Future research demands of the United European Gastroenterology (UEG) and its member societies

Introduction

The vast majority of European medical associations started as an assembly of national societies of the same subspecialty (e.g. gastroenterology, cardiology, rheumatology etc.) but display a much higher diversity not only due to the heterogeneity of languages across Europe. They tend to organise themselves as ‘umbrella organizations’ focusing on harmonization, training and education, while leaving research initiatives mostly in the hands of either national societies or subspecialty societies. This is no different in the United European Gastroenterology (UEG) federation that was founded in 1992 by the ‘Seven Sisters’: Association of National European and Mediterranean Societies of Gastroenterology (ASNEMGE), European Society of Gastrointestinal Endoscopy (ESGE), European Association of Gastroenterology, Endoscopy, and Nutrition (EAGEN), European Association for the Study of the Liver (EASL), European Federation International Society for Digestive Surgery (EFISDS), European Pancreatic Club (EPC), European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) (for the history see the UEG video). ¹

However, from the very beginning the situation in European gastroenterology was quite different from the situation in other medical specialties. Gastroenterology, being organ-based, was already split into seven subspecialties that have increased subsequently by another 10 ‘sister societies’ representing different aspects of medical and surgical gastroenterology, including clinical, research as well as education angles. In fact, many – but not all – of the sister societies (e.g. the European Society of Neurogastroenterology and Motility (ESNM) and the European Crohn’s and Colitis Organisation (ECCO)) started out with a strong focus on research, leaving clinical management and medical education up to either the national gastroenterological societies or the representation of the national societies under the umbrella of the UEG.

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Table 1.

Research topics identified with the six questions (Q1–Q6) and shared by three of more of the 13 specialist societies of the United European Gastroenterology Federation (UEG). For details of the methodology, see text and Supplementary Material 1 and 2.

Question	Topic	Shared by
Q1	Life-style, nutrition, diet	5
	High-tech medicine	4
Q2	Host-microbe interaction	7
	Immunity	5
	Gut-brain interaction	3
Q3	Biomarkers	7
	Artificial intelligence,  precision medicine	5
Q4	EU trials, networks	2
	Studies, epidemiology	5
	Biomarkers	5
Q5	Education	4
	Studies, trials	3
Q6	Education	4
	Screening, surveillance	4

Under these complicated circumstances it is easily conceivable that developing a research agenda would be challenging for the UEG, leading to possible competition due to rather diverse research interests of the individual societies under its umbrella. To bundle the various research activities of the UEG and its member societies, to foster common research activities for all of the UEG, and to develop and promote future research plans, the UEG established a Research Committee with representatives of all member societies in 2017, which paved the way for subsequent actions, among which the survey reported here is just one. It was preceded by the ‘white book project’, ² a successful attempt to collect epidemiological data illustrating the range as well as the economic and social burden of major gastroenterological diseases across Europe, with emphasis on the differences and similarities between individual countries.

However, as outlined in the UEG strategic plan 2019–2022, the ultimate goal and mission of the UEG is to act as the united and trusted voice of all fields of European gastroenterology. ³ Its strategic research objectives are (among others):

Initiating and stimulating collaborative research efforts to support our member societies in facilitating digestive health research in Europe.

These objectives require not only harmonization of clinical and educational strategies across Europe, but also outlining of future demands and requirements for diagnostic and therapeutic developments, patient management and research that needs to be accomplished to provide better health care in all areas of medicine. The publication of the UEG White Book ² was a step in this direction, as it established a lobbying platform in Brussels, including formal meetings with European stakeholders and politicians, and fostered European gastroenterology grant applications. ⁴ With this in mind, the UEG Research Committee initiated a survey of the current and future research interests of each individual UEG ordinary member society (specialist societies). The development of a map of these interests was another attempt towards this common goal.

Methods

Results

Evaluation B: key terms and global sorting

From the extracted key sentences per question across all societies, we identified and highlighted terms denoting society-specific research topics (Figure 1(a)), as well as those that appeared across more than one society’s answers (Figure 1(b)). OPEN IN VIEWER

Figure 1.

Example of the qualitative analysis of answers, here for Question 1 and 4. (a) All answers of all societies to Question 1, with the raw answers (left), answers identified as society-specific (middle, yellow), and topics that occur in more than one societies’ statement (right, marked in different colours); (b) The same sorting for Question 4 where society-specific topics were not identified, but three topics for more than two societies.

By following this strategy, we identified 14 topics across the six questions that were of common interest to at least two societies, and in the majority of cases to four or more societies (Table 1). They can be sorted into five clusters, each with two aspects (Table 2).

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Table 2.

Clustered research topics and aspects of research. For details of the methodology, see text and Supplementary Material 1 and 2.

Cluster	Aspect 1	Aspect 2
1: Hot topics in research	Life-style, nutrition, diet, obesity	Microbiota-host interaction, immunity
2: Biomarkers	Biomarkers, profiling, genetics	Gut-brain interaction, enteric nervous system,  neural controls
3: Advanced technology	Hi-tech imaging, artificial intelligence,  precision medicine	Personalised medicine
4: Global research tools	Biobanking, surveillance, trials, studies	EU trials, epidemiology, networks, surveys,
5: Medical training	Education, support	Prevention

The society statements attributed to each of the clusters are shown in Supplementary Material 2.

Discussion

In agreement with the strategic plan of UEG as of 2018, ³ the Research Committee set out to follow up its initial ‘White Book’ initiative ² with a survey among its member societies asking for ‘the most urgent need' in various research areas (basic, translational, clinical, patient management, prevention) to stimulate collaborative research efforts among them, to establish a network and platform of researchers and to increase EU funding for digestive health research. ⁴ In the past, digestive health research has been poorly funded by EU calls. This was deemed necessary especially because of the wide range of clinical and scientific activities under the umbrella of UEG, as compared to other medical subspecialties.

The approach chosen was an open, though structured, questionnaire to the respective research boards and/or chairpersons of the 17 member societies, similar to a project conducted under the supervision of the European Society of Gastrointestinal Endoscopy (ESGE) among its national member societies. ⁶ It was meant to provide an unsupervised and unbiased survey to distil important research topics across the entire gastroenterological field. Yet, it carried the risk of being dominated by the interests of single societies that are stronger in research, and in funding for research, than others. While it was surprising to see that most of the 17 societies responded favourably to the request, it has to be noted that for unknown reasons four (=23%) societies did not respond. This is indicative of the fact that UEG still needs to put some efforts into reaching out to all European gastroenterologists, at least with respect to research activities under its umbrella.

As we have discussed above, while the chosen approach (open questions) may have been close to optimal to receive a response, it was fairly suboptimal to standardise the volume of responses received, and instead allowed too much variability in answering. Thereby, it prevented a simple and quantitative evaluation and, instead, required a semi-quantitative or a vigorous qualitative approach to overcome the quantitative imbalance. For this, we had no valid template but had to develop one in the course of the study.

By extracting core statements for each question and each society, subsequently eliminating society-specific and trivial research demands, and finally condensing research questions that are nominated by two or more societies, we were able to identify 10 research topics that cluster into five areas, most of which were coherent with the majority of member societies involved.

The key remaining, yet unanswered, question is how this can be turned into a research or a research-supporting agenda, from an UEG point of view in the future. For a start, the societies that have named similar research interests within one cluster or aspect should join forces and collaborate on topics they otherwise would promote and conduct ‘on their own’, as this clearly will enhance their chances to receive national and European funding. In a similar fashion, the UEG can provide support for collaborative research proposals along these clusters and aspects, rather than for individualised projects, as done currently done with their educational projects. Finally, the clusters would allow more coordinated political lobbying for future UEG-funded research projects, e.g. for the UEG Public Affairs Committee, that would overcome current limitations, ⁴ and would also feed into other initiatives, e.g. the Biomed-Alliance.

Supplemental Material