New Research Trends in Gastroenterology: pancreatitis is in Danger

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Introduction: By definition research and development (R&D) is a process of creating new products, processes and technologies that can be used and marketed for mankind’s benefit in the future. The largest investor into and key player in health related R&D is the USA. The second largest investor into R&D is China and there is a strong will there to become a key leader in health related R&D and innovation in the future. In Europe, Germany, France, UK, Switzerland and Spain are the largest health related R&D spenders. Northern European countries are emerging from smaller countries thanks to their more intense investments in research and education. Remarkably, Central and Eastern European countries have little sources for health-related R&D. In the last decade there was a serious global decrease in the business investment due to several reasons including the global financial crisis from 2008 through 2010 affecting seriously both central and industrial funding of research. Objectives: 1) to understand the research trends in the field of gastroenterology and highlight the most endangered areas based on the gastrointestinal research publications in the last 50 years and 2) to identify possibilities of developing a better environment for pancreatic research and improvement of patient care within the framework of the Hungarian Pancreatic Study Group. Methods: We searched for PubMed hits for gastrointestinal (GI) diseases for the 1965–2015 period. Overall, 1,554,325 articles were analyzed. Since pancreatology was identified as the most endangered field of research within gastroenterology, we carried out a detailed evaluation of research activity in pancreatology. Results: In 1965, among the major benign GI disorders, 51.9% of the research was performed on hepatitis, 25.7% on pancreatitis, 21.7% on upper GI diseases and only 0.7% on the lower GI disorders. Half a century later, in 2015, research on hepatitis and upper GI diseases had not changed significantly; however, studies on pancreatitis had dropped to 10.7%, while work on the lower GI disorders had risen to 23.4%. With regard to the malignant disorders (including liver, gastric, colon, pancreatic and oesophageal cancer), no such large-scale changes were observed in the last 50 years. Detailed analyses revealed that besides the drop in research activity in pancreatitis, there are serious problems with the quality of the studies as well. Only 6.8% of clinical trials on pancreatitis were registered and only 5.5% of these registered trials were multicentre and multinational (more than five centres and nations), i.e., the kind that provides the highest level of impact and evidence level. In the second part of the thesis I describe the steps the Hungarian Pancreatic Study Group has made as a start for improvement. The activity of the study group includes the development of the Pancreatic Registry and Biobank, initiation of observational clinical trials, also the adaptation of the international evidence based guidelines and disseminating them through publication, trainings and courses. Conclusions: There has been a clear drop in research activity in pancreatitis. New international networks and far more academic R&D activities should be established in order to find the first therapy specifically for acute pancreatitis. The analysis has also confirmed that multinational-multicentre trials are of higher quality, providing higher evidence and impact, but the share of the multinational-multicentre studies are very low. Consequently, there is still much space for improving both the quantity and quality of research activity in the field of pancreatology. Current barriers in pancreatology should be eliminated by an international research network, cooperation between pancreatic communities in different countries that will result in more and higher quality prospective multicenter observational clinical trials and randomized controlled trials, evidence based guidelines available in more countries, improvement of compliance through education, influence on national financing of pancreatology, ultimately in quality research.

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