Viral gastroenteritis, more commonly known as the “stomach flu”, affects over 20 million people in the United States each year. Symptoms include nausea, vomiting, fever, and general gastric distress for several days, with most symptoms disappearing in about a week. If you’ve ever had the stomach flu, you know how bad the disease can make you feel – thankfully just for a short time.
But for many people, similar digestive issues are a part of their daily lives. Conditions like irritable bowel syndrome or Chron’s disease disrupt patients’ lives and make it uncomfortable to even leave the house. Fortunately, there are doctors who specialize in the field of gastroenterology who can spot the difference between a stomach bug and a chronic condition. With this specialized training, these digestive experts can help patients minimize symptoms and resume a normal quality of life.
What is Gastroenterology?
Gastroenterology is the medical field that deals with issues and diseases of the digestive system, with a special focus on the stomach, liver, and intestines. The organs that make up the digestive tract, which is sometimes referred to as the gastrointestinal tract, run from the mouth all the way through the body to the anus.
In part due to the nature of the average human diet, the digestive tract can become blocked or inflamed. Since this system removes waste from the body, the organs along this tract are also susceptible to disease. A specially trained doctor called a gastroenterologist can diagnose and treat these diseases and conditions.
What does a gastroenterologist do?
A gastroenterologist, often referred to as a GI doctor or a GI specialist, treats patients who have any number of digestive system issues or diseases. These specialists place a priority on patient care and symptom management, since many of these conditions can be quite painful and have a serious impact on the patient’s quality of life.
Procedures and Treatments
Since many conditions affecting the digestive system are inside the intestines and share similar symptoms, they can be difficult to diagnose without the aid of specialized procedures. Gastroenterologists are trained to perform any of the following during the normal course of their work:
• Blood panels – Like many doctors, gastroenterologists often start with blood tests before using more invasive procedures. Blood tests with elevated digestive enzymes can give doctors helpful clues of what to look for next in the diagnosis and treatment process.
• Colonoscopies – GI doctors routinely perform colonoscopies on patients to check for early signs of colon cancer or other abnormalities. In this procedure, a flexible tube with a camera on one end is used to give doctors a clear view of the inside of a patient’s colon.
• Endoscopic procedures – Endoscopies are the more general name for any type of procedure that is guided by an endoscope, which is a flexible tube with a camera and a light on one end. GI doctors can use endoscopes to get a better picture during ultrasounds or to see inside organs that otherwise wouldn’t be visible.
• Endoscopic retrograde cholangiopancreatography (ERCP) – This specialized procedure is used to treat problems involving the liver, pancreas, and gallbladder. Gastroenterologists use X-ray technology and a specialized endoscope to evaluate the ducts in these organs and look for blockages or stones. If a gall stone is found, it can often be removed during the procedure, eliminating the need for major surgery.
• Liver biopsies – In patients diagnosed with liver disease, gastroenterologists will frequently perform liver biopsies to check for progression of the disease. During the procedure, a small piece of tissue from the liver is removed and sent to a lab for evaluation, where doctors will use a microscope to check for liver function and signs of damage.
• Percutaneous Endoscopic Gastrostomy (PEG) – When a patient is not able to eat or swallow without assistance, a GI doctor may perform this procedure. A small incision is placed in the abdomen and an endoscope guides the placement of a feeding tube directly into the stomach. The PEG tube allows the patient to get the necessary nutrition until normal digestive function returns.
Using the procedures mentioned above, gastroenterologists can diagnose and treat a variety of diseases and conditions that affect the digestive organs. In many cases, these conditions are chronic, so long-term treatment and disease management plans are critical for physicians in this field. Gastroenterologists treat:
• Ulcerative colitis – An inflammation of the inner lining of the colon
• Colon polyps – Small clumps of cells that form on the inner lining of the colon, which can sometimes develop into cancer
• Irritable bowel syndrome (IBS) – An intestinal disorder that causes abnormal digestive function, including gas, bloating, cramping, pain, and diarrhea
• Gastroesophageal reflux disease (GERD) – A disease that causes acids from the stomach to flow backward into the esophagus, causing irritation and heartburn
• Chron’s disease – A chronic inflammatory bowel disease that causes abdominal pain, diarrhea, weight loss, and fatigue
• Pancreatic disease – An inflammation of the pancreas, which is the organ that lies behind the stomach, causing abdominal pain, nausea, and vomiting
• Heartburn – A burning sensation in the upper chest that usually worsens when lying down, frequently caused by acids or other digestive system issues
• Hemorrhoids – Swollen or inflamed veins in the rectum that cause discomfort or bleeding
• Hepatitis C – A viral infection that attacks the liver and can cause permanent damage if left untreated
• Ulcers – Sores that develop on the inner lining of the digestive organs, causing pain and damage to the lining
GI doctors can also treat colon cancer or pancreatic cancer in some cases, but most cancer patients are referred to an oncology specialist to develop a treatment plan.
How to become a gastroenterologist
Gastroenterologists follow a pathway through medical school that is similar to most other doctors. If you’ve wondered how long to become a gastroenterologist, expect this career pathway to take approximately 14 years after completing your high school degree.
Education and Training
To become a gastroenterologist, you’ll start by completing a 4-year undergraduate program. While you do not have to complete a pre-med undergraduate curriculum, following this pathway can demonstrate your competency in the sciences. During the last two years of your undergraduate program, you will prepare for the MCAT exam and apply to medical school.
To continue your training, you must complete a 4-year medical school program, which typically consists of two years of classroom instruction follows by two years of clinical rotations. During clinicals, you will apply to an internal medicine residency program. After the four years of medical school, gastroenterologists must complete three years of internal medicine residency followed by three years in a gastroenterology fellowship. During this training, doctors receive hands-on experience in performing some of the more complex procedures for their field, including endoscopies and ERCPs.
During these initial 14 years of training, a gastroenterologist will take and pass the licensing exams required by the state to be licensed to practice gastroenterology. While it is not a requirement, many doctors will also become “board certified” and complete an additional testing process that is regulated by the American Board of Internal Medicine (ABIM).
Doctors can specialize in gastroenterology or pediatric gastroenterology, depending on whether they would prefer to work with adult or adolescent patients. Most physicians will complete a residency in internal medicine with a subspecialization in gastroenterology. Doctors who prefer to work with children, however, will complete a residency in pediatrics with a subspecialization in pediatric gastroenterology. All gastroenterologists must complete the requisite 3-year fellowship in gastroenterology after their initial residency in order to practice in the field.
Gastroenterologists Salary Expectations
According to the 2020 Medscape Gastroenterologist Compensation Report, doctors working in this field are the sixth-highest paid specialty among all physicians. Gastroenterologists can expect to make about $419,000 per year, which is above average when compared to other specialists, who earn on average $346,000 per year, and significantly above average when compared to primary care providers, who earn on average $243,000 per year.
Gastroenterologists Frequently Asked Questions
1. What is the difference between a gastroenterologist and a colorectal surgeon?
Although both gastroenterologists and colorectal surgeons treat many of the same conditions, there are some major differences in these two professions. In training, gastroenterologists specialize in internal medicine and learn a few specialized procedures, such as endoscopies and biopsies. Colorectal surgeons, however, specialize in surgery and learning proper surgical procedures.
Gastroenterologists rarely perform surgeries, while colorectal surgeons rarely treat conditions of the stomach, pancreas, or liver. Colorectal surgeons also rarely treat non-surgical conditions, such as GERD or IBS.
2. Are gastrology and gastroenterology the same thing?
Technically, gastrology is the study of illnesses and diseases of the stomach. However, gastrology is no longer a recognized specialty in the United States. If you had a condition affecting your stomach, you would visit a gastroenterologist, who is more widely trained in the entire digestive tract.
3. How has the COVID-19 pandemic affected the field of gastroenterology?
Gastroenterologists have been on the front lines of COVID-19 more than most people might expect. A study published in The American Journal of Gastroenterology reported that out of 204 COVID-19 patients, over 48% reported digestive system issues as their chief complaint. Gastric symptoms, including nausea and diarrhea, have been extremely prevalent among positive COVID-19 patients, causing medical teams to bring gastroenterologists in for patient consultations and collaborative treatment.
More importantly, gastroenterologists are often treating patients by examining some of the most likely areas for viral contamination – the mouth, throat, and esophagus. GI doctors are frequently putting themselves in harm’s way when working with COVID-19 patients, and they must take extra precautions when performing their normal procedures.
Gastroenterologists have also been affected by COVID-19 in the way that many other specialists have; since many specialty procedures are elective or non-emergency, gastroenterologists have seen a decrease in their workload and an increase in telemedicine consultations.