Hepatologist vs. Gastroenterologist

The diseases hepatologists and gastroenterologists treat have some overlap, and those with liver disease in particular may wonder if they should see one, the other, or both.

While a gastroenterologist diagnoses and treats diseases involving all 10 components of the digestive tract, the liver being just one, a hepatologist's focus is limited to only the liver, gallbladder, pancreas, and bile ducts.

Weighing the differences between a gastroenterologist vs. a hepatologist can help you and your primary care provider decide who you should see to diagnose and help manage liver disease.

Hepatologist vs. Gastroenterologist Training

Gastroenterologists and hepatologists learn about many of the same organ systems, but the specifics of their education and training are a little different depending on where their focus is.

• A hepatologist is trained to treat disorders of the liver, pancreas, gallbladder, and bile ducts. There is no specific certification exam to specialize in hepatology, but there are intense one- and two-year fellowships during which a specialist-in-training receives extensive exposure to a broad range of liver disorders.
• In addition, a transplant hepatologist is specially trained to manage advanced liver disease and liver transplants. Transplant hepatology involves a one-year fellowship after completing a general gastroenterology fellowship. It is an accredited board-certified fellowship.
• A gastroenterologist is a provider who is board certified in both internal medicine and gastroenterology. To obtain the latter credential, they must complete a two- to three-year fellowship in gastroenterology, which involves an in-depth study of disorders of the digestive tract organs (the liver, esophagus, stomach, small intestine, large intestine, pancreas, gallbladder, bile ducts, rectum, and anus).

Diagnoses and Treatment

You might assume that a provider who is trained in liver disorders is better suited to treat hepatitis, but that’s not always the case.

For example, while a hepatologist will likely know more about current and experimental treatments for liver disease, it does not mean they are necessarily better at caring for patients with the disease than a gastroenterologist.

Both providers use many of the same approaches to diagnosing and treating liver diseases.

• A gastroenterologist can diagnose and treat liver problems, as well as other digestive organs that can be affected by them. They can use a combination of exams, blood tests, and imaging scans to look at your liver, see how it's functioning, and recommend treatment.
• A hepatologist is more focused on the liver and the organs near it. They can use some of the same tests, like bloodwork and imaging, to check your liver function. If they are a specialist in transplants, they may want to talk to you about a liver transplant if that's necessary.

Deciding Between a Hepatologist and a Gastroenterologist

Choosing a gastroenterologist vs. hepatologist will also come down to your needs, not just the training, experience, and expertise of the provider. It's important for you to find someone that you feel comfortable with who answers your questions and addresses your concerns.

Other Members of Your Liver Care Team

It's likely that more than one practitioner will help you manage your liver disease and its impact on your overall health.

Even if your primary care provider refers you to a gastroenterologist or hepatologist, they will still be an important part of your care team. And if you have HIV, an infectious disease specialist will also play an important role.

Primary Care Provider

Your primary care provider, or PCP, will help you make informed decisions about the most appropriate course of your care.

Your primary care provider also serves as the liaison among your other providers, including the hepatologist or gastroenterologist. In this role, your primary care provider will make sure all your other providers are on the same page to prevent any disruptions to your care.

Your primary care provider will also be the one to help you set goals for improving your overall health, which will be key to how well you respond to liver disease treatment.

For example, you may work on reducing your alcohol intake, dealing with substance use, finding strategies to help you stick with your treatment, or getting a referral to mental health or social work services if you need them.

Infectious Disease Specialists

Some liver specialists have experience treating and managing HIV, but many do not. If you have liver disease and are also infected with HIV, you will need to see an infectious disease specialist.

An infectious disease provider can make sure that you are getting the safest and most effective care for both conditions. They can prescribe antiretroviral therapy to treat HIV and make sure that any medications you need to take will not interact with any liver drugs you take (for example, those that treat hepatitis).

An infectious disease specialist also can watch your liver enzymes to make sure the antiretroviral treatment does not cause any side effects or affect your liver function. The tests can also check to make sure that your HIV viral load is controlled while you are getting therapy for hepatitis.

Summary

If you have liver disease, including hepatitis, comparing a gastroenterologist vs. a hepatologist will probably be one of the first steps you take in your care. Your primary care provider can help you figure out which specialist you need to see—you may even work with both.

Whichever provider you choose, make sure that you feel comfortable with them. Ask them any questions you have about your treatment and care.