Who Is a Gastroenterologist?
A gastroenterologist is a type of physician who specializes in disorders of the digestive tract. This includes all of the organs that span the alimentary canal from the mouth to the anus, as well as the liver. Gastroenterologists must undergo training and certification in internal medicine before pursuing a subspecialty in gastroenterology. In addition to the study of digestive physiology and diseases, gastroenterologists are trained to perform procedures like endoscopy used in diagnosis and treatment.
A gastroenterologist may be the primary point of care for people with chronic or serious gastrointestinal (GI) diseases. In most cases, however, people would be referred to a gastroenterologist if a digestive problem is beyond the scope of practice of a family doctor, internist, or primary care physician.
Gastroenterology is the study of the function and diseases of the esophagus, stomach, small intestine, colon, rectum, pancreas, gallbladder, bile ducts, and liver. It involves an in-depth understanding of digestion, nutrient absorption, gastrointestinal motility, and the function of the liver indigestion.
The aim of the gastroenterologist is to identify and treat conditions affecting the normal function of the digestive tract, both common and uncommon. These include:
- Anorectal fistulas, fissures, or abscesses
- Celiac disease (CD)
- Crohn’s disease
- Colon polyps
- Colorectal cancer
- Diverticular disease
- Fatty liver disease
- Gallbladder diseases (such as gallstones, cholecystitis, or gallbladder cancer)
- Gastroesophageal reflux disease (GERD)
- Hiatal hernia
- Irritable bowel syndrome (IBS)
- Liver cancer
- Peptic ulcer
- Stomach cancer
- Ulcerative colitis
- Viral hepatitis
According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), 60 to 70 million Americans are affected by a digestive disorder, resulting in over 21 million hospitalizations and 48 million doctor visits each year.
In addition to treatment, gastroenterologists perform cancer screenings to detect malignancies early, when they are most easily treated.
A gastroenterologist’s expertise extends from the evaluation and treatment of digestive disorders to the prevention of disease and the maintenance of good gastrointestinal health.
The diagnostic tools used by a gastroenterologist are extensive and include lab tests, radiologic studies, directing imaging tests, and tissue studies. Here are just some of the tools central to a gastroenterology practice:
- Abdominal X-ray
- Abdominal ultrasound
- Barium enema
- Barium swallow
- Capsule endoscopy
- Colonoscopy (including virtual colonoscopy)
- Computed tomography (CT) scan of the abdomen, pancreas, or liver and biliary tract
- Exploratory laparoscopy
- Liver biopsy
- Upper GI endoscopy
The treatments a gastroenterologist may explore range from medications and lifestyle changes to surgery and organ transplantation. Some of these can be provided by the gastroenterologist; others may require a team of specialists, including surgeons, dietitians, and oncologists.
The list of drugs used to treat digestive disorders is extensive and may include antibiotics, antacids, antidiarrheals, proton pump inhibitors (PPIs), H2 blockers, and promotility agents like Reglan (metoclopramide). Over-the-counter medications like stool softeners, laxatives, fiber supplements, nonsteroidal anti-inflammatory drugs (NSAIDs), and hemorrhoid creams may also be prescribed.
In addition to medications, various procedures may be used to manage or cure a digestive disorder. In some cases, all that may be needed are changes in diet or eating habits in tandem with weight loss, exercise, and smoking cessation.
More intensive treatments are sometimes required, particularly in cases of cancer, bowel perforation, or severe inflammatory bowel disease (IBD). Examples include:
- Biliary stenting (used to unblock the bile duct)
- Gallstone or biliary stone removal (via ERCP or MRCP)
- Polypectomy (removal of colon polyps via thermal ablation, electrocautery, etc.)
Some gastroenterologists choose to specialize in specific disorders or organ symptom. One of the most common is hepatology, devoted to the study of the liver.
Others will partake in fellowships and training in subspecialties such as inflammatory bowel diseases, colorectal cancer, gastrointestinal motility, interventional endoscopy, neurogastroenterology, pediatric gastroenterology, and transplant hepatology, among others.
Training and Certification
Gastroenterologists undergo no less than 13 years of education and practical training to achieve a board certification. This includes three years of fellowship training devoted specifically to the diagnosis, management, treatment, and prevention of gastrointestinal diseases. Hepatology requires an additional one-year fellowship.
The fellowship training is overseen one or several national societies, including the American Board of Internal Medicine (ABIM), the American College of Gastroenterology (ACG), the American Gastroenterological Association (AGA), and the American Society for Gastrointestinal Endoscopy (ASGE).
Once the fellowship training is complete, certification can be obtained by passing the gastroenterology board exam administered by the ABIM.
Some gastroenterologists receive special recognition for extraordinary achievements in gastroenterology. Those afforded the honor are declared Fellows of the ACG or ACP, denoted by the letters FACG or FACP after their names.
- Greenberger, N.; Blumberg, R.; and Burakoff, R. (2011) Current Diagnosis and Treatment: Gastroenterology, Hepatology, and Endoscopy. New York, New York: McGraw Hill Professional.
- National Institute of Diabetes and Digestive and Kidney Disorders. Digestive Diseases Statistics for the United States. Bethesda, Maryland: National Institutes of Health; updated November 2014.
- Northup, P.; Argo, C.; DeCross, A. et al. Procedural Competency of Gastroenterology Trainees: From Apprenticeship to Milestones. Gastroenterol. 2013 Apr;144(4):677-80. DOI: 10.1053/j.gastro.2013.02.020.