Gastroenterology

DEFINITION

Gastroenterology is a particular branch of medicine that focuses on diseases and disorders of the gastrointestinal tract.

DESCRIPTION

Gastroenterology is the research study of diseases and disorders that affect the gastroenterological tract, specifically, the esophagus, stomach, small and large intestines, pancreas, and liver.

A physician who specializes in this branch of medicine is called a gastroenterologist.

Gastroenterologists are physicians who have studied internal medicine with a specialization in adults and then gone on to specialize in the field of gastroenterology.

According to the American Gastroenterological Association, symptoms and complaints related to the gastroenterological tract are the most common reasons people seek medical advice or take medication.

Many digestive problems can be treated by a family physician or need surgery; however, more severe and specialized problems.

Many diseases and disorders gastroenterologists are trained to handle can be treated through special diets and medication.

Gastroenterologists treat intestinal tract conditions, including irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD).

People with IBS suffer from constipation, diarrhea, or sometimes go back and forth between the two.

Although IBS causes discomfort, it has not been found to harm the digestive tract and can often be controlled through diet and medication.

On the other hand, problems such as Crohn’s disease and ulcerative colitis are IBDs. They can lead to life-threatening issues, making it essential that a person with an IBD works closely with a gastroenterologist to ensure optimal health.

Gastroesophageal reflux disease (GERD) occurs when the muscle at the end of the esophagus does not properly close and contents of the stomach leak back into the esophagus, causing heartburn.

When heartburn occurs more than twice a week, the individual may be suffering from GERD and should work with a gastroenterologist to prevent a more severe health problem, such as Barrett’s esophagus, which is a precursor to cancer, from developing.

Often GERD can be treated by working with a gastroenterologist to create a new diet plan. Other times, medication or surgery is needed.

Other disorders and diseases commonly treated by gastroenterologists include pancreatitis, cirrhosis of the liver, gallstones, hemorrhoids, celiac disease, colon cancer, constipation, nutritional deficiencies, and obesity.

Often a gastroenterologist works with other physicians to diagnose and treat problems. Some problems with the gastroenterological tract may need surgery, which is not performed by gastroenterologists, making it essential for them to work with a surgeon to develop a treatment and recovery plan for the patient.

Additionally, gastroenterologists provide tests to people who may be at risk of developing a gastroenterological problem. The two types of tests that gastroenterologists perform are colonoscopies and endoscopies.

A colonoscopy is most often given to people age 50 or older to check for colon cancer. A colonoscope has a camera attached to the end and allows gastroenterologists to check the entire colon and rectum for any abnormalities.

An endoscopy is used to check for problems in people who have difficulty swallowing or experience pain in the stomach, ulcers, or abnormal bleeding.

An endoscope has a camera attached to the end and allows gastroenterologists to examine the upper digestive tract abnormalities.

Origins

Even during ancient times, people made a connection between food and health. They understood some of the things they ate made them feel better while other things made them feel sick and led to vomiting or diarrhea.

Physicians in Ancient Greece, Rome, Egypt, China, and India all had theories about what food did to the body and how digestion worked. During the second century, Claudius Galen (129–216) built on the concepts first developed by Hippocrates (460–370 BCE).

Galen believed that after being consumed, food went to the stomach, where it was chopped up. The food would then be transferred to the bowel, decomposed before heading to the liver, and is transformed into blood.

Galen believed that the amount of food consumed was directly related to the amount of blood someone had.

The theories developed by Galen existed until the Renaissance, and his incorrect theory that food turned instantly into bodily fluids, such as blood, remained until the seventeenth century.

In 1543, Andreas Vesalius (1514–1564) published his seven-volume work, De humani corporis fabrica.

Within this work, Vesalius provided the first correct description of the gastrointestinal tract, which he developed after studying human autopsies.

Although the report was generally correct, many of Galen’s theories of how the system is constructed was closer to correct.

The field of gastroenterology slowly developed over the next two hundred years. In 1648, Jan Baptiste van Helmont (1580–1644) became the first person to understand that digestion begins at the mouth with the help of saliva.

At the end of the eighteenth century, Lazzaro Spallanzani (1729–1799) used a sponge attached to a thread to collect stomach juice. The line allowed patients to swallow the sponge and for Spallanzani to later pull it out.

The turn of the nineteenth century marked the beginning of clinical work in gastroenterology. Beginning in 1822, William Beaumont (1785–1853) did the first modern experiments in the physiology of digestion.

He wrote a book about his results and his belief that hydrochloric acid is the main ingredient in stomach juice. This theory was later proven correct by William Prout (1785–1850) in 1823.

Once clinical work in gastroenterology began, the field took off. Ivan Pavlov (1849–1936), most famous for his experiments on dogs, won a Nobel Prize in 1904 in physiology and medicine to confirm his work in gastroenterology.

Pavlov’s experiments showed the nervous system’s influence on the stomach, and his discovery of Pavlov’s pouch in the belly still bears his name today.

The American Society of Gastroenterology was founded in 1932. Since then, the area of gastroenterology has continued to improve.

With the advancements in science, medicine, and technology, gastroenterologists can now diagnose, treat, and prevent problems involving the gastroenterological tract that were not understood as recently as one hundred years ago.

PURPOSE

Gastroenterology aims to understand, prevent, diagnose, and treat disorders and diseases that affect the gastrointestinal tract.

TRAINING AND CERTIFICATION

A gastroenterologist is a physician who has been specially trained to diagnose and treat diseases and disorders of the gastrointestinal tract.

Gastroenterologists must first attend an accredited medical school and graduate with a Doctor of Medicine or a Doctor of Osteopathy. After medical school, the individual must complete a three- or four-year residency in internal medicine, focusing on adults.

Gastroenterologists cannot study pediatrics for their residency. After studying internal medicine, the individual must pass the examinations to become certified through the American Board of Internal Medicine as an internist.

Once approved, the physician must participate in an additional two- to three-year accredited fellowship in gastroenterology. This qualifies a physician to take the gastroenterology certification examination through the American Board of Internal Medicine.

Completing the examinations certifies a person as a gastroenterologist. All gastroenterologists certified after 1990 must participate in the American Board of Internal Medicine’s Maintenance of Certification (MOC) program.

This involves becoming re-certified in general internal medicine and gastroenterology specialty at least once every ten years.

KEY TERMS

Colonoscopy— A procedure in which the colon is cleansed. The lighted fiber-optic instrument is inserted through the anus to allow the physician to view the entire length of the colon and detect abnormalities in the colon lining, including polyps and ulcers.

Endoscopy— A diagnostic procedure in which a tube is inserted through the mouth, into the esophagus, and stomach. It is used to visualize various digestive disorders, including Hiatal hernias.

Gastroesophageal reflux— A condition in which the stomach contents back up into the esophagus. Because the stomach contents are highly acidic, this can cause irritation and heartburn.

Heartburn— A burning sensation in the chest that can sometimes also be felt in the neck, throat, and face. It is the primary symptom of GERD.

Inflammatory bowel disease (IBD)— A serious condition causing inflammation of the colon and rectum.