Telemedicine for Chronic Digestive Diseases: A Systematic Qualitative Review

According to 2004 statistics from the National Digestive Diseases Information Clearinghouse, digestive diseases affect 60-70 million people in the United States, resulting in 105 million ambulatory visits and 13.5 million hospitalizations. The cost burden associated with these diseases is high. It is estimated that direct and indirect medical costs related to digestive diseases are $98 billion and $44 billion, respectively. Chronic digestive diseases make up a significant proportion of these disorders, including but not limited to celiac disease, chronic constipation, chronic pancreatitis, cirrhosis, Crohn’s disease, gastroesophageal reflux disease, irritable bowel syndrome, ulcerative colitis, and viral hepatitis. Telemedicine has been used successfully in chronic conditions such as asthma, diabetes, and congestive heart failure. In patients with asthma, telemedicine improves symptoms, decreases use of quick relief inhalers, improves adherence with self-action plans, improves quality of life and patient knowledge, and decreases urgent care visits (Joshi et al, 2005). In diabetes, telemedicine reduces glycosylated hemoglobin levels (Quinn et al, 2009). Telemedicine improves quality of life, and decreases hospitalizations and costs in congestive heart failure (Roth et al, 2004). Telemedicine has proven to be a feasible and well accepted method of treatment delivery in the field of gastroenterology as well. A systematic review of scientific publications was performed in order to identify all studies conducted examining the application of telemedicine in digestive diseases. Database searches in MEDLINE, the Cochrane Controlled Trials Register, and Web of Science Conference Proceedings Citation Index were done with the following search terms: telemedicine, gastroenterology, inflammatory bowel disease, ulcerative colitis, Crohn’s disease, gastroesophageal reflux disease, hepatitis C, hepatitis B, chronic liver disease, cirrhosis, constipation, irritable bowel syndrome, microscopic colitis, celiac disease and chronic pancreatitis. This search yielded telemedicine studies conducted in one of three disease states: inflammatory bowel disease with a specific focus in ulcerative colitis, irritable bowel syndrome, and chronic viral hepatitis C. In this chapter, we will review the use of telemedicine for these chronic digestive diseases and the effect of telemedicine on access to care, disease activity, education, and quality of life.