The digestive system functions to move material through the GI tract viaperistalsis, break down that material viadigestion, absorb nutrients for use throughout the body, and remove waste from the body viadefecation.[3] Physicians who specialize in the medical specialty of gastroenterology are called gastroenterologists or sometimesGI doctors.
In 1805,Philipp Bozzini made the first attempt to observe inside the living human body using a tube he namedLichtleiter (light-guiding instrument) to examine theurinary tract, therectum, and thepharynx. This is the earliest description ofendoscopy.[9][10]
In 1833,William Beaumont publishedExperiments and Observations on the Gastric Juice and the Physiology of Digestion following years of experimenting on test subjectAlexis St. Martin.
In 1871, at the society of physicians in Vienna,Carl Stoerk demonstrated an esophagoscope made of two telescopic metal tubes, initially devised by Waldenburg in 1870.
Rudolf Schindler described many important diseases involving the human digestive system duringWorld War I in his illustrated textbook and is portrayed by some as the "father of gastroscopy". He andGeorg Wolf developed a semiflexible gastroscope in 1932.
A procedure using along thin tube with a camera passed through theanus to visualize therectum and the entire length of the colon. It is performed to screen forcolon polyps andColorectal cancer, or to evaluate symptoms such asrectal bleeding,dark stools, changes in bowel habits, abdominal pain, and unexplained weight loss. During the procedure, the patient is usuallysedated and the colon is examined for polyps, bleeding, or abnormal tissue; abiopsy orpolyp removal may be performed. The procedure typically takes 30–60 minutes, followed by a brief observation period. Complications can include bloating, cramping, reaction to anesthesia, bleeding, andperforation of the colon.[15]
A procedure similar to a colonoscopy using a long thin tube with a camera (scope) passed through theanus but only intended to visualize therectum and thelast part of the colon closest to the rectum. All aspects of the procedure are the same as for a colonoscopy with the exception that this procedure only lasts ten to twenty minutes and is done without sedation. This usually allows for the patient to return to normal activities immediately after the procedure is finished.[16]
A flexible endoscope is passed through the mouth to examine theesophagus,stomach, andduodenum. EGD is used to evaluate symptoms such as persistentheartburn,difficulty swallowing, upper-GI bleeding (e.g.,vomiting blood orblack stools), unexplained anemia or weight loss, and abnormal imaging or lab results. The procedure allows direct visualization,biopsy for histology, and therapies includingbanding ofesophageal varices anddilation of strictures. Most examinations take about 15–30 minutes. Common transient effects arebloating and a sore throat; uncommon risks include reactions to sedation, bleeding, andperforation of the esophagus, stomach, or duodenum.[17]
Ultrasound has become a standard tool in many medical settings. Its widespread availability, affordability, safety, and lack of radiation have established it as a common initial diagnostic method. In gastroenterology, ultrasound is highly accurate in diagnosing various conditions (e.g.,Appendicitis,Diverticulitis). Furthermore, bowel ultrasound is crucial for identifying and managingInflammatory bowel disease and their complications, including the early detection ofCrohn's disease recurrence after surgery, as highlighted in the ECCO–ESGAR guidelines.[19] Modern ultrasound techniques like contrast-enhanced ultrasound offer real-time functional and vascular information, improving diagnostic capabilities. Additionally, operative abdominal ultrasound is increasingly important in minimally invasive interventions, including guidedbiopsies, drainage, and thermal ablation of liver lesions. Nevertheless, the accuracy of ultrasound is operator-dependent, and inadequate training can lead to diagnostic errors.[20] The European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) has established guidelines to define professional standards and the minimum training needed for ultrasound examinations. These guidelines outline three levels of expertise based on anatomical knowledge, the ability to assess diseases using ultrasound, and the volume of exams performed (at least 300 per year for level 1).[21]A recent study indicated that the majority of young Italian gastroenterologists (<40 y.o.) (58.9%) acquired their ultrasound skills during their gastroenterology training. Throughout their training, participants performed a median of 320 abdominal ultrasound examinations and 240 bowel ultrasound examinations.[22]
A condition that is a result of stomach contents consistently coming back up into the esophagus causing troublesome symptoms or complications.[23] Symptoms are considered troublesome based on how disruptive they are to a patient's daily life and well-being. This definition was standardized by the Montreal Consensus in 2006.[24] Symptoms include apainful feeling in the middle of the chest and feeling stomach contentscoming back up into the mouth. Other symptoms include chest pain, nausea,difficulty swallowing,painful swallowing, coughing, and hoarseness.[25] Risk factors include obesity, pregnancy, smoking,hiatal hernia, certain medications, and certain foods. Diagnosis is usually based on symptoms and medical history, with further testing only after treatment has been ineffective. Further diagnosis can be achieved bymeasuring how much acid enters the esophagus or looking into the esophagus with ascope. Treatment and management options[23] include lifestyle modifications, medications, and surgery if there is no improvement with other interventions. Lifestyle modifications include not lying down for three hours after eating, lying down on the left side, elevating head while laying by elevating head of the bed or using extra pillows, losing weight, stopping smoking, and avoiding coffee, mint, alcohol, chocolate, fatty foods, acidic foods, and spicy foods. Medications includeantacids,proton pump inhibitors,H2 receptor blockers. Surgery is usually aNissen fundoplication and is performed by a surgeon. Complications of longstanding GERD can includeinflammation of the esophagus that may cause bleeding or ulcer formation,narrowing of the esophagus leading to swallowing issues, a change in the lining of the esophagus that can increase the chances of developing cancer (Barrett's esophagus), chronic cough, asthma,inflammation of the larynx leading to hoarseness, andwearing away of tooth enamel leading to dental issues.[23][25]
A condition in which the lining of the esophagus changes to look more like the lining of the intestine and increases the risk of developingesophageal cancer.[26] There are no specific symptoms although symptoms of GERD may be present for years prior as it is associated with a 10–15% risk of Barrett's esophagus.[26] Risk factors include chronic GERD for more than 5 years, being age 50 or older, being non-Hispanic white, being male, having a family history of this disorder,belly fat, and a history of smoking.[27] Diagnosis can be made by looking into the esophagus with ascope and possibly taking abiopsy of the lining of the esophagus. Treatment includes managing GERD,destroying abnormal parts of the esophagus,removing abnormal tissue in the esophagus, andremoving part of the esophagus as performed by a general surgeon.[26] Further management could include periodic surveillance with repeat scopes at certain intervals determined by the physician, likely not more frequently than every three to five years.[27] Complications from this disorder can result in a type of cancer calledesophageal adenocarcinoma.[28]
In Gastroenterology, as in other specialties,telehealth has led to a reshaping of healthcare systems by introducing new ways of providing care, facilitating access to services throughout the entire Countries.[36][37]
Some gastroenterology trainees will complete a "fourth-year" (although this is often their seventh year of graduate medical education) in transplanthepatology, advanced interventionalendoscopy,inflammatory bowel disease,motility, or other topics.
Advanced endoscopy, sometimes called interventional or surgical endoscopy, is a sub-specialty of gastroenterology that focuses on advanced endoscopic techniques for the treatment ofpancreatic,hepatobiliary, andgastrointestinal disease. Interventional gastroenterologists typically undergo an additional year of rigorous training in advanced endoscopic techniques including endoscopic retrograde cholangiopancreatography, endoscopic ultrasound-guided diagnostic and interventional procedures, and advancedresection techniques includingendoscopic mucosal resection andendoscopic submucosal dissection. Additionally, the performance of endoscopic bariatric procedures is also performed by some advanced endoscopists.
American College of Gastroenterology (ACG)[38] - was founded in 1932 by a group of 10 gastroenterologists in New York City and now consists of over 16,000 gastroenterologists from 86 countries. The ACG sponsors conferences regionally and nationally, publishes several journals includingThe American Journal of Gastroenterology,Clinical and Translational Gastroenterology, and ACG Case Reports Journal, hostscontinuing medical education (CME) programs, supports initiatives for fellows-in-training, develops and promotes evidence-based guidelines, supports advocacy and public policy, and provides clinical research funding consisting of $27 million in research grants and career development awards ($2.2 million in 2022).[39]
American Gastroenterological Association (AGA)[40] - was founded in 1897 and now includes over 16,000 members worldwide. Their mission statement reads "Empowering clinicians and researchers to improve digestive health." The AGA publishes two journals monthly titledGastroenterology andClinical Gastroenterology and Hepatology, sponsors an annual meeting called Digestive Disease Week (DDW), provides more than $3 million each year in research grants to over 50 investigators through the AGA Research Foundation Awards Program ($2.56 million to 61 investigators in 2022), develops and promotes evidence-based guidelines, influences public policy through AGA's Congressional Advocates Program and the AGA political action committee (PAC), and supports a variety of educational opportunities including those that qualify for continuing medical education (CME) and maintenance of certification (MOC) credits.
American Society for Gastrointestinal Endoscopy (ASGE)[34] - was founded in 1941 and now includes around 15,000 members worldwide. Their mission statement reads "The American Society for Gastrointestinal Endoscopy is the global leader in advancing digestive care through education, advocacy and promotion of excellence and innovation in endoscopy." The ASGE publishes a monthly journal titledGastrointestinal Endoscopy (GIE), develops and promotes evidence-based guidelines, offers educational resources for its members, and provides advocacy resources for influencing public policy.
World Gastroenterology Organisation (WGO)[41] - was founded in 1958 and consists of 119 Member Societies and 4 regional affiliated associations from around the world which represents a combined 60,000 individuals. The WGO mission statement reads "To promote, to the general public and healthcare professional alike, an awareness of the worldwide prevalence and optimal care of gastrointestinal and liver disorders, and to improve care of these disorders, through the provision of high quality, accessible and independent education and training." The WGO publishes a newsletter titled the electronic World Gastroenterology News (e-WGN), develops global guidelines, engages in advocacy through World Digestive Health Day (WDHD) held yearly on 29 May, and provides educational resources including 23 training centers around the world and a Train the Trainers (TTT) program.
United European Gastroenterology The United European Gastroenterology (UEG) was formally established in 1992. Over the years, UEG has grown significantly, establishing itself as a leading and prestigious medical specialty organization worldwide. UEG's mission is to advance the field of digestive diseases through prevention, research, diagnosis, treatment, and increased awareness. It unites over 50,000 professionals, including members from national and specialist societies, individual experts, and scientists in digestive health. UEG organizes the annual UEG Week, a major international gastroenterology congress. It also focuses on education, research support, and advocating for clinical standards and public health policies related to digestive diseases in Europe. UEG publishes the UEG Journal and the UEG White Book, which analyzes the burden and economic impact of digestive diseases in Europe.
^Edgardo Rivera, MDJames L. Abbruzzese, MD; Pancreatic, Hepatic, and Biliary Carcinomas, Medical Oncology: A Comprehensive Review[1]Archived 2007-12-12 at theWayback Machine
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