What 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)
• Gastroenteritis
• Gastroesophageal reflux disease (GERD)
• Hemorrhoids
• Hiatal hernia
• Irritable bowel syndrome (IBS)
• Liver cancer
• Pancreatitis
• Peptic ulcer
• Stomach cancer
• Ulcerative colitis
• Viral hepatitis

People are often referred to a gastroenterologist if the cause of a disorder cannot be found or there is an abnormal finding in a stool test or abdominal X-ray. Among some of the symptoms that may warrant an investigation by a gastroenterologist:

• Abnormal stool color
• Anal leakage
• Bloody stools (hematochezia)
• Chronic abdominal pain or cramping
• Chronic constipation or diarrhea
• Chronic heartburn and indigestion
• Chronic nausea or vomiting
• Difficulty swallowing (dysphagia)
• Excessive bloating or gas
• Loss of appetite
• Loss of bowel control
• Malnutrition
• Pain when swallowing (odynophagia)
• Rectal bleeding
• Sudden changes in blood habit
• Unexplained weight loss
• Yellowing of the eyes and/or skin (jaundice)

In addition to treatment, gastroenterologists perform cancer screenings to detect malignancies early, when they are most easily treated. As of 2018, adults at average risk in the United States are advised to get a colonoscopy every 10 years starting at age 45 to screen to for colon cancer.

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
• Sigmoidoscopy
• 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.

Medications

Newer pharmaceutical medications often target specific components of the digestive tract or treat specific conditions. Examples include:

• Aemcolo (rifamycin), used for relief of traveler's diarrhea
• Entyvio (vedolizumab), used for ulcerative colitis and Crohn's disease
• Keytruda (pembrolizumab), used for certain types of stomach, colon, or esophageal cancer
• Onivyde (irinotecan liposome), used for metastatic pancreatic cancer
• Opdivo (nivolumab), used for metastatic colorectal cancer
• Symproic (naldemedine), used for opioid-induced constipation
• Viberzi (eluxadoline), used for IBS with diarrhea
• Viokace (pancrelipase), used for pancreatic insufficiency
• Xerava (eravacycline), used to treat intra-abdominal infections
• Zinplava (bezlotoxumab), used for recurrent Clostridium difficile infection

Procedures

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.

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.

Meeting a gastroenterologist for the first time can be uncomfortable given that most people don't like to discuss things like bowel movements, gas, or diarrhea. It is important not to let this get in the way of a diagnosis. The more accurately you describe your symptoms—including things like the consistency, smell, and color of stools—the sooner the doctor will know where to start the investigation.

If you have chronic symptoms, keep a journal outlining the time, date, duration, and specifics of each event. Be sure to write down what you were doing at the time, including the foods you ate and whether you were stressed, lying down, or exercising vigorously.

Moreover, ask as many questions as you need to fully understand the procedures and what a test result may or may not mean. Examples include:

• What do you suspect is causing my symptoms?
• What tests can you use to confirm this?
• What is involved in the test?
• How long will it take to get the results?
• What can I do in the meantime to control my symptoms?
• Are there things I am doing that make my symptoms worse?
• Is my condition something that needs to be managed, or can it be cured?

If the out-of-pocket costs are too high, ask the gastroenterologist if there are any less costly alternatives. In some cases, the gastroenterologist may offer an upfront cash discount or an interest-free installment plan.

When searching for a gastroenterologist, a professional referral is usually the best place to start. Ask your primary care physician for a list of local referrals. The ACG also provides an online locator to find board-certified specialists in your area. People searching for a hepatologist can use the ACG liver specialist locator.

To check a physician's certification, use the online verification portal offered by the American Board of Medical Specialties (ABSM).

The DocInfo website managed by the Federation of State Medical Boards (FSMB) also allows you to review a doctor's education, the states in which the doctor is licensed, and any legal or disciplinary actions taken against the doctor.