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A gastroenterologist is a specialist physician who focuses on diseases and disorders of the gastrointestinal tract. This article will discuss the training such a specialist receives and what activities are included in their daily schedule.

Gastroenterologists are physicians who specialise in diagnosing and managing diseases and conditions that affect the organs of the gastrointestinal tract. These organs and tissues include the oesophagus, stomach, small intestine, pancreas, gallbladder and bile-ducts, liver, colon, rectum and anus.

Training

A gastroenterologist can spend up to 15 years to become a specialist in this chosen discipline. The training consists of 5-6 years of medical school to obtain their undergraduate degree and qualify as medical doctors, 1-2 years of internship training to be exposed to the different medical and surgical disciplines, 4 years residency in internal medicine and 3 years fellowship training in gastroenterology.

A gastroenterologist wanting to specialise further in hepatology (dealing with the liver, gallbladder and bile-ducts) needs to complete another 1 year of fellowship training in this discipline.

Conditions that a Gastroenterologist manages

The following are examples of the medical conditions that a gastroenterologist diagnoses and manages.

Oesophagus

  • Gastro-oesophageal reflux (GORD/GERD)
  • Barrett's oesophagitis secondary to GORD.
  • Trauma due to the ingestion of corrosive substances.
  • Oesophagitis.
  • Strictures.
  • Achalasia and dysmotility disorders.
  • Varices secondary to portal hypertension.
  • Mallory-Weiss tears.

Stomach

  • Gastritis
  • Gastroenteritis.
  • Gastric ulcer.
  • Peptic ulcer.
  • Pyloric stenosis.
  • Gastric cancer.
  • Helicobacter pylori infection.
  • Zollinger-Ellison syndrome.

Pancreas

  • Acute pancreatitis mainly due to gallstones that have impacted in the pancreatic part of the biliary tree or due to acute or chronic alcohol use.
  • Chronic pancreatitis.
  • Pancreatic cancer which is strongly linked to alcohol use. 
  • Pancreatic pseudocysts.
  • Pancreatic fistulas.
  • Exocrine pancreatic insufficiency.

Liver

  • Acute or chronic hepatitis which is inflammation of liver tissue. Causes include viral infections (hepatitis A,B or C).
  • Non-alcoholic steatohepatitis (NASH) which occurs in individuals who consume little or no alcohol.
  • Fatty liver disease due to acute alcohol use.
  • Alcoholic liver disease and alcoholic hepatitis due to chronic alcohol use.
  • Liver cirrhosis due to chronic hepatic fibrosis.
  • Acute liver failure that can result in hepatic encephalopathy and hepatorenal syndrome.
  • Liver abscesses
  • Chronic liver disease due to autoimmune illnesses such as Wilson's disease, haemochromatosis and autoimmune hepatitis.

Gallbladder and bile-ducts

  • Gallstones.
  • Cholecystolithiasis (gallstones impacted in the gallbladder).
  • Choledocholithiasis (gallstones impacted in the common bile duct).
  • Cholecystitis (inflammation of the gallbladder).
  • Cholangitis (inflammation of the biliary ducts). 
  • Primary sclerosing cholangitis which may be associated with autoimmune diseases.
  • Ascending cholangitis caused by bacterial infections.
  • Cholangiocarcinoma (bile-duct cancer).

Small intestines

  • Enteritis.
  • Enterocolitis.
  • Duodenal ulcers.
  • Chronic diseases due to malabsorption of nutrients and minerals such as iron, calcium and magnesium.
  • Mesenteric ischaemia.
  • Ileus.
  • Intussusception.
  • Volvulus. 
  • Inflammatory bowel diseases such as Crohn's disease or ulcerative colitis.
  • Intestinal pseudo-obstruction
  • Necrotizing enterocolitis.

Large intestine

  • Constipation.
  • Irritable bowel syndrome (IBS).
  • Diverticulitis.
  • Colon cancer.
  • Pseudomembranous colitis.

Rectum and anus

  • Internal or external haemorrhoids.
  • Thrombosed heamorrhoids.
  • Pruritis ani.
  • Vascular outpouchings of skin.
  • Proctitis.
  • Faecal incontinence and encopresis.
  • Anal fissures.
  • Anal fistula.
  • Anal abscesses.
  • Rectal cancer.
  • Anal cancer.
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