What is a Gastroenterologist?

Gastroenterologists are internists who specialize in diseases of the digestive tract. Nowadays, the prerequisite training includes a medical internship and residency in internal medicine.

Areas of subspecialization include

• Advanced endoscopy (ERCP and endoscopic ultrasound)
• Transplant hepatology
• Motility
• Inflammatory bowel disease
• Esophagology
• Nutrition and metabolism

Any physician completing training in gastroenterology should be competent in treating the whole spectrum of gastrointestinal disorders and be competent in all aspects of upper endoscopy and colonoscopy. Separate training may be devoted to hepatology, but usually this is incorporated into the general training.

The most common reasons for referral to a gastroenterologist are for evaluation and management of:

• Irritable bowel
• Constipation
• Chronic diarrhea
• Gastrointestinal bleeding
• Gastroesophageal reflux therapy refractory to H2 blockers
• Management of acute and chronic hepatitis or other liver disorders.
• Noncardiac chest pain
• Abdominal pain
• Iron deficiency anemia (to evaluate for a source of occult GI blood loss).
• Evaluation of malabsorption/weight loss.
• Management of acute and chronic pancreatitis

The most important area of primary or preventive care is that of colon cancer screening and secondary prevention through colonoscopy and polypectomy. Colon cancer is the second most common cause of cancer death in this country, affecting 150,000 people (men and women equally) with an annual mortality greater than 50,000. True primary prevention includes stressing a low fat, high fiber diet, adequate calcium intake, and identification of any risk factors such as a strong family history of colon cancer, which might increase an individual's risk.

Current recommendations for colon cancer screening include the performance of a yearly fecal occult blood test starting at the age of 50 with examination by flexible sigmoidoscopy every 3-5 years.

All primary care physicians should learn how to perform this simple procedure. The findings of occult blood in the stool or any abnormality found on flexible sigmoidoscopy should prompt referral to a gastroenterologist for further evaluation.

For more information on the contribution of gastroenterology to the field of medicine, contact:

Digestive Health News & Information Center
The American Gastroenterological Association
7910 Woodmont Avenue, Seventh Floor
Bethesda, Maryland 20814 USA
Telephone: (301) 654-2055
FAX: (301) 654-5920
Website: http://www.gastro.org

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