How to Choose Liver Specialists

If you've been diagnosed with a chronic hepatitis infection, an immediate concern you may have is how to find the right doctors to help you manage your condition. If you happen to live in a community where viral hepatitis is prevalent, your primary care physician (PCP) may have enough experience with the disease to provide you with adequate care.

It's more likely, however, that you'll want to see a liver specialist—either a hepatologist or gastroenterologist. What's more, if you're co-infected with HIV, which is relatively common with some types of hepatitis infections, you also may need to bring in an infectious disease specialist. Having the right team of healthcare providers for your situation will be essential to ensuring you get the best care possible.

Even if your PCP has had little experience treating hepatitis and refers you to a liver specialist, they should still play a vital role in managing your condition.

First, they will help you to make informed decisions about the most appropriate course of your care. They also will serve as the liaison among your other doctors—the hepatologist or gastroenterologist who will be your liver specialist and, if you need one, your infectious disease specialist. In this capacity, your PCP can make sure all your providers are on the same page so that there are no disruptions in your care.

Equally important, your primary care physician can help you set goals for improving your overall health, which will be key to how well you respond to treatment for your hepatitis infection. This may include reducing your alcohol intake, dealing with substance abuse, helping you to adhere to your treatment, or referring you to mental health or social work services if you need them.

When it comes to selecting a specialist to treat hepatitis, there are two choices: a gastroenterologist or a hepatologist. Both are qualified to treat liver diseases but are somewhat different in how they've been trained. Understanding these differences can help inform your decision about which to choose.

A gastroenterologist is a doctor who is board-certified in internal medicine as well as in gastroenterology. In order to obtain the latter credential, they must have completed a two- to three-year fellowship in gastroenterology, which involves in-depth study of disorders of the digestive tract organs. In addition to the liver, these include the stomach, intestines, pancreas, and gallbladder.

By contrast, a hepatologist is trained to specifically treat disorders of the liver as well as its associated organs—the pancreas and gallbladder. There is no specific certification exam for hepatology, but there are intense one- and two-year fellowships during which a specialist-in-training receives extensive exposure to the broad range of liver disorders.

In addition, a transplant hepatologist is specially trained to manage advanced liver disease and liver transplants. Transplant hepatology is one-year fellowship after completing a general gastroenterology fellowship. It is an accredited board-certified fellowship.

While common sense might dictate that a doctor trained in liver disorders is better suited to treat hepatitis infections, it’s not always the case. While a hepatologist will invariably be well-versed in both current and experimental treatments for liver disease, there is no fundamental reason why a hepatologist is better suited to treat hepatitis than a gastroenterologist.

Whichever type of specialist you choose, it's important to find a doctor who not only has the right credentials but who is someone with whom you can share mutual trust and transparency. It's your right to ask a doctor you're considering to take over your care any questions that will help you to feel they are both qualified and will be open and attentive.

While some liver specialists may have experience in the treatment and management of HIV, many don’t. So if you are co-infected with HIV, you will want to seek out an infectious disease specialist.

They will be able to prescribe the antiretroviral therapy necessary to treat your HIV and to make sure any medications you take are not contraindicated for use with hepatitis drugs.

An infectious disease specialist also can monitor your liver enzymes to make sure your antiretroviral treatment does not cause any side effects that can adversely impact your liver function and that your HIV viral load is controlled during the course of hepatitis therapy. This way, you can be sure that you're receiving the safest and most effective care for both infections.