematic review and meta-analysis. Int J Colorectal Dis 2021; 36: 11–18. PubMed

Zhu Z, Mei Z, Guo Y, et al.. Reduced risk of inflammatory bowel disease-associated colorectal neoplasia with use of thiopurines: a systematic review and meta-analysis. J Crohns Colitis 2018; 12: 546–558. PubMed

Burisch J, Vardi H, Schwartz D, et al.. Health-care costs of inflammatory bowel disease in a pan-European, community-based, inception cohort during 5 years of follow-up: a population-based study. Lancet Gastroenterol Hepatol 2020; 5: 454–464. PubMed

Ferman M, Lim AH, Hossain M, et al.. Multidisciplinary team meetings appear to be effective in inflammatory bowel disease management: an audit of process and outcomes. Intern Med J 2018; 48: 1102–1108. PubMed

Park J, Park S, Lee SA, et al.. Improving the care of inflammatory bowel disease (IBD) patients: perspectives and strategies for IBD center management. Korean J Intern Med 2021; 36: 1040–1048. PubMed PMC

Bischoff SC, Escher J, Hébuterne X, et al.. ESPEN practical guideline: clinical nutrition in inflammatory bowel disease. Clin Nutr 2020; 39: 632–653. PubMed

Taft TH, Ballou S, Bedell A, et al.. Psychological considerations and interventions in inflammatory bowel disease patient care. Gastroenterol Clin North Am 2017; 46: 847–858. PubMed PMC

Brandt CF, Hvistendahl M, Naimi RM, et al.. Home parenteral nutrition in adult patients with chronic intestinal failure: the evolution over 4 decades in a tertiary referral center. J Parenter Enter Nutr 2017; 41: 1178–1187. PubMed

Bisschops R, East JE, Hassan C, et al.. Advanced imaging for detection and differentiation of colorectal neoplasia: European Society of Gastrointestinal Endoscopy (ESGE) guideline – update 2019. Endoscopy 2019; 51: 1155–1179. PubMed

Carballal S, Maisterra S, López-Serrano A, et al.. Real-life chromoendoscopy for neoplasia detection and characterisation in long-standing IBD. Gut 2018; 67: 70–78. PubMed

Belling R, McLaren S, Woods L.Specialist nursing interventions for inflammatory bowel disease. Cochrane Database Syst Rev. Epub ahead of print October 2009. DOI: 10.1002/14651858.CD006597.pub2. PubMed DOI

Hernández-Sampelayo P, Seoane M, Oltra L, et al.. Contribution of nurses to the quality of care in management of inflammatory bowel disease: a synthesis of the evidence. J Crohns Colitis 2010; 4: 611–622. PubMed

Smith GD, Watson R, Roger D, et al.. Impact of a nurse-led counselling service on quality of life in patients with inflammatory bowel disease. J Adv Nurs 2002; 38: 152–160. PubMed

Nightingale AJ, Middleton W, Middleton SJ, et al.. Evaluation of the effectiveness of a specialist nurse in the management of inflammatory bowel disease (IBD). Eur J Gastroenterol Hepatol 2000; 12: 967–973. PubMed

Leach P, De Silva M, Mountifield R, et al.. The effect of an inflammatory bowel disease nurse position on service delivery. J Crohns Colitis 2014; 8: 370–374. PubMed