Physicians Perspective

What Exactly is a Gastroenterologist?

I sometimes get asked what gastroenterologists do. People who ask usually have some notion that gastroenterologists treat problems involving the stomach, such as ulcers and acid reflux, and conditions affecting the intestines, such as irritable bowel and colon cancer. However, they’re often surprised to learn about the broad range of conditions the field encompasses.

Having recently joined Sentara Gastroenterology Specialists, I’d like to introduce myself and explain more fully the types of problems my colleagues and I handle.

Put simply, gastroenterologists are physicians who specialize in diagnosing and treating disorders of the digestive tract. Throughout our medical training, we study the functioning of the esophagus, stomach, small and large intestines, and rectum—as well as the organs associated with digestive processes: the liver, pancreas, gallbladder and bile ducts. We have an in-depth understanding of the diseases and disorders that can affect these organs and our digestive processes.

What Conditions Do Gastroenterologists Treat?

Among the more common issues gastroenterologists treat are the following:

•  Barrett’s Esophagus: a serious complication of gastroesophageal reflux disease resulting in damage to the lining of the esophagus, the tube leading from the mouth to the stomach

•  Bile duct stones and strictures (narrowings): these can block bile, a substance necessary for the efficient digestion of fats

•  Celiac disease and gluten sensitivity: celiac disease is an autoimmune condition that occurs in reaction to the ingestion of gluten, a protein component in wheat and other cereal grains; gluten sensitivity is an allergic reaction to gluten

•  Colon polyps and colorectal cancer: polyps are growths in the colon or rectum; many are benign, but some can develop into colon or rectal cancer

•  Diverticulosis: a condition characterized by small pouches that form in the lining of the digestive tract—especially the large intestine—that often cause no problems but can become inflamed or infected

•  Fatty liver: a condition of excess fat in the liver, generally related to obesity or excessive alcohol consumption

•  Gallbladder disease: including gallstones and inflammation (cholecystitis)

•  Gastric and duodenal ulcers: lesions in the lining of the stomach (gastric ulcers) or the upper portion of the small intestine (duodenal ulcers)

•  Gastritis: inflammation, irritation or erosion of the stomach lining

•  Gastroesophageal reflux disease (GERD): weakness of the lower esophageal sphincter (the ring of muscle between the stomach and esophagus) that allows stomach acid to leak into the lower esophagus, resulting in acid indigestion or heartburn

•  Hepatitis: liver inflammation

•  Hiatal hernia: a condition in which the stomach pushes through a weak spot in the diaphragm, the muscle responsible for breathing that also separates the chest cavity from the abdomen

•  Irritable bowel syndrome: problems affecting the large intestine that frequently result in abdominal pain, bloating, gas, and constipation or diarrhea

•  Liver cirrhosis: scarring (fibrosis) of the liver caused by problems like hepatitis or chronic alcoholism

•  Obesity: excessive body fat that increases a person’s risk for heart disease, stroke and Type 2 diabetes

•  Pancreatitis: inflammation of the pancreas, an organ that produces insulin and other chemicals important for digestion

•  Ulcerative colitis and Crohn’s disease: both forms of inflammatory bowel disease

Some of the common GI complaints or symptoms that would bring someone under the care of a gastroenterologist include:

•  Blood in the stool

•  Chronic abdominal pain or cramping

•  Chronic constipation or diarrhea

•  Chronic heartburn and indigestion

•  Chronic nausea or vomiting

•  Excessive bloating or gas

•  Jaundice (yellowing of the eyes or skin)

•  Loss of appetite

•  Loss of bowel control

•  Malnutrition

•  Pain or other difficulty when swallowing

•  Rectal bleeding

•  Sudden changes in bowel habit

•  Unexplained weight loss

In most cases, patients would be referred to a gastroenterologist if their GI problem is beyond the scope of practice of their primary care provider.

Scoping It Out

Gastroenterologists are trained extensively in endoscopy, a nonsurgical procedure that permits a gastroenterologist or other physician to view the digestive tract directly. The procedure involves the use of a flexible, narrow tube called an endoscope, which is fitted with a light and camera that sends images to a monitor. Using an endoscope, the physician can examine the esophagus, stomach, bile duct, pancreas, small intestine, colon and rectum.

One potentially life-saving use of endoscopy is the screening colonoscopy, the visual examination of the large bowel and rectum to screen for colon and rectal cancer. In general, most people should start having colonoscopies at age 50. Thereafter, they should have a repeat colonoscopy every 10 years, unless their physician thinks the risk of cancer is great enough to justify more frequent screenings. In patients with a family history of or other significant risk factors for colorectal cancer, the screening colonoscopy should begin before age 50.

Regular colonoscopy screenings can help detect colonic polyps (growths), which can be removed during the colonoscopy procedure, thus preventing them from developing into cancer.

Prevalence of GI Problems

Gastrointestinal and digestive problems are very common throughout all populations. It’s the rare person who never suffers a bout of nausea, bloating, constipation, diarrhea or heartburn. In many cases these complaints resolve by themselves in a day or two, or can be treated with fairly modest means. Unfortunately, a large percentage of persons in the United States also suffer from more chronic, serious and debilitating GI conditions. The good news is that gastroenterology has progressed to the point where we can offer significant help to patients with serious, chronic GI problems.

I am pleased to serve alongside my colleagues and peers in a medical specialty that helps so many people by improving their quality of life significantly.

Sentara RMH Welcomes Dr. Fadi Diab

Fadi Diab, MD, is a board-certified, fellowship-trained gastroenterologist who has practiced for more than 25 years.

A graduate of the University of Jordan College of Medicine, Dr. Diab completed his internship and residency in internal medicine at Nassau University Medical Center in Long Island, N.Y. He then completed a gastroenterology fellowship at the University of Missouri-Columbia School of Medicine, followed by a therapeutic endoscopy fellowship at the University of Illinois at Chicago College of Medicine.

His clinical interests include therapeutic endoscopy, biliary and pancreatic endoscopy, bariatric endoscopy, luminal stenting and polypectomy. Dr. Diab joined Sentara Gastroenterology Specialists in January 2019.

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