Digestive tract (image thanks to wikipedia)
Gastroenterology
People often make assumptions about medical specialists and their areas of expertise. This is certainly true with gastroenterology, where many people assume that gastroenterologists are experts in all things related to the digestive tract.
Gastroenterologists are experts in diseases of the digestive tract, not syndromes or symptoms. While Gastroenterologists do primarily pay attention to the digestive tract, there are some surprising gaps in their training on the science of digestion. Gastroenterologists primarily focus on performing colonoscopies and upper endoscopies. They may also do other imaging work of the GI tract, such as an ultrasound, CT scan,MRI, x-rays, and even “pill cameras”. And they may perform studies that assess the motility of the digestive tract. Therefore, if you go to a gastroenterologist your diagnosis will be based on this testing.
Notice that all of the things mentioned so far are visual exams. Gastroenterology is primarily a specialty in assessing the structure of the digestive tract. Gastroenterologists are focused on diagnosing ulcers, polyps, cancers, and other physically apparent abnormalities of the digestive tract.
A gastroenterologist may run a stool test for pathogens such as giardia, salmonella, and hemorrhagic E. coli, although any doctor can test for these. However, H. pylori may be assessed via a biopsy done during an endoscopy.
Surprisingly, gastroenterologists do not have training in nutrition or most reactions to foods. And though the digestive tract is the single most concentrated area of immune activity, gastroenterologists have no special training in immunology.The tools of the gastroenterologist are all very useful tools – they are really important to diagnose cancers, structural problems, certain kinds of infections, and other problems. But the standard of care for problems other than those is purely palliative (also known as care to make you feel better about having IBS). The American College of Gastorenterology recommends (in their 2009 position paper) fiber, lowering stress, and a few drugs. This is where the specialties of gastroenterology and IBS diverge.
IBS Specialty
IBS specialists are experts in irritable bowel syndrome (IBS). A gastroenterologist may diagnose IBS, but that will only tell you what you already know, that your bowel irritates you. To the IBS specialist the label of IBS only serves as a starting point for further investigation, nothing more. The IBS specialist focuses on assessing and diagnosing the cause of your digestive problems, not on the gross structural integrity of the digestive tract. Rather than focusing on the patients symptoms, or simply treating the symptoms, the IBS specialist is devoted to identifying the condition or conditions in the patient that are causing the symptoms.
There are literally hundreds of different causes of IBS and the digestive problems associated with IBS. An IBS specialist does not have any idea about how they will treat an IBS patient when they first meet that patient. Patients with identical symptoms may have radically different causes for those symptoms. An IBS specialist focuses on the detective work required to develop the proper treatment plan for each unique patient.
This process involves a detailed evaluation of how the body is responding to the foods in the diet (food allergies, intolerances, and sensitivities), and a thorough assessment of the profound ecosystem (including probiotics, yeast, bad bacteria, and parasites) that is contained within the digestive tract. It may also involve evaluating enzyme production, acid production, and the overall functioning of the digestive tract.
IBS specialists do not do what gastroenterologist do, and gastroenterologists do not do what IBS specialists do. These are completely different specialties. There is only a very tiny amount of overlap with regard to stool testing. But even this is extremely minor as the IBS specialist utilizes much more advanced stool analyses.
If you have IBS and continue to see gastroenterologists, then you will continue to get the same kind of testing and treatment that you’ve always gotten even if you go to the Mayo Clinic, or the Cleveland Clinic, or any other big name medical facility or highly regarded expert – because they have a “standard of care” that recommends limiting testing. If that hasn’t helped, or you’d simply like to begin your journey with a different approach, then you need to see an IBS specialist. Your experience will be very different, which makes it far more likely that the outcome will be very different.
Image thanks to wikipedia
