What Is a Gastroenterologist—And What Do They Do?

If you are experiencing severe or consistent digestive problems, your healthcare provider may refer you to a specialized provider called a gastroenterologist. Sometimes called gastrointestinal or GI doctors, these healthcare providers are experts of the digestive system.

Before going to see a gastroenterologist, it’s important to understand what conditions these providers treat, the procedures they perform, and what to expect from your first appointment.  

What Is a Gastroenterologist? 

Gastroenterologists are specialists who focus on diagnosing and treating conditions affecting the gastrointestinal tract, or GI tract. 

The GI tract includes the organs you use when swallowing, digesting, absorbing, and emptying the food and drinks you consume. That means gastroenterologists can help manage conditions that affect the:

• Esophagus
• Stomach
• Small intestine
• Colon 
• Rectum

Gastroenterologists can also help manage conditions of other organs involved in the digestive process, including the:

• Pancreas
• Gallbladder
• Bile ducts
• Liver

Gastroenterologists can perform imaging tests, analyze blood and stool test results, and ask about symptoms to make a diagnosis. They can then prescribe medication, order follow-up tests, and monitor symptoms to manage any diagnosed condition. 

When Should You See a Gastroenterologist? 

There are several reasons you might need to see a gastroenterologist. You might need to get an opinion on symptoms you are experiencing, undergo diagnostic or preventative testing, or keep up with the monitoring of a condition with which you’ve already been diagnosed.

Unless you’re already an established patient of a gastroenterologist for a chronic condition, your primary healthcare provider can let you know when to see a gastroenterologist based on your symptoms, any current conditions, as well as your medical history.                                             

To Check On Persistent Symptoms

Sometimes, occasional digestive issues, such as a bout of food poisoning, can be managed on your own or with the help of a primary care physician. Persistent or certain symptoms may call for the expertise of a gastroenterologist. 

Common symptoms that call for a referral to a gastroenterologist include:

• Difficulty swallowing (dysphagia)
• Persistent nausea and vomiting
• Stomach and/or abdominal pain
• Heartburn
• Diarrhea
• Constipation
• Signs of jaundice, including yellowing of skin and eyes
• Sudden weight gain or loss
• Blood in the stool

The gastroenterologist can determine what is causing the symptoms.

To Manage Gastrointestinal Conditions

Gastroenterologists can provide long-term management for conditions that affect each part of the gastrointestinal tract or organs related to the digestive process. 

Common conditions of the esophagus, which is the tube connecting the throat and stomach, include:

• Gastroesophageal reflux disease (GERD): A condition that develops when stomach acids flood the esophagus 
• Barrett’s esophagus: A change in the lining of the the lower portions of the esophagus
• Esophagitis: A persistent inflammation and irritation of the esophagus
• Hiatal hernia: A condition that occurs when the stomach pushes through the diaphragm, the thin layer of tissue that separates the chest from the abdomen

Gastroenterologists treat conditions, such as food allergy or small intestinal bacterial overgrowth, that impact the health of the stomach and intestines. Other common intestinal conditions gastroenterologists can manage are:

• Gastritis: An inflammation of the stomach lining
• Diverticulitis: An inflammation of small pouches in the intestines
• Celiac disease: An immune reaction to eating gluten (wheat)
• Irritable bowel syndrome (IBS): Swelling and bloating in the stomach or intestines
• Inflammatory bowel disease (IBD): Crohn’s disease or ulcerative colitis, two conditions marked by inflammation in the GI tract 
• Appendicitis: An infection of the appendix
• Hemorrhoids: Swollen veins in the anus or rectum
• Certain cancers: These include cancers of the colon, rectum, intestines, or stomach

Gastroenterologists can also manage conditions affecting the liver, including:

• Hepatitis: An inflammation of the liver, which can be caused by a viral infection or damage due to drug or alcohol use
• Fatty liver disease: Excess fat stored in the liver
• Cirrhosis: Late-stage liver disease caused by hepatitis, excessive alcohol use, or fatty liver disease

Gastroenterologists can diagnose and treat conditions that affect the gallbladder, such as:

• Gallstones: Hardened build-ups of bile within the gallbladder
• Cholecystitis: An inflammation of the gallbladder often due to gallstones
• Pancreatitis: An irritation and inflammation of the pancreas due to alcohol use or gallstones

For Routine Screening

Many people visit a gastroenterologist to screen for colorectal cancer, which is cancer that develops in the colon (large intestine) or rectum. 

During a screening, the gastroenterologist will search the colon and rectum for polyps—extra tissue growths that are usually non-cancerous but may develop into cancer—and other abnormal growths. 

There are several tests to screen for colorectal cancer, including different imaging tests such as a sigmoidoscopy or colonoscopy. 

There’s also a virtual colonoscopy, in which x-ray equipment is used to take pictures of the entire colon and rectum from outside of the body. The gastroenterologist will examine these images to determine if a standard colonoscopy is needed. 

A gastroenterologist may also order a stool test, for which you would send a stool (poop) sample to the gastroenterologist, and they will test for small amounts of blood from potential polyps. 

Getting screened regularly can help prevent the development of colorectal cancer or help find the cancer early so that it is more easily treated. In both a sigmoidoscopy and a colonoscopy, the gastroenterologist is able to remove polyps during the exam, which can prevent them from becoming cancerous. 

The recommendation for colorectal cancer screening is to start at age 45 and continue to get tested every five to 10 years, depending on the test. If you have any risk factors such as IBD or a family history of colorectal cancer, you may need to start testing early and be tested more regularly. 

What Procedures Do Gastroenterologists Perform? 

Since they have expertise in a wide range of conditions, gastroenterologists perform many kinds of procedures for diagnosis, monitoring, and treatment, and screening. The most common of these procedures are:

Esophageal endoscopy: In this procedure, often called an upper endoscopy, gastroenterologists insert a thin, flexible, lighted tube with a camera, or endoscope, down the throat and esophagus, accessing the stomach and small intestine. This allows them to visually examine these areas.    

Sigmoidoscopy: The sigmoid is a portion of the lower part of your colon. When a gastroenterologist needs to observe and evaluate the sigmoid, they will insert a type of endoscopic device called a sigmoidoscope up the rectum and into the colon. This procedure can be performed with a flexible tube (flexible sigmoidoscopy) or a rigid one (rigid sigmoidoscopy).

Colonoscopy: For the test, the doctor will insert an endoscopic device into your rectum to examine your rectum and the entire colon for signs of inflammation, cancer, or other growths. 

Polypectomy: A minimally invasive alternative to abdominal surgery, polypectomy is the removal of polyps—abnormal growths—from the colon performed with the aid of sigmoidoscopy or colonoscopy. The polyps may either be removed with forceps or burnt off with a surgical device called a snare.

Dilation: Performed either on the esophagus (esophageal dilation) or intestines (intestinal dilation), this procedure mildly stretches the area to ease symptoms of inflammation and narrowing within the tube.

Hemostasis: Using endoscopy, this procedure treats internal bleeding—often in the upper gastrointestinal tract—using an injection of a special substance, the application of heat, or a hemoclip (a kind of clamp used temporarily).

Endoscopic biliary examination: This endoscopic procedure allows gastroenterologists to observe and evaluate the biliary tract, which is the liver, gallbladder, and bile ducts. It is also known as endoscopic retrograde cholangiopancreatography (ERCP).

Endoscopic mucosal resection (EMR): This endoscopic procedure is used to remove cancerous, precancerous, or other abnormal tissues from the esophagus, stomach, intestines, or rectum.

Stent placement: Gastroenterologists may use endoscopic procedures to place hollow tubes called stents, which can help expand or prop open a blocked section of the intestine. The placement of stents can help treat obstructions in the digestive tract.

Endoscopic ultrasound (EUS): Also known as echo-endoscopy, EUS combines endoscopy with ultrasound imaging to assess the health of the gastrointestinal tract.

 Tips for Your First Appointment 

Going to see a specialist like a gastroenterologist for the first time may be different from a routine visit to a general healthcare provider. Here’s what to expect from your first visit—and a few ways to prepare for your appointment. 

What to Expect

The first appointment with a gastroenterologist typically takes anywhere from 30 minutes to an hour. The doctor will ask about your medical status and history and talk to you about your symptoms. 

In addition, the doctor will perform a physical exam. This exam may involve:

• Visual observation: The doctor will look at your abdomen to check for any abnormal growths or other issues.
• Auscultation: This is a diagnostic procedure in which the doctor uses a stethoscope to listen to any sounds your bowels or abdomen makes.
• Palpation: The gastroenterologist will feel around the four quadrants of your abdomen to check for any abnormal growths, pain, or tenderness in any areas. You may be asked to breathe deeply or cough during the exam.
• Rectal exam: The doctor may need to insert a finger into your rectum to feel for any abnormal growths, masses, or any signs of inflammation.  

If further testing, such as a colonoscopy, is needed, the provider will have you schedule a different time for that procedure to be done. Before any follow-up procedure, the office will give you guidance about how to prepare.

How to Prepare For Your First Appointment

As with any kind of appointment, it’s important to go prepared if you’ve been referred to a gastroenterologist. Having certain information with you can help the doctor make a diagnosis. 

Know Your Medical History

Many doctor’s offices will have you upload your medical information into an online portal before the appointment, but you might also be asked to discuss this in person during the appointment. Come prepared to talk about any conditions you currently have or have had in the past, as well as any previous treatments or procedures you have received. 

The doctor will also ask about which medications you’re taking if you have any allergies and any family history of the disease. The more the provider knows about your medical status and history, the better they can identify and treat your condition.

Keep Track of Your Symptoms

It’s important for your gastroenterologist to get a sense of how you’re feeling and what your symptoms are like. Before your appointment, keep a log of your symptoms, including any over-the-counter medications or at-home methods you’ve taken to manage your symptoms. It may also be helpful to track your diet. Bring these notes to your appointment so you can discuss them with the doctor. 

Send Any Test Results Ahead of Time

The gastroenterologist will likely want to review your test results from any relevant medical tests or evaluations, such as imaging, stool tests, and blood tests. This includes any test results related to chronic conditions you may have, such as diabetes or IBD. Typically, you can have your primary healthcare provider or testing facility send these directly to the gastroenterologist’s office. 

Prepare a List of Questions

During the appointment, it will be important to learn as much as you can about your condition and potential treatments. You may also want to ask about your GI doctor’s experience. Here are potential questions to ask your GI doctor:

• What may be causing my symptoms?
• Which tests do I need to take? How can I prepare for them?
• How severe is my condition?
• What are my treatment options?
• How many times have you performed this procedure?
• What does recovery from my treatment look like?
• What will follow-up or additional care look like?
• What sorts of dietary adjustments or lifestyle changes do I need to make?
• How long have you been practicing gastroenterology?

Gastroenterologist Education and Training Requirements 

As with all medical specialists, gastroenterologists undergo specific training following medical school. After completing medical school, gastroenterologists spend an additional five to six years of training in gastroenterology before they can practice independently. 

Gastroenterologists’ training is as follows:

Medical School

All physicians have to graduate from medical school before entering into their specific field or specialty. In medical school, students will study advanced biomedical sciences and clinical skills and may begin working with patients through clinical rotations. Typically, these programs take four years, with graduates receiving a doctor of medicine (MD) or doctor of osteopathic medicine (DO) degree upon completion.

Internal Medicine Residency

The next step is a residency in internal medicine. Typically, residency is a rigorous, three-year program in which residents (postgraduate medical students) work and learn under the supervision of specialists and gain a foundation of medical practice. 

All medical specialists, including gastroenterologists, must complete a residency program. 

Fellowship 

After residency, a gastroenterologist then receives training focused on their field through a gastroenterology fellowship program. A fellowship is continued specialized training that can last for two to three years. Under the direction of board-certified GI specialists, the student doctors learn how to diagnose and provide care for people with gastroenterological diseases. 

During their fellowship, gastroenterologists are trained in procedures like endoscopy and polypectomy.    

Board Certification

National organizations such as the American College of Gastroenterology and the American Gastroenterological Association establish guidelines for gastroenterologists’ training. 

Upon completion of their fellowships, gastroenterologists are considered “board-eligible” and take a certification exam that the American Board of Internal Medicine administers. After passing the exam, the gastroenterologist is considered “board-certified.”

Sub-Specialization

Following their residency and fellowships, gastroenterologists may opt to receive further training in specific sub-specialties of the field. For instance, after an additional one-year program, gastroenterologists can specialize in hepatology, which is focused on conditions affecting the liver. Other such sub-specialties include: 

• Interventional endoscopy
• IBD
• Gastrointestinal cancer
• Pancreatic disease
• Transplantation
• Functional bowel disease  
• Reflux esophagitis (inflammation of the esophagus, the tube that runs from the throat to the stomach)

 A Quick Review 

Gastroenterologists are highly trained specialists of the gastrointestinal tract, as well as other organs involved in the digestive process. Gastroenterologists can diagnose and manage diseases that affect the esophagus, stomach, upper and lower intestines, gallbladder, liver, and rectum. When it is time for you to have a colon cancer screening, you will have to go to a gastroenterologist. You might also be referred to a gastroenterologist if you are experiencing certain symptoms. During this initial appointment, be prepared to talk about your symptoms and medical history. The gastroenterologist will decide what the next best step is, which may be imaging tests. If you are diagnosed with a GI condition, you will likely have to return to the gastroenterologist for follow-up monitoring.