The Specialists on Your IBD Team

Inflammatory bowel disease (IBD) is a complicated condition and many people who live with these diseases see several specialists. A gastroenterologist is usually the physician that oversees most of the care of people who live with Crohn's disease, ulcerative colitis, or indeterminate colitis.

However, because IBD puts people at risk for other diseases and conditions, as well as certain complications, there may be several other healthcare professionals on the care team. Having a relationship with healthcare providers in different specialties is helpful when problems outside of the digestive system, called extra-intestinal manifestations, occur.

Here are some of the other types of specialists that may be part of the healthcare team for people who live with IBD.

Gastroenterologist

For people who have IBD, a gastroenterologist is a main point of contact. A gastroenterologist is a physician who has learned how to care for people who live with diseases of the esophagus, stomach, small intestine, colon, rectum, pancreas, gallbladder, bile ducts, and liver.

Gastroenterologists may also specialize in IBD, because the disease is so complicated, especially in patients who have severe disease. For people who live with IBD, a gastroenterologist will order tests, prescribe medications, and help in referring to other doctors or specialists when needed.

A gastroenterologist will also perform endoscopy procedures, such as an upper endoscopy, colonoscopy, or sigmoidoscopy, to look inside the digestive tract. Having these procedures to look inside the digestive system is important to learn about what's going on and to take biopsies.

A gastroenterologist will also order blood tests, which are part of regular IBD care. However, it is the endoscopy procedures that offer the most information about inflammation inside the digestive tract. 

A gastroenterologist will see to the signs and symptoms of the IBD but can also advise on other issues. IBD affects the whole person and it can lead to signs and symptoms outside of the digestive tract, which are called extra-intestinal complications.

People with IBD are also at risk for other conditions both because of the inflammation the disease causes and sometimes due to the medications used to treat the disease. For that reason, there may be referrals to other specialists in order to keep track of these potential complications outside the digestive tract.

Primary Care Physician 

A primary care physician is another doctor who is important in the care of people with IBD. For some patients, their primary care doctor may be a first point of contact and acts as the lead person on the healthcare team.

A primary care physician will be able to address some of the concerns that may not be managed by a gastroenterologist. For people with IBD this can include preventive care, vaccinations, smoking cessation, and cancer screenings.

People who live with IBD, and especially those who receive immune-suppressing medications, should be fully vaccinated against infectious diseases. This means going over records of when some shots were received in the past and deciding when to get boosters as well as new vaccinations.

However, many IBD patients do not receive the vaccinations that they need. A primary care provider can help make sure vaccinations are up to date, which is especially important before starting certain medications, like biologics.

Dermatologist

Skin problems are common for people with IBD and can include some serious conditions such as psoriasis, skin cancer, erythema nodosum, and pyoderma gangrenosum.

Some of the medications that are used to treat IBD have been connected with an increased risk of skin cancer. For this reason, a dermatologist is often an important part of the IBD healthcare team.

For many people with IBD, a yearly skin cancer screening will be recommended. For those who have dealt with some skincare issues in the past, or who also have psoriasis, more frequently visits may be needed.

People with IBD should have a low threshold for seeing a dermatologist about skin problems, because small issues can become large, complicated ones fairly quickly. A gastroenterologist may be able to help in determining when seeing a dermatologist is appropriate, beyond the yearly skin cancer screening. 

Ophthalmologist

People with IBD are at increased risk of certain eye conditions. Some of these include uveitis, episcleritis, cataracts, and glaucoma. Some of these eye problems are connected to taking certain medications but others are related to IBD and can occur before or during an IBD flare-up.

For this reason, it's important to see an eye doctor, an ophthalmologist, on a regular basis. As long as there are no issues, it may be recommended that people with IBD see an ophthalmologist every year or every few years for a check-up.

Colorectal Surgeon

Surgery is one type of treatment for IBD. People with IBD may have surgery on their digestive tract for a variety of reasons. This includes resection to remove a part of the bowel, placing an ostomy, creating a j-pouch, repairing fistulas, or removing abscesses. Colorectal surgeons are the specialists who are trained to do these types of surgery.

Getting a referral to a colorectal surgeon does not always mean that surgery is necessary. However, having a working relationship with a surgeon is helpful in case a complication occurs for which surgery is needed. Before having surgery, patients will meet with a colorectal surgeon several times in order to understand the type of surgery and to get prepared.

After having surgery, appointments will a surgeon may be fairly frequent during the recovery period, sometimes every few weeks. Once recovery is well on the way, meeting with a colorectal surgeon may only be needed if there are any complications. 

Dietitian

A dietitian is a specialist in nutrition who can help in making a diet plan that is tailored to an individual patient. A dietitian is an important part of the IBD care team but so many patients are never referred to see one.

Diet is complicated and people with IBD will go through periods where their diet may need to change, including during a flare-up and after surgery. There is no one specific diet that can help with IBD. That's why it's important to have the help of a registered dietitian.

There are dietitians who specialize in helping people who live with digestive diseases. Referrals are not common unless there is a major issue, so patients may need to ask their gastroenterologist or primary care physicians to help find a dietician who is experienced in helping people with IBD.

How often one sees a dietitian will vary based on what is happening with the IBD. Having surgery, having a flare-up, and being in remission are all times when a dietician can help patients with their eating plan. It is probably only necessary to see a dietitian on an as-needed basis.

Mental Health Provider

People with IBD have an increased risk of developing depression, anxiety, and other mental illnesses. For that reason, a mental health specialist such as a psychologist, psychiatrist, or social worker.

It’s not common for people with IBD to be screened for mental illnesses or to receive a referral for treatment. In some cases, patients may need to ask for a referral or seek out one on their own.

There is a subspecialty of psychology called gastropsychology. These are psychologists that specialize in the treatment of patients who live with digestive disease. If a referral to a gastropsychologist isn’t possible, it may also be helpful to work with a mental health professional who has experience in treating patients who live with chronic illness. 

Obstetrician/Gynecologist 

People with IBD are at increased risk of certain cancers, including cervical cancer. For that reason, people with IBD who have a cervix should receive screening for cervical cancer with a Pap test.

This means seeing a gynecologist on a routine basis for a Pap test as well as any other issues that may occur, as well as screening for breast cancer, if needed. Recommendations may differ slightly depending on a patient's age and other health conditions, but in general, receiving a Pap test every year may be needed.

Contraceptive choices are also important for people with IBD who may become pregnant. It's generally recommended that the IBD be in remission before becoming pregnant. A gynecologist can help in explaining contraceptive choices and helping in making decisions about which should be used and when they can be discontinued.

Rheumatologist

One of the most common extra-intestinal manifestations in IBD is different forms of arthritis. Some forms of arthritis are related to the IBD and may get better or worse along with the disease. Other types of arthritis can lead to permanent joint damage, so it is important to receive a diagnosis and treatment promptly.

Not every person who lives with IBD will need a referral to a rheumatologist, a physician who treats arthritic conditions. However, when it does look like joint problems have gone beyond what can be treated by a primary care physician or a gastroenterologist, a referral to a rheumatologist may be needed.

People with IBD who have been diagnosed with a form of arthritis will see their rheumatologist on a regular basis. This could be more frequently during the diagnosis process and the beginning of treatment, as well as when the arthritis is more active. 

Enterostomal Therapy (ET) Nurse 

An ET nurse is a specialist who helps people who live with an ostomy. For those who have had ileostomy or colostomy surgery, an ET nurse will be helpful in managing their stoma.

Patients should first meet with an ET nurse before ostomy surgery. During this initial appointment, the ET nurse will explain more about living with a stoma and help determine its placement during surgery. After surgery, an ET nurse can help with teaching patients how to change the ostomy appliance.

After the learning period on how to change an ostomy appliance and care for a stoma, an ET nurse can help if and when complications occur. Caring for the skin around the stoma (the peristomal skin) is important to having a good quality of life. An ET nurse can help with treatment if that skin starts to break down.

People who live with a stoma will see an ET nurse prior to having surgery and then several times again after having surgery for appliance changes and check-ins. In some cases, an ET nurse may also be a visiting nurse, and can do visits at home after surgery to help with appliance changes and advice on life with a stoma.

After that, working with an ET nurse might only be needed if complications occur with the IBD, the stoma, or the peristomal skin.

A Word From Verywell

This long list of potential specialists seems daunting, especially to those who are newly diagnosed with IBD. Having a chronic illness does come with a need to be proactive and manage health in a new way. For those diagnosed young, as most people with IBD are, they will see their doctors far more often than their peers do.

However, with a disease as complicated as IBD, it's important to stay on top of not only the digestive problems, but also any other related conditions. IBD unfortunately puts people at the risk of having other health problems.

Seeing different specialists on a regular basis can help in getting any complications treated as soon as they crop up. It can seem disheartening to have so many specialists but thinking of all the touchpoints as all being part of having a full quality of life with IBD that is well-controlled can help.