Description of specialty
Gastroenterologists and hepatologists care for patients with benign or malignant disorders of the gastrointestinal tract, liver, pancreas and gall bladder. Many gastroenterologists also participate in general internal medicine (GIM). For brevity in this section, use of the term gastroenterology also includes hepatology where appropriate.
Gastroenterology has developed and expanded at a greater rate than any other acute major medical specialty over the past 30 years. This is particularly as a result of increased demand both for diagnostic and therapeutic endoscopy.
Gastrointestinal symptoms and related disease account for:
- 10% of consultations in primary care
- more than 25% of all cancers. Gastroenterologists are involved in the diagnosis and/or treatment of the vast majority of these cancers.
The drive for earlier cancer diagnosis and introduction of screening tests generates a significant workload for gastroenterological and hepatological services. This has led to an increase in consultant numbers as well as an expansion of the numbers of radiologists, pathologists, nurse endoscopists, specialist nurses and dietitians.
In order to provide a sustainable and deliverable specialist service, an increasing number of gastroenterologists have relinquished their involvement in acute general medicine to focus on delivering a comprehensive gastroenterology service to patients which includes a full out-of-hours emergency endoscopy service. Further expansion of the gastroenterology workforce will be required in the future in order to deliver a 7-day a week, comprehensive and safe emergency service in all acute hospitals and to cover the additional workload of flexible sigmoidoscopic screening for colorectal cancer in 55-year-olds (see below).
Gastroenterologists also perform diagnostic and therapeutic endoscopy including:
- flexible sigmoidoscopy
- endoscopic retrograde cholangiopancreatography (ERCP)
- wireless capsule endoscopy (WCE)
- endoscopic ultrasound (EUS)
Gastroenterologists treat patients with a wide range of conditions. These include common disorders such as:
- irritable bowel syndrome.
And patients with highly complex problems such as:
- inflammatory bowel disease (IBD)
- liver failure
- complex nutritional support including home parenteral nutrition
- treatment of viral hepatitis
- treatment of complex hepatobiliary disease
- assessment for, and monitoring after, small intestine and liver transplantation.
The rapid diagnosis of patients with colorectal, pancreatic, hepatobiliary, stomach and oesophageal cancers, is also carried out, usually in an outpatient setting.
Gastroenterologists perform specialised procedures, including:
- endoscopic resection of cancers
- colonic polypectomy (removal of polyps) both in standard care and under the bowel cancer screening programme.
Gastroenterologists also see patients with a variety of general medical problems including:
- weight loss.
They provide an acute and emergency inpatient service for common problems such as:
- acute gastrointestinal bleeding
- acute IBD
- decompensated liver disease (particularly due to alcohol).
Gastroenterologists also participate in the admission and immediate care of patients with general medicine emergencies (the acute medical take). Across the NHS there are a number of models showing how this contribution to the acute take is integrated with the delivery of out-of-hours emergency gastroenterological, hepatological and endoscopic care. The delivery of an enhanced acute emergency specialist gastrointestinal and hepatological service is increasingly being found to make a valuable contribution to the general medical take in terms of quality of care, patient safety and patient throughput.