May 2024
Medical Country of Origin Information

Bangladesh

Gastroenterology

Bangladesh
Gastroenterology
MedCOIMay 2024

Manuscript completed in May 2024
Neither the European Union Agency for Asylum (EUAA) nor any person acting on behalf of the
EUAA is responsible for the use that might be made of the information contained within thispublication.
Luxembourg: Publications Office of the European Union, 2024
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ISBN 978-92-9410-111-2

doi: 10.2847/981297 BZ-02-24-514-EN-N© European Union Agency for Asylum (EUAA), 2024
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BANGLADESH TOPICAL MEDCOI REPORT: GASTROENTEROLOGY

Acknowledgements
The EUAA acknowledges International SOS as the drafters of this report.
The report has been reviewed by International SOS and EUAA.

3

EUROPEAN UNION AGENCY FOR ASYLUMContents
Acknowledgements........................................................................................................................ 3
Disclaimer ........................................................................................................................................ 5
Glossary and abbreviations ........................................................................................................... 6
Introduction ..................................................................................................................................... 8
Methodology ......................................................................................................................................... 8
Terms of reference...................................................................................................................... 8
Collecting information ................................................................................................................ 8
Quality control .............................................................................................................................. 8
Sources ................................................................................................................................................... 9
1.

Gastrointestinal diseases ................................................................................................ 10
1.1. Peptic ulcer, incidence and prevalence ............................................................................... 11
1.2. Upper gastrointestinal symptoms, incidence and prevalence....................................... 11
1.3. Irritable bowel syndrome (IBS), incidence and prevalence ........................................... 121.4. Pancreatitis, incidence and prevalence .............................................................................. 121.5. Inflammatory bowel disease (IBD), incidence and prevalence ..................................... 12
1.5.1.

Ulcerative colitis........................................................................................................... 12

1.5.2.

Crohn’s disease ............................................................................................................13

1.6. Gastroesophageal reflux disease (GERD), incidence and prevalence ........................13
1.7. Diseases of colon and rectum, incidence and prevalence .............................................13
2.

Access to treatment ..........................................................................................................14

3.

Cost of treatment ..............................................................................................................15

4.

Cost of medication ............................................................................................................18

Annex 1: Bibliography .................................................................................................................. 23
Annex 2: Terms of Reference (ToR) ............................................................................................ 26

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BANGLADESH TOPICAL MEDCOI REPORT: GASTROENTEROLOGY

Disclaimer
This report was written according to the EUAA COI Report Methodology (2023). The report isbased on carefully selected sources of information. All sources used are referenced.
The information contained in this report has been researched, evaluated and analysed withutmost care. However, this document does not claim to be exhaustive. If a particular event,person or organisation is not mentioned in the report, this does not mean that the event has
not taken place or that the person or organisation does not exist.
Furthermore, this report is not conclusive as to the determination or merit of any particularapplication for international protection. Terminology used should not be regarded asindicative of a particular legal position.
‘Refugee’, ‘risk’ and similar terminology are used as generic terminology and not in the legal
sense as applied in the EU Asylum Acquis, the 1951 Refugee Convention and the 1967
Protocol relating to the Status of Refugees.
Neither the EUAA, nor any person acting on its behalf, may be held responsible for the use
which may be made of the information contained in this report.
The drafting of this report was finalised on 25 February 2024. Any event taking place after thisdate is not included in this report.

5

EUROPEAN UNION AGENCY FOR ASYLUMGlossary and abbreviations
Term

Definition

BDT

Bangladeshi Taka

BSMMU

Bangabandhu Sheikh Mujib Medical University

CEA

Carcinoembryonic Antigen

CT

Computed Tomography

CVD

Cardiovascular Diseases

DM

Diabetes Mellitus

ERCP

Endoscopic Retrograde Cholangiopancreatography

GERD

Gastroesophageal Reflux Disease

HDL

High-Density Lipoprotein

ICU

Intensive Care Unit

IBS

Irritable Bowel Syndrome

IPD

Inpatient Department

KCl

Potassium ChlorideLDL

Low-Density Lipoprotein

MOHFW

Ministry of Health and Family Welfare

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BANGLADESH TOPICAL MEDCOI REPORT: GASTROENTEROLOGY

TermDefinition

MRI

Magnetic Resonance Imaging

NaCl

Sodium Chloride

NaHCO₃

Sodium Bicarbonate

OPD

Outpatient Department

PET

Positron-Emission Tomography

UpazilaAn administrative unit, which is a subdivision of a district
formerly known as “thana”. Bangladesh has 495 Upazilas.

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EUROPEAN UNION AGENCY FOR ASYLUM

Introduction
Methodology
The purpose of the report is to provide information on access to gastroenterology treatment in
Bangladesh. This information is relevant to the application of international protection statusdetermination (refugee status and subsidiary protection) and migration legislation in EU+
countries.

Terms of reference
The terms of reference for this Medical Country of Origin Information Report can be found in
Annex 2: Terms of Reference (ToR). The initial drafting period finished on 09 November 2023,
peer review occurred between 09-30 November 2023, and additional information was added
to the report as a result of the quality review process during the review implementation up
until 25 February 2024. The report was internally reviewed subsequently.

Collecting information
EUAA contracted International SOS (Intl.SOS) to manage the report delivery including datacollection. Intl.SOS recruited and managed a local consultant to write the report and a publichealth expert to edit the report. These were selected from Intl.SOS’ existing pool ofconsultants. The consultant was selected based on their experience in leading comparable
projects and their experience of working on public health issues in Bangladesh.
This report is based on publicly available information in electronic and paper-based sources
gathered through desk-based research. This report also contains information from oral
sources with ground-level knowledge of the healthcare situation in Bangladesh who wereinterviewed specifically for this report. For security reasons, all oral sources are anonymised.

Quality control
This report was written by Intl.SOS in line with the European Union Agency for Asylum (EUAA)
COI Report Methodology (2023), 1 the EUAA Country of Origin Information (COI) Reports
Writing and Referencing Guide (2023) 2 and the EUAA Writing Guide (2022). 3 Quality control of
the report was carried out both on content and form. Form and content were reviewed by
Intl.SOS and EUAA.
The accuracy of information included in the report was reviewed, to the extent possible,
based on the quality of the sources and citations provided by the consultants. All the

EUAA, Country of Origin Information (COI) Report Methodology, February 2023, url
EUAA, Country of Origin Information (COI) Reports Writing and Referencing Guide, February 2023, url
3
EUAA, The EUAA Writing Guide, April 2022, url
12

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BANGLADESH TOPICAL MEDCOI REPORT: GASTROENTEROLOGY

comments from reviewers were reviewed and were implemented to the extent possible, undertime constraints.

Sources
In accordance with EUAA COI methodology, a range of different published sources have been
consulted on relevant topics for this report. These include: governmental publications,academic publications, reports by international organisations, as well as Bangladeshi
pharmaceutical websites.
In addition to using publicly available sources, two oral sources were contacted for this report.
The oral sources are both professors and they are anonymised in this report for security
reasons. The sources were assessed for their background and ground-level knowledge. Alloral sources are described in the Annex 1: Bibliography. Key informant interviews were carriedout in September 2023.

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EUROPEAN UNION AGENCY FOR ASYLUM

1.

Gastrointestinal diseases

Common diseases of the gastrointestinal system encountered in Bangladesh are peptic ulcers(including gastric and duodenal ulcer), pancreatitis, irritable bowel syndrome (IBS),
inflammatory bowel disease, infective diarrhoeal diseases, colorectal cancer and intestinal
tuberculosis. 4 Based on disease severity and seriousness of the condition, patients seen in theUpazila health complex are then advised to visit district hospitals or above for further
investigation and treatment. Usually, uncomplicated cases of gastrointestinal systems aremanaged at the Upazila level and below in public health facilities. 5
There is a specialised national institute called the Sheikh Russel National Gastrointestinal
Institute & Hospital 6 in Dhaka for treating gastrointestinal diseases. This 250-bed hospital has
paediatric, medical and surgical gastroenterology, anaesthesia and intensive care unit (ICU),
laboratory medicine, radiology and imaging, and nursing departments. 7
Links of other private hospitals that provide services for gastroenterology are provided inTable 1 below.
Table 1. Private hospitals that provide services for gastroenterology
Facility

Web address

1.

https://sebaghar.com/hospital/24/Gastro-Liver-Hospital-ResearchInstitute-Ltd

Gastro Liver Hospital& Research InstituteLtd.

2. Dhaka Gastro-Liver
Center

https://dhakagastrolivercenter.com

3.

Crescent Gastroliver& General Hospital

https://crescentgastroliver.com/ws/details.php?cid=2&id=17426

4.

Evercare Hospital
Dhaka

https://www.evercarebd.com/dhaka/specialities/gastroenterologyhepatology/

5. Asgar Ali Hospital

https://www.asgaralihospital.com

Source A, telephone interview, 14 September 2023, Dhaka. Source A is a Professor of Medicine at Mymensingh
Medical College. The person wishes to remain anonymous.
5
Source A, telephone interview, 14 September 2023, Dhaka. Source A is a Professor of Medicine at Mymensingh
Medical College. The person wishes to remain anonymous.
6
Sheikh Russel National Gastrointestinal Institute & Hospital, 2023, url
7
Sheikh Russel National Gastrointestinal Institute & Hospital, Department, 2023, url
4

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BANGLADESH TOPICAL MEDCOI REPORT: GASTROENTEROLOGY

Facility

Web address

6. United Hospital

https://www.uhlbd.com/bn/consultant/departments/gastro-liver-centre

1.1.

Peptic ulcer, incidence and prevalence

Peptic ulcers are sores in the lining of stomach or duodenum. 8 An interview with a medical
specialist revealed gastric and duodenal ulcers to be common conditions encountered in daily
medical practice in Bangladesh, although population-based data on gastric or duodenal ulcer
prevalence and incidence is not available for Bangladesh due to a lack of recent large clinicalstudies. 9 However, a retrospective multicentre study on gastric and duodenal ulcer conducted
between January 2012 and July 2013 reported duodenal ulcer incidence to be 7.4 % andgastric ulcer incidence to be 3.28 %. 10
Another study conducted in an urban medical college in Dhaka amongst patients with peptic
ulcer disease showed a higher prevalence of gastric ulcers (54.5 %) as compared to duodenal
ulcers (29 %). About 56 % of the studied respondents were female and belonged to age group
41 to 50 years. Almost 55.69 % of respondents had pain that was exacerbated after ingestionof food, and 52.09 % had loss of appetite. 11

1.2.

Upper gastrointestinal symptoms, incidence andprevalence

A 2014 study on upper gastrointestinal symptoms conducted in the general population
reported the existence of multiple concurrent disease symptoms. Symptom prevalence variedin number, frequency and duration of symptoms. More than 3 in 4 people (75.8 %) had at least
1 upper gastrointestinal symptom, whereas 7 out of 10 respondents (69.1 %) had 2 or more
symptoms and over half of the respondents (56.8 %) had 3 or more upper gastrointestinal
symptoms in the 3 months preceding the interviews. Study results revealed that 32.1 % of
respondents had upper abdominal pain, 42.16 % had bloating, 45.13 % had heartburn, 38.87 %had chest pain, 44.9 % had early satiation and 8.6 % had vomiting. According to this study,
40.56 % of dyspeptic patients had overlapping gastroesophageal reflux disease (GERD)
symptoms. 12

NIDDK, Definition & Facts for Peptic Ulcers (Stomach or Duodenal Ulcers), 2022, url
Source A, telephone interview, 14 September 2023, Dhaka. Source A is a Professor of Medicine at Mymensingh
Medical College. The person wishes to remain anonymous.
10
Ghosh, C. K., et al., Peptic Ulcer Disease in Bangladesh: A Multi-centre Study, January 2017, url, p. 141
11
Saber, S., et al., Study on Socio-Demographic Profile of Peptic Ulcer Disease in A Tertiary Care Teaching Hospital,
Dhaka, Bangladesh, February 2021, url, p. 12
12Perveen, I., et.al, Upper Gastrointestinal Symptoms in General Population of a District in Bangladesh, January
2014, url, p. 79
8

9

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EUROPEAN UNION AGENCY FOR ASYLUM

1.3.

Irritable bowel syndrome (IBS), incidence andprevalence

The reported prevalence of IBS in the first study conducted in 2001 among people aged 15
years and older in the rural population in Bangladesh was 24.4 %.13 A more recent study from2022, done to determine prevalence of IBS within university students, reported a prevalenceof 39.3 %. 14

1.4.

Pancreatitis, incidence and prevalenceAhmed et al. conducted a study on the clinical features of pancreatitis. They found the male tofemale ratio was 1.78 : 1. The most common factors of causality for pancreatitis were gallstones(18 %) and alcoholism (10 %). The study population reported symptoms of abdominal pain,
nausea and vomiting. 15 Pancreatitis was either acute or chronic. While acute pancreatitis may
be mild to life threating, most deaths due this disease occurred when the disease progressed
to severe acute pancreatitis. Overall mortality of the study population was 6 %. 16

1.5.

Inflammatory bowel disease (IBD), incidence andprevalence

IBD is a broad term that describes conditions characterised by chronic inflammation of thegastrointestinal tract. The two most common inflammatory bowel diseases are ulcerative
colitis and Crohn’s disease. 17

1.5.1.

Ulcerative colitis

A hospital-based study conducted between 1990 and 2010 at the Bangabandhu Sheikh Mujib
Medical University (BSMMU) in Dhaka looked at patients who had previously been diagnosed,
or who had been recently diagnosed, with ulcerative colitis. Study findings reveal that a higher
proportion of males are affected (65.24 %) than females (34.76 %). 87.28 % of the study
respondents had bloody diarrhoea, 20.12 % had per rectal bleeding, and 4.26 % had diarrhoea
without per rectal bleeding. 18

Masud, M. A., et al., Irritable Bowel Syndrome in a Rural Community in Bangladesh: Prevalence, Symptoms
Pattern, and Health Care Seeking Behavior, May 2001, url, p. 1547
14
Das, A., et al., Prevalence of irritable bowel syndrome and its associated risk factors among university students of
Bangladesh, June 2022, url, p. 421
15
Ahmed, K. U., et al., Clinical profile of acute pancreatitis in a teaching hospital, March 2017, url, p. 7
16
Ahmed, K. U., et al., Clinical profile of acute pancreatitis in a teaching hospital, March 2017, url, pp. 11-12
17CDC, Inflammatory bowel disease (IBD), 2023, url
18
Chowdhury, M. S.et al., Clinical presentation of ulcerative colitis among Bangladeshi population twenty years’
experience from a tertiary care hospital in Bangladesh, 2013, url, p. 19
13

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BANGLADESH TOPICAL MEDCOI REPORT: GASTROENTEROLOGY

1.5.2.

Crohn’s disease

A separate BSMMU study reviewed patients diagnosed with Crohn’s disease from 1991 to2010. The study identified arthritis, aphthous ulcers, erythema nodosum and episcleritis, which
are extra intestinal clinical features of Crohn’s disease. In this study, 70.7 % of the respondents
were male and 29.3 % were female. 19

1.6.

Gastroesophageal reflux disease (GERD),
incidence and prevalence

GERD usually presents clinically with burning sensation behind the chest (retrosternal) and / orregurgitation that mimics flow of acidic materials in the mouth, occasionally with difficulty inswallowing and sore throat with or without cough. 20
A study on the prevalence and risk factors for GERD, between January and June 2015 in arural community of Bangladesh, reported the prevalence of GERD to be 6.8 %. Study results
show a higher prevalence in patients with diabetes, the elderly and specifically within the
Muslim community. 21 Another study on GERD conducted in Northeast Bangladesh reported aprevalence of 5.5 % and the results showed a higher prevalence in females (6.73 %) ascompared to males (4.41 %). The highest prevalence (18.8 %) of GERD was found in the agegroup of 55 to 65 years.22

1.7.

Diseases of colon and rectum, incidence andprevalence

According to the cancer country profile (2020) of Bangladesh, colorectal cancer incidence andmortality in the country are 3.8 and 2.3 per 100 000 population. Colorectal cancer is ninth outof the 10 most common cancers in Bangladesh. 23 A BSMMU demographic andclinicopathological evaluation study found that the most common clinical features of colorectal
cancers are rectal bleeding (38.7 %) and generalised weakness, and pale colour of the skin. 24
Another study on the symptoms of colorectal carcinoma conducted from 2009 to 2010 at
BSMMU showed that per rectal bleeding was the most common (40 %) finding in patients. 25

Barua, R., et al., Extraintestinal Manifestations of Crohn's Disease in Bangladesh, 2010, url, p. 58
Guarner et al., Maps of Digestive Disorders & Diseases, WGO, n.d., url, p. 7
21
Ghosh, D. K., et al., Gastroesophageal Reflux Disease: Prevalence and Its Risk Factors in Rural Bangladesh, 2018,
url, p. 45
22Shaha, M., et al., Prevalence and risk factors for gastro-esophageal reflux disease in the North-Eastern part of
Bangladesh, 2012, url, p. 111
23
WHO, IARC, Globocan, Bangladesh fact sheet, March 2021, url, p. 2
24
Shiraj-Um-Mahmuda, S., et al., Demographic and Clinicopathological Evaluation of Colorectal Adenocarcinoma in
Bangladesh at a Tertiary Level Hospital, January 2023, url, p. 1
25
Raza, A. M., et al., Clinico-demographic Characteristics of Colorectal Carcinoma in Bangladeshi Patients, January
2016, url, p. 24
19

20

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EUROPEAN UNION AGENCY FOR ASYLUM

2.

Access to treatment

Patients with any gastrointestinal symptoms, such as abdominal pain, discomfort andoccasionally even diarrhoea, seek care at an Upazila or union healthcare centre, or a private
healthcare facility, where they are clinically assessed and physically examined by theattending healthcare provider, following which investigations may be requisitioned as
required. After the relevant investigation of stool, vomitus or blood samples, patients are
confirmed for their exact diagnosis at these centres. 26
With countrywide health network of Upazila health complexes and their downstream healthfacilities in the unions and below, the Ministry of Health and Family Welfare (MOHFW) in
Bangladesh is able to provide health services for diseases of gastrointestinal system to its
population. Private hospitals, clinics and private practice done by the doctors from public
hospitals also meet demands of health service requirements for these patients. There are no
cultural, geographical or ethnic barriers to access of treatment. 27
With an increasing patient load due to the country’s large population, waiting times to visit
specialists for gastrointestinal diseases are likely to be high. The typical route for a patientwith this disease is to visit the Upazila health complexes or their downstream health facilities
and get advice from the attending health personnel about the need to see a specialist either
in district health facilities or specialist hospitals. This causes issues in the system. On the other
hand, they get right treatment at their earliest, which most of the time is desirable. The same
scenario is applicable for a citizen returning to the country after having spent a number ofyears abroad. 28

Source A, telephone interview, 14 September 2023, Dhaka. Source A is a Professor of Medicine at Mymensingh
Medical College. The person wishes to remain anonymous.
27
Source A, telephone interview, 14 September 2023, Dhaka. Source A is a Professor of Medicine at Mymensingh
Medical College. The person wishes to remain anonymous.
28
Source A, telephone interview, 14 September 2023, Dhaka. Source A is a Professor of Medicine at Mymensingh
Medical College. The person wishes to remain anonymous.
26

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BANGLADESH TOPICAL MEDCOI REPORT: GASTROENTEROLOGY

3.

Cost of treatment

Patients are required to pay for each consultation either at outpatient departments (OPDs) or
inpatient departments (IPDs), for diagnostic services and for hospital bed charges if
hospitalised. This applies to both public and private health facilities. The waiver for any
discounted payment for any of the elements of consultations either in OPD or IPD, hospitalcharges for admittance, and laboratory charges in the public hospitals and other healthcare
facilities can be available if the Social Welfare Departments evaluate and certify. Private
facilities have no provision to exempt patients from payment for any hospital service charge. 29
The EUAA MedCOI general report for the Bangladesh health system notes the high rate ofout-of-pocket health expenditure across the country and that health expenditure is one of themain reasons for poverty and deprivation amongst low-income households. 30
Official prices are fixed for laboratory investigations, fees for consultations, rents for patients’
bed and operation charges in public facilities; these are strictly implemented. Health insurance
coverage for diseases of the gastrointestinal system is not available in Bangladesh. 31
For the treatments listed below, there is usually no exemption, but in public health facilities theSocial Welfare Department can recommend a partial or full discount to the fee. 32
Table 2. Prices for consultation 33
Specialist

Publicoutpatient
treatment pricein BDT

Public inpatient
treatment pricein BDT

Privateoutpatient
treatment pricein BDT

Private inpatient
treatment pricein BDT

Gastroenterologist

300

500

1 200

1 800

Surgeon

300

500

1 200

1 800

Oncologist

300

500

1 200

1 800

Source B, telephone interview, 20 September 2023, Dhaka. Source B is a Professor of Chest Diseases at LabAid
Private Hospital in Dhaka. The person wishes to be anonymous.
30
EUAA, Healthcare Provision in Bangladesh, June 2023, url, p. 39
31
Source A, Professor of Medicine at Mymensingh Medical College, Telephone Interview, 14 September 2023
32
Source B, telephone interview, 20 September 2023, Dhaka. Source B is a Professor of Chest Diseases at LabAid
Private Hospital in Dhaka. The person wishes to be anonymous.
33
Source B, telephone interview, 20 September 2023, Dhaka. Source B is a Professor of Chest Diseases at LabAid
Private Hospital in Dhaka. The person wishes to be anonymous.
29

15

EUROPEAN UNION AGENCY FOR ASYLUMTable 3. Prices for treatments and diagnostic tests 34
Public treatment price in
BDTPrivate treatment price in
BDTLaboratory test: electrolytes:
sodium, calcium, potassium,chloride, phosphate, andmagnesium

300

800

Laboratory test: faecal
calprotectin: stool test for
intestinal inflammation/ diseaseactivity

3 000

5 000

Laboratory test: lipid profile (totalcholesterol, HDL cholesterol, LDL
cholesterol, triglycerides)

600

1 500

Laboratory test: pancreas function(amylase, lipase)

900

1 200

Laboratory test: tumor marker:
CEA (Carcinoembryonic antigen)

450

900

Laboratory test: reticulocytes
counting in blood

300

600

Diagnostic imaging: oesophagogastro-duodenoscopy

1 500

2 500

Diagnostic imaging:
sigmoidoscopy

1 000

2 000

Ultrasound imaging of theabdomen

1 000

2 500

Diagnostic imaging: endoscopy

2 500

5 000

Diagnostic imaging: endoscopic
ultrasound

1 000

3 000

Diagnostic imaging: colonoscopy

2 500

5 000

Diagnostic imaging: MRI scan

4 000

10 000Laboratory measurements

Medical imaging

Source B, telephone interview, 20 September 2023, Dhaka. Source B is a Professor of Chest Diseases at LabAid
Private Hospital in Dhaka. The person wishes to be anonymous.
34

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BANGLADESH TOPICAL MEDCOI REPORT: GASTROENTEROLOGY

Public treatment price in
BDTPrivate treatment price in
BDT

Diagnostic imaging: integrated
PET/CT- scan

4 000

5 500 to 10 000

Diagnostic imaging: computed
tomography (CT) scan

4 000

10 000Diagnostic imaging: computed
tomography (CT) scan with
contrast

5 000

10 000Diagnostic imaging: endoscopic
retrograde
cholangiopancreaticography(ERCP)

5 000

15 000Diagnostic test: gastric tissue
biopsy300

1 500

Diagnostic test: colon biopsy

1 400

2 500

Surgery; specificallygastrointestinal: colostomy
operation and closure

13 50040 000Gastroenterology: enema

600

1 440

Surgery: specificallygastrointestinal surgery

7 500

15 000Surgery, specifically fundoplication
surgery for gastro-oesophageal
reflux disease

22 500100 000

Surgery: specific gastrointestinal:
ileostomy

13 50018 000Surgery: specific gastrointestinal;(segmental) duodenal resection

13 50030 000Surgery: specific gastrointestinal;
Whipple operation/procedure

100 000

800 000

Surgery: specificallygastrointestinal: to restore biledrainage

12 50030 000Surgery; specificallygastrointestinal: colostomy
operation and closure

13 50040 000Treatments

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EUROPEAN UNION AGENCY FOR ASYLUM

Oncology: radiation therapy

4.

Public treatment price in
BDTPrivate treatment price in
BDT

15 000 per session

50 000 per session

Cost of medication

Prices from online medicine shops are provided in Table 5. Cost of medications. These aretaken from the following websites:
Table 4. Online medicine websites
Website nameWeb address

Lazz Pharma Limited

https://www.lazzpharma.com

MedEx

https://medex.com.bd
https://epharma.com.bd

ePharma

https://www.arogga.com

AroggaRelating to all medicines in the table below; medication prices are usually not reimbursed byany public health insurance mechanisms, but the Social Welfare Department can recommend
free or partial payment for the public facilities. 35

Source B, telephone interview, 20 September 2023, Dhaka. Source B is a Professor of Chest Diseases at LabAid
Private Hospital in Dhaka. The person wishes to be anonymous.
35

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BANGLADESH TOPICAL MEDCOI REPORT: GASTROENTEROLOGY

Table 5. Cost of medications
Generic
Name

Brand nameStrength of
unit

Form

Numberof units inthecontainer

Price perbox in
BDT

Place(pharmacy,
hospital,…)For constipation / laxatives
Macrogol +electrolytes[KCl, NaCl,NaHCO₃(=bicarbonate)]

GOL™

13.125 gm
macrogol,
178.500 gm
potassiumchloride,350.700 gm,
sodiumbicarbonate,46.600 gm
sodiumchloride

Suspension

1

160

Pharmacy

Sodiumphosphate(as enema)

Anema®

(7 gm dibasic
sodiumphosphate,
19 gm
monobasic
sodiumphophate)/118 ml

Liquid1

250

Pharmacy

Sodium acidphosphate

Phosphoprep®

(2.711 gm
sodiumdihydrogen
phosphate,
1.2 gmdisodiumhydrogenphophate)/5 ml

Liquid1

230

Pharmacy

Sodiumlaurylsulfoacetate/ sodiumcitrate /sorbitolenema
Microlax®

Micolett®

133 mlLiquid1

250

Pharmacy

Lactulose

Avolac®

100 mlLiquid1

170

Pharmacy

Lactitol

Fibolac®

10 g

Powder1

40

Pharmacy

Bisacodyl

Duralax®

5 mg

Tablet20

142

Pharmacy

19

EUROPEAN UNION AGENCY FOR ASYLUMGeneric
Name

Brand nameStrength of
unit

Form

Numberof units inthecontainer

Price perbox in
BDT

Place(pharmacy,
hospital,…)Sodiumpicosulfate

Abdolax®

10 mg

Tablet30

300

Pharmacy

Psylliumseeds

Ispergul®

3.5 g

Powder15

150

PharmacyΑmoxicillin

Moxacil®

500 mgCapsule1075

Pharmacy

ClarithromycinClarimax®

250 mgCapsule10270

Pharmacy

Metronidazole

Nidazyl®

400 mgTablet10170

Pharmacy

Tinidazole

T-zol™

500 mgTablet1028

Pharmacy

Tetracycline

Tetrasina®

250 mgTablet10

17

Pharmacy

Levofloxacin

Levoflox

750 mgTablet10201

Pharmacy

Antibiotics

Aminosalicylates
Sulfasalazine

Salazine®

500 mgSuppository

10

100

Pharmacy

Mesalazine

Mesacol®

400 mgTablet50

379

Pharmacy

Betamethasone

Bet-A®

0.5 mgTablet100

85

Pharmacy

Prednisolone

Prednisolone®

5 mg

Tablet200

240

Pharmacy

Methylprednisolone

Depomed®

4 mg

Tablet50

300

Pharmacy

Corticosteroids

Histamine-2-receptor antagonists
Cimetidine

GCimetidine®

200 mg/2 ml

Injection

1060

Pharmacy

Famotidine

Famotack®

20 mg

Tablet100

200

Pharmacy

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BANGLADESH TOPICAL MEDCOI REPORT: GASTROENTEROLOGY

Generic
Name

Brand nameStrength of
unit

Form

Numberof units inthecontainer

Price perbox in
BDT

Place(pharmacy,
hospital,…)ImmunosuppressantsAzathioprine

Imruza®

50 mg

Tablet30

600

Pharmacy

Ciclosporin

Neoral®

100 mgCapsule50

11 700

Pharmacy

Tacrolimus

Crilomus®

1 mg

Capsule50

2 500

Pharmacy

Methotrexate

Meth®

2.5 mgTablet28

112

Pharmacy

Mycophenolate mofetil

Graftcept®

500 mgTablet30

1 950

Pharmacy

Sodiumalginate +sodiumbicarbonate+ calcium
carbonate

Ariscon®

(500 mg
sodiumalginate,
267 mgNaHCO₃,160 mgcalciumcarbonate)/10 mlSuspension

200 ml250

Pharmacy

Magnesiumhydroxide +aluminiumoxide

Acedone-Z®

400 mgmagnesiumhydroxide,
250 mgaluminium

tablet200

106

Pharmacy

Antacids

Proton Pump Inhibitor
Esomeprazole

Esigerd®

20 mg

Tablet50

250

Pharmacy

Omeprazole

Losectil®

20 mg

Capsule120600

Pharmacy

Pantoprazole

Panprazo®

20 mg

Tablet50

225

Pharmacy

Lansoprazole

Lansec®

30 mg

Capsule50

302

Pharmacy

40 mg/0.8 ml

Injection1

15 000

Pharmacy

TNF alpha blockers
Adalimumab

Adalimab21

EUROPEAN UNION AGENCY FOR ASYLUMGeneric
Name

Brand nameStrength of
unit

Form

Numberof units inthecontainer

Price perbox in
BDT

Place(pharmacy,
hospital,…)Infliximab

Remicade®

100 mg/20 ml

Injection

1

32 554

Pharmacy

Golimumab

Simponi®

50 mg/0.5 ml

Injection

1

51 131

Pharmacy

Etanercept

Etacept®

50 mg/ml

Injection

1 ml

13 635

Pharmacy

Against diarrhea
Loperamide

Lopamid®

2 mg

Capsule100

100

Pharmacy

Colestyramine

Hepacol®

4gtablet60

1 866

Pharmacy

Octreotide

Sandostatin®

50 mcg/ml

Injection

5

1 810

Pharmacy

Bismuth

Bispep®

87.5 mg/5 ml

Suspension

100 ml75

Pharmacy

Subsalicylate

Peptocid®

87.5 mg/5 ml

Suspension

200 ml95

Pharmacy

Gastroprotection
Sucralfate

Protecto®

1 000 mg

Tablet50

300

Pharmacy

Misoprostol

Indula®

200 mcg

Tablet30

450Pharmacy

22

BANGLADESH TOPICAL MEDCOI REPORT: GASTROENTEROLOGY

Annex 1: Bibliography
Oral sources, including anonymous sources
Source A, telephone interview, 14 September 2023, Dhaka. Source A is a Professor of
Medicine at Mymensingh Medical College. The person wishes to remain anonymous.
Source B, telephone interview, 20 September 2023, Dhaka. Source B is a Professor of Chest
Diseases at LabAid Private Hospital in Dhaka. The person wishes to be anonymous.

Public sources
Ahmed, K. U., Ahad, M. A., Alim, M. A. and Ekram, A. S., Clinical profile of acute pancreatitis in ateaching hospital, in: Bangladesh Medical Journal Khulna, Vol. 49, Issues 1 and 2, March 2017,
http://dx.doi.org/10.3329/bmjk.v49i1-2.31818, pp. 7-12, accessed 1 October 2023
Arogga Limited, 2024, http://www.arogga.com/, accessed 29 March 2024
Barua, R., Ahmed, D. S., Raihan, A., Azad, M. A. K., Chakrovorty, S. K. and Azad, M. A. K.,
Extraintestinal Manifestations of Crohn's Disease in Bangladesh, in: Bangladesh Journal of
Medicine, Vol. 21, 2010, https://doi.org/10.3329/bjmed.v21i2.13611, pp. 58-59, accessed 1
October 2023
CDC (Centers for Disease Control and Prevention), Inflammatory bowel disease (IBD), 2023,
https://www.cdc.gov/ibd/index.htm, accessed 1 October 2023
Chowdhury, M. S., Khan, M. M. R., Rahman, M. Z., Saha, M., Dhakala, G. P., Roy, P. K. andRaihan, A. S. M. A., Clinical presentation of ulcerative colitis among Bangladeshi population
twenty years’ experience from a tertiary care hospital in Bangladesh, in: Bangabandhu Sheikh
Mujib Medical University Journal, Vol. 6, Issue 1, 2013,https://doi.org/10.3329/bsmmuj.v6i1.29016, pp. 16-20, accessed 1 October 2023
Das, A., Razon, A. H., Ahmad, T. and Paul, D. K., Prevalence of irritable bowel syndrome and its
associated risk factors among university students of Bangladesh, in: Journal of
Gastroenterology and Hepatology, Vol. 6, Issue 6, June 2022, pp. 363-442
https://doi.org/10.1002/jgh3.12757, accessed 1 October 2023
Epharma, 2024, https://epharma.com.bd/, accessed 29 March 2024
EUAA (European Union Agency for Asylum), Provision of healthcare in Bangladesh, Medical
Country of Origin Information Report, European Union Agency for Asylum, 2023,
https://euaa.europa.eu/publications/provision-healthcare-bangladesh, accessed 8 January
2024
Ghosh, C. K., Khan, M. R., Alam, F., Shil, B. C., Kabir, M., Mahmuduzzaman, M., Das, S. C.,
Masud, H. and Roy, P., Peptic Ulcer Disease in Bangladesh: A Multi-centre Study, in:23

EUROPEAN UNION AGENCY FOR ASYLUM

Mymensingh Medical Journal, Vol. 26, Issue 1, January 2017,https://pubmed.ncbi.nlm.nih.gov/28260768/, pp. 141-144, accessed 1 October 2023
Ghosh, D. K., Nath, M., Ghosh, C. K., Ahmed, A., Rahim, S. and Rowshon, A., Gastroesophageal
Reflux Disease: Prevalence and Its Risk Factors in Rural Bangladesh, in: Bangladesh Medical
Research Council Bulletin, Vol. 44, Issue 1, 2018, available by subscription:
https://doi.org/10.3329/bmrcb.v44i1.36804, pp. 45-51, accessed 1 October 2023
Guarner, Lázaro, Gascón, Royo, Eximan and Herrero, Maps of Digestive Disorders & Diseases,
World Gastroenterology Organisation (WGO), n.d.,
https://www.worldgastroenterology.org/UserFiles/file/wdhd-2008-map-of-digestivedisorders.pdf, accessed 1 October 2023
Lazz Pharma Limited, https://www.lazzpharma.com/, accessed 29 March 2024
Masud, M. A., Mahmud, H., Azad Khan, A. K., Irritable Bowel Syndrome in a Rural Community in
Bangladesh: Prevalence, Symptoms Pattern, and Health Care Seeking Behavior, American
Journal of Gastroenterology, Vol. 96, Issue 5, May 2001, available by subscription:
https://doi.org/10.1111/j.1572-0241.2001.03760.x, pp. 1547-1552, accessed 1 October 2023
MedEx, n.d., https://medex.com.bd, accessed 29 March 2024
NIDDK (National Institute of Diabetes and Digestive and Kidney Diseases), Definition & Facts
for Peptic Ulcers (Stomach or Duodenal Ulcers), 2022, https://www.niddk.nih.gov/healthinformation/digestive-diseases/peptic-ulcers-stomach-ulcers/definition-facts, accessed 24
September 2023
Perveen, I., Rahman, M. M. and Saha, M., Upper Gastrointestinal Symptoms in General
Population of a District in Bangladesh, in: Journal of Enam Medical College, Vol. 4, January
2014, https://www.banglajol.info/index.php/JEMC/article/view/19458, pp. 79-88, accessed 1
October 2023
Raza, A. M., Kamal, M., Begum, F., Yusuf, Md. A., Mohammad, D., Begum, M. and Talukder, A.
R., Clinico-demographic Characteristics of Colorectal Carcinoma in Bangladeshi Patients, in:Journal of Current and Advance Medical Research, Vol. 3, January 2016,
https://doi.org/10.3329/jcamr.v3i1.29388, pp. 22-25, accessed 1 October 2023
Saber, S., Alam, M. T., Hossain, M. M. and Alam, R. F., Study on Socio-Demographic Profile of
Peptic Ulcer Disease in A Tertiary Care Teaching Hospital, Dhaka, Bangladesh, in: European
Journal of Medical and Health Sciences, Vol. 3, Issue 1, February 2021,
https://www.researchgate.net/publication/351722128_Study_on_SocioDemographic_Profile_of_Peptic_Ulcer_Disease_in_A_Tertiary_Care_Teaching_Hospital_Dha
ka_Bangladesh, pp. 12-15, accessed 1 October 2023
Shaha, M., Perveen, I., Alamgir, M., Masud, M. and Rahman, M., Prevalence and risk factors for
gastro-esophageal reflux disease in the North-Eastern part of Bangladesh, in: Bangladesh
Medical Research Council Bulletin, Vol. 38, Issue 3, 2012,https://doi.org/10.3329/bmrcb.v38i3.14338, pp. 108-113, accessed 1 October 2023

24

BANGLADESH TOPICAL MEDCOI REPORT: GASTROENTEROLOGY

Sheikh Russel National Gastrointestinal Institute & Hospital, 2023, https://srngih.gov.bd/,
accessed 24 September 2023
Sheikh Russel National Gastrointestinal Institute & Hospital, Department, 2023,
https://srngih.gov.bd/page/department, accessed 24 September 2023
Shiraj-Um-Mahmuda, S., Begum, F., Rahman, Md. M., Rahman, P., Islam, T., Shabnam, U. S.,
Emita, U.-T.-N., Afroz, S., Abedin, N., Zahan, A. and Islam, K. B. M. S., Demographic andClinicopathological Evaluation of Colorectal Adenocarcinoma in Bangladesh at a Tertiary Level
Hospital, in: Cancer Studies and Therapeutics Journal, Vol. 8, Issue 1, January 2023,
https://researchopenworld.com/demographic-and-clinicopathological-evaluation-of-colorectaladenocarcinoma-in-bangladesh-at-a-tertiary-level-hospital/, pp. 2-8, accessed 1 October 2023
WHO (World Health Organization), IARC (International Agency for Research on Cancer), The
Global Cancer Observatory (Globocan), Bangladesh fact sheet, March 2021,
https://gco.iarc.fr/today/data/factsheets/populations/50-bangladesh-fact-sheets.pdf, accessed
1 October 2023

25

EUROPEAN UNION AGENCY FOR ASYLUM

Annex 2: Terms of Reference (ToR)
Gastroenterology
Note for drafters: These are guidelines on the information to be included. If one aspect is
not relevant, e.g., there is no national institute to treat this disease or no international
donor programme, there is no need to mention it. Keep the focus on treating medicine –preventive care can be mentioned but is of less interest to the target group.

General information
•

•
•
•

•
•
•
•

Briefly describe prevalence and incidence of gastrointestinal diseases(gastroesophageal reflux disease, peptic ulcer, inflammatory bowel disease, stomach
and colorectal cancers / types of this disease (epidemiologic data).
How is the health care organized for gastrointestinal diseases?
How are gastrointestinal diseases treated – at specific centres, in primary health care
centres, secondary care / hospitals, tertiary care etc.?
Which kinds of facilities can treat gastrointestinal diseases [public, private not for profit(e.g., hospitals run by the church), private for-profit sector]? Include links to facilities’
websites if possible.
How are the resources organized in general to treat patients with gastrointestinal
diseases? Are there sufficient resources available to treat all patients?
Is there a particular type of gastrointestinal diseases for which no (or only partial)
treatment exists in the country?
Is there a (national) institute specialised in treating gastrointestinal diseases?
Are there any national or international plans or (donor) programmes for gastrointestinal
diseases; if yes, could you elaborate on such programme(s) and what it entails?

Access to treatment
•
•
•

•
•

Are there specific treatment programmes for gastrointestinal diseases? If so, what are
the eligibility criteria to gain access to it and what they contain?
Are there specific government (e.g., insurance or tax) covered programmes for
gastrointestinal diseases? If so, what are the eligibility criteria to gain access to it?
Are there any factors limiting the access to healthcare for patients? If so, are theyeconomic, cultural, geographical, etc.? Are there any policies to improve access tohealthcare and/or to reduce the cost of treatments and/or medication? What is thenumber of people having access to treatment? Keep focus on e.g., waiting times rather
than the exact number of specialists in the field.
If different from information provided in the general section; is the treatment
geographically accessible in all regions?
What is the ‘typical route’ for a patient with this disease (after being diagnosed with thedisease)? In other words: for any necessary treatment, where can the patient find help
26

BANGLADESH TOPICAL MEDCOI REPORT: GASTROENTEROLOGY

•
•
•

•

and/or specific information? Where can s/he receive follow-up treatment? Are there
waiting times for treatments (e.g., colonoscopy, consultation by a gastroenterologist,
etc)?
What must the patient pay and when?
Is it the same scenario for a citizen returning to the country after having spent a
number of years abroad?
What financial support can a patient expect from the government, social security or apublic or private institution? Is treatment covered by social protection or an additional /communal health insurance? If not, how can the patient gain access to a treatment?
Any occurrences of healthcare discrimination for people with this disease?

Insurance and national programmes•••

National coverage (state insurance).
Programmes funded by international donor programmes, e.g., Gates foundation,
Clinton foundation etc.
Include any insurance information that is specific for patients with this disease.

Cost of treatment
Guidance / methodology on how to complete the tables related to treatments:
•
•
•

•
•
•
•

Do not delete any treatments from the tables. Instead state that they are not available
or information could not be found if that is the case.
In the table, indicate the price for inpatient and outpatient treatments in public andprivate facilities and if the treatments are covered by any insurance or by the state.
For inpatient, indicate what is included in the cost (bed / daily rate for admittance,
investigations, consultations…). For outpatient treatment, indicate follow up or
consultation cost.
Is there a difference in respect to prices between the private and public facilities?
Are there any geographical disparities?
Are the official prices adhered to in practice?
Include links to online resources used, if applicable (e.g., hospital websites).

Note: a standardised list of treatments was also included in the original ToR, as can beviewed in the report. Any treatment without a found price was removed at the editorial
stage.

Cost of medication
Guidance / methodology on how to complete the tables related to medications:••

Do not delete any medicines from the tables. Instead, state that they are not available
or information could not be found if that is the case.
Are the available medicines in general accessible in the whole country or are there
limitations?
27

EUROPEAN UNION AGENCY FOR ASYLUM

•
•
•

•
•

Are the medicines registered in the country? If yes, what are the implications of it
being registered?
Indicate in the tables: generic name, brand name, strength of unit, form, pills per
package, official prices, source, insurance coverage.
Are (some of the) medicines mentioned on any drug lists like national lists, insurance
lists, essential drug lists, hospital lists, pharmacy lists etc.? If so, what does such a list
mean specifically in relation to coverage?
Are there other kinds of coverage, e.g., from national donor programmes or otheractors?
Include links to online resources used, if applicable (e.g., online pharmacies).

Note: a standardised list of medication was also included in the original ToR, as can beviewed in the report. Any medication without a found price was removed at the editorial
stage.

NGOs (include if relevant, otherwise delete section)••

Are any NGOs or international organisations active for patients with gastroenterology
diseases? What are the conditions to obtain help from these organisations? What help
or support can they offer?
Which services are free of charge and which ones are at a cost? Is access provided to
all patients or access is restricted for some (e.g., in case of faith-based institutions or incase of NGOs providing care only to children for instance).

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ISBN 978-92-9410-111-2

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BZ-02-24-514-EN-N

BANGLADESH TOPICAL MEDCOI REPORT: GASTROENTEROLOGY