Medical Gastroenterology

Gastroenterology is an area of medicine that focuses on the health of the digestive system, or the gastrointestinal (GI) tract. Gastroenterologists can treat everything from irritable bowel syndrome (IBS) to hepatitis C. The specialist primarily diagnose and treat GI diseases in both men and women.

They perform endoscopic procedures, in which they use specialized instruments to view the GI tract and make a diagnosis. They don’t perform surgery. In some cases, they may work closely with a GI surgeon. They primarily work in clinic or hospital settings.

Functions Of GI System:

  • Digests and moves food
  • Absorbs nutrients
  • Removes waste from your body

Gastroenterologists can treat any part of this system.

Although the GI system includes the mouth, these specialists generally don’t provide care or services here. Instead, dentists and dental specialists focus on the health of the oral cavity.

Other parts of the GI system include the:

  • Tongue
  • Epiglottis
  • Salivary glands
  • Pharynx
  • Esophagus
  • Stomach
  • Small intestine
  • Large intestine
  • Liver
  • Gallbladder
  • Pancreas
  • Rectum
  • Anal Canal


Gastroenterology is a specialized area of medicine that focuses on the GI tract. Some gastroenterologists treat general diseases of the GI. Others focus on a particular type of gastroenterology.

Some possible areas of emphasis are:

  • Hepatology, which focuses on the diagnosis and treatment of diseases of the liver, gallbladder and biliary tree.
  • Pancreatology, which deals with diseases of Pancreatic gland like acute, chronic Pancreatic diseases and Pancreatic Malignancies.
  • Inflammatory bowel disease, or chronic inflammation of the digestive tract which leads to ulcerations in the bowel leading to Abdominal pain, bleeding through rectum.
  • Gastrointestinal cancers can be detected by doing upper and lower GI endoscopies.
  • Endoscopic surveillance is indicated in Patients with first degree relatives of GI cancers and also in those with past history of GI malignancies which are treated by surgery.
  • Reflux esophagitis, which is commonly due to gastroesophageal reflux disease


These specialists treat a number of conditions affecting the GI system. This can include:

  • acid reflux
  • ulcers
  • IBS
  • hepatitis C
  • polyps, or growths, which typically occur in the large intestine
  • jaundice, or a yellowing of the skin
  • hemorrhoids
  • bloody stool
  • pancreatitis, or a rare disease causing inflammation of the pancreas
  • colon cancer


These specialists perform a range of nonsurgical procedures. This can include:

  • endoscopic ultrasounds to examine the upper and lower GI tract, as well as other internal organs
  • colonoscopies to detect colon cancer or colon polyps
  • endoscopic retrograde cholangiopancreatography to identify gallstones, tumors, or scar tissue in the bile duct area
  • sigmoidoscopies to evaluate blood loss or pain in the bowel
  • liver biopsies to assess inflammation and fibrosis
  • capsule endoscopies to examine the small intestine
  • double balloon enteroscopies to examine the small intestine

When should you see a gastroenterologist?

Your primary care doctor may refer you to this specialist if you:

  • have unexplained blood in your stool
  • have unexplained difficulty swallowing
  • are experiencing abdominal pain

If you’re over the age of 50, you may also want to meet with a gastroenterologist for preventive care. Men and women over the age of 50 have an increased risk for colon cancer.

If you’re in this age group, you should get screened regularly. If you have a relative with colon cancer, you should ask your doctor about when to start getting screenings.

Upper GI endoscopy is a procedure to evaluate the mucosa of esophagus, stomach and duodenum.

Endoscope is introduced by the mouth after sedation, mucosal appearance of esophagus, stomach and duodenum is evaluated and biopsy can be taken from suspicious areas, and endotherapy can be done for the bleeding lesions.

Endoscopy is extremely safe procedure without any complications. It is usually done on outpatient basis and patient can be discharged in 2-3 hours

Indications of UGI endoscopy

1. Bleeding (red or coffee colored blood) from mouth
2. Difficulty in swallowing food
3. Upper abdominal pain
4. Chronic diarrhea

Therapeutic procedures that can be done during endoscopy are

1. Banding of varices
2. Endoteharpy of ulcers
3. Polyp removal
4. Foreign body removal
5. Dilatation of strictures
6. APC application for GAVE/PHG/PGP
7. Stenting of esophagus and duodenum

Colonoscopy is a test for evaluation of large intestine, and the terminal portion of small intestine. Procedure is performed under anesthesia. During colonoscopy, colonoscope is introduced through the anus and gradually advanced further.

During colonoscopy, Biopsy can be taken from suspicious areas, or endotherapy can be done for the bleeding lesions

Indications for colonoscopy are

1. Bleeding from the anus
2. Loose motions with blood in stool
3. Pain in lower abdomen
4. CECT or ultrasound showing mass in the colon
5. Suspicion of ulcers in small bowel
6. Screening colonoscopy after the age of 50 years for early detection of cancer/premalignant lesions

Therapeutic indications for colonoscopy are

1. Polypectomy
2. Endotherapy of bleeding ulcers
3. Stenting of the colon in malignant obstruction

Endoscopic Retrograde Ccholangio Pancreaticography (ERCP) is a procedure for treatment of biliary and pancreatic diseases

ERCP is performed by the oral route after sedation. During ERCP, bile duct and pancreatic ducts are evaluated after injection of contrast agent, and various therapeutic procedures can be performed

During ERCP stones can be removed from CBD or pancreatic duct and stents can be placed in CBD for treatment of jaundice and in MPD for pain relief

Indications of ERCP are:

1. Removal of common bile duct or pancreatic duct stones
2. Removal of worm form CBD or pancreatic duct
3. Jaundice due to obstruction of bile duct by compression due to lymph node or cancer
4. Sphincter of oddi dysfunction
5. Biliary ascites due to leakage of bile from bile duct
6. Stricture in common bile duct after surgery
7. Chronic pancreatitis with stricture in the main pancreatic duct
8. Pancreatic ascited because of pancreatic duct fluid leak
9. Tumor of gall bladder, ampulla, pancreas and bile duct leading to common bile duct obstruction

ERCP is a safe procedure in expert hands, and is performed on day care basis, however serious complications like cholangitis, pancreatitis, perforation can occur in 1-3% of cases, which may require longer hospital stay.

Double balloon enteroscopy (DBE) is a procedure for evaluation of the small intestine DBE is performed after sedation, enterosocpe is introduced through the mouth or anal route. Over the scope, overtube is passed for deep intubation of small intestine

Indications of double balloon enteroscopy are

1. GI bleed of suspected small intestine origin
2. Evaluation of stricture in small intestine
3. Tumor of small intestine
4. Evaluation of small intestine in a patient with Crohn's disease

During double balloon enteroscopy, biopsy can be taken from suspicious areas and endotherapy can be done for the bleeding lesions

Capsule Endoscopy

Capsule endoscopy is non invasive test, which does not require any sedation For capsule endoscopy, patient swallows a small capsule, capsule has inbuilt camera, which captures and send the images of small inetstine to external data recorder, which are later studied for the evaluation of small intestine

Capsule should not be used, if there is suspicion of stricture in small intestine Moreover, tissue cannot be obtained from diseased areas and endotherapy cannot be done

Capsule is passed out later in the stool, and it is not required to retrieve the capsule.

EUS is ultrasound of internal structures surrounding the GI tract with the help of endoscope. EUS provides excellent resolution of pancreas, biliary system and the mediastinum.

EUS is performed by oral route after conscious sedation.

During EUS, sample can be taken from the nodes in mediastinum, tumor of pancreas and bile duct. With the help of endoscopic ultrasound various collections can be drained internally in the stomach or rectum and the major surgeries can be avoided.

Indications of EUS are

1. Sampling of chest and abdominal nodes, adrenal gland
2. Evaluation of dilated CBD without known cause
3. Sampling of mass in pancreas or CBD
4. Drainage of perirectal and peripancreatic collection
5. Celiac plexus block for pain relief in patients with chronic pancreatitis
6. Celtic plexus neurolysis for pain relief in patients with pancreatic cancer

Liver biopsy is done for the diagnosis of various liver ailments, during liver biopsy a small piece of liver is taken for the microscopic examination.

Indications of liver biopsy:

Raised liver enzymes of unknown cause

Staging of chronic hepatitis B and C/autoimmune hepatitis and Wilson disease Sampling of liver lesions.
Liver biopsy is a is a safe procedure Severe complication can occur in 1 in 50,000 procedures

Fibroscan is a new technology for the assessment of severity of liver disease, and is safe test which is performed by putting a probe on skin of upper abdomen, and there are no complications of fibroscan.

For assessment of severity of liver disease, Fibroscan is replacing the liver biopsy.

Manometry is the study where a pressure sensing thin probe is passed from the nose or anus to study the pressure of esophagus, lower esophageal sphincter, rectum and anal canal.

Esophageal manometry

Esophgeal manometry is performed by nasal route, to study the pressure in the esophagus and lower oesophagalsphincter

Indication of esophageal manometry are

1. Dysphagia - in patients with normal UGI endoscopy, motor disorders are common cause in this setting, which can be diagnosed by manometry
2. Gastroesophageal reflux- Low esophgaeal sphincter pressure predisposes to acid reflux symptoms

Anorectal manometry

Anorectal manometry is done by the anal route.

Indications of anorectal manometry are

1. Anal incontinence
2. Chronic constipation because of neuronal diseases

24 hour pH study

24 hour pH study is indicated in patients with suspected gatroesophageal reflux disease. 24 hour pH study is an ambulatory study, where pH probe is passes through the nose to lower esophagus, probe has to be kept in situ for 24 hours. All the reflux episodes from stomach to esophagus leads to change in esophageal pH, which are sensed by pH probe, and are recorded in data recorder, which is later studied.