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 that is passed through theanus to visualize therectum and the entire length of the colon. The procedure is performed either to look forcolon polyps and/orcolon cancer in somebody without symptoms, referred to asscreening, or to further evaluate symptoms includingrectal bleeding,dark tarry stools, change in bowel habits or stool consistency (diarrhea, pencil-thin stool), abdominal pain, and unexplained weight loss. Before the procedure, the physician might ask the patient to stop taking certain medications including blood thinners, aspirin, diabetes medications, ornonsteroidal anti-inflammatory drugs. Abowel prep is usually taken the night before and into the morning of the procedure which consists of anenema orlaxatives, either pills or powder dissolved in liquid, that will cause diarrhea. The procedure might need to be stopped and rescheduled if there is stool remaining in the colon due to an incomplete bowel prep because the physician can not adequately visualize the colon. During the procedure, the patient issedated and the scope is used to examine the entire length of the colon looking for polyps, bleeding, or abnormal tissue. Abiopsy orpolyp removal can then be performed and the tissue sent to the lab for evaluation. The procedure usually takes thirty minutes to an hour followed by a one to two hour observation period. Complications include bloating, cramping, a reaction to anesthesia, bleeding, and ahole through the wall of the colon that may require repeat colonoscopy or surgery. Signs of a serious complication requiring urgent or emergent medical attention include severe pain in the abdomen, fever, bleeding that does not improve, dizziness, and weakness.[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 procedure using along thin tube with a camera that is passed through the mouth to view theesophagus ("esophago-"),stomach ("gastro-"), and theduodenum ("duodeno-"). It is also referred to as upper endoscopy or just endoscopy. The procedure is performed for further evaluation of symptoms including persistentheartburn,indigestion,vomiting blood,dark tarry stools, persistent nausea and vomiting, pain,difficulty swallowing,painful swallowing, and unexplained weight loss. It is also performed for further testing following a lab test that showslow hemoglobin levels without a known cause or an abnormalbarium swallow. The procedure can be used to diagnose many disorders through direct visualization or tissue biopsy includingesophageal varices,esophageal strictures,gastroesophageal reflux disease,Barrett's esophagus, cancer,celiac disease,gastritis,peptic ulcer disease, and aH. pylori infection. Intra-operative techniques can then be used for treatment of certain disorders likebanding esophageal varices ordilating esophageal strictures. The patient will likely be required to not eat or drink anything starting 4 hours prior to the procedure. Sedation is usually required for patient comfort. This procedure usually lasts around thirty minutes followed by a one to two hour observation period. Side effects includebloating, nausea, and a sore throat for 1 to 2 days. Complications are rare but include reaction to the anesthesia, bleeding, and ahole through the wall of the esophagus, stomach, or small intestine which could require surgery. Signs of a serious complication requiring urgent or emergent medical attention include chest pain, problems breathing, problems swallowing, throat pain that gets worse, vomiting with blood or the appearance of "coffee-grounds", worsening abdominal pain,bloody or black tarry stool, and fever.[17]
A procedure using along thin tube with a camera passed through the mouth into thefirst part of the small intestine to locate, diagnose, and treat disorders related to thebile andpancreatic ducts. These ducts carry fluids that help with digesting food from the liver, gallbladder, and pancreas and can become narrowed or blocked as a result ofgallstones, infection, inflammation,pancreatic pseudocysts, and tumors of the bile ducts or pancreas. As a result, one may experience back pain,yellowing of the skin, and an abnormal lab test showing an elevatedbilirubin level which could necessitate this procedure. However, the procedure is not recommended if the patient hasacute pancreatitis unless the level of bilirubin remains high or is increasing which could suggest the blockage is still present. The patient will likely be required to not eat or drink anything starting 8 hours prior to the procedure. After the patient is sedated, the physician will pass the scope through the mouth, esophagus, stomach, and into the duodenum to locate theopening where the ductsdrain into the small intestine. The physician can then inject dye into these ducts and take X-rays which show a real time view, viafluoroscopy, allowing the physician to locate and relieve the blockage. This is done through multiple techniques includingcutting the opening and creating a bigger hole for drainage, removing gallstones and other debris, dilating narrow parts of the ducts, or placing a stent which keeps the ducts open. The physician can also take abiopsy of the ducts to evaluate for cancer, infection, or inflammation. Side effects include bloating, nausea, or a sore throat for one to two days. Complications includepancreatitis, infection of thebile ducts orgallbladder, bleeding, reaction to the anesthesia, and perforation of any structures that the scope or its instruments pass but particularly the duodenum, bile duct, and pancreatic duct. Signs of a serious complication requiring urgent or emergent medical attention include bloody orblack tarry stool, chest pain, fever, worsening abdominal pain, worsening throat pain, problems breathing, problems swallowing, vomit that is bloody or looks likecoffee-grounds. Most of the time complications from this procedure require hospitalization for treatment.[18]
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 lead 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
^DeStoll M: Rationis Mendendi, in Nosocomio Practico vendobonensi.Part 1 LugduniBatavarum, Haak et Socios et A et J Honkoop 1788,OCLC23625746
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^Wüstner, M.; Radzina, M.; Calliada, F.; Cantisani, V.; Havre, R.F.; Jenderka, K.V.; Kabaalioğlu, A.; Kocian, M.; Kollmann, C.; Künzel, J.; et al. Professional Standards in Medical Ultrasound—EFSUMB Position Paper (Short Version)—General Aspects. Ultraschall Med. 2022, 43, 456–463.
^Wüstner, M.; Radzina, M.; Calliada, F.; Cantisani, V.; Havre, R.F.; Jenderka, K.V.; Kabaalioğlu, A.; Kocian, M.; Kollmann, C.; Künzel, J.; et al. Professional Standards in Medical Ultrasound—EFSUMB Position Paper (Short Version)—General Aspects. Ultraschall Med. 2022, 43, 456–463
^Cortellini F, Fichera A, Guarino AD, Laterza L, Alemanni LV, Lopetuso L, Marasco G, Costantino A. Abdominal and Bowel Ultrasound Knowledge Among Young Gastroenterologists: Results of an Italian Survey. Journal of Clinical Medicine. 2025; 14(8):2693.https://doi.org/10.3390/jcm14082693
^Gellad ZF, Diamond S, Crockett SD, Cross RK. AGA Clinical Practice Update on Telemedicine in Gastroenterology: Commentary. Gastroenterology. 2023 Apr;164(4):690-695. doi: 10.1053/j.gastro.2022.12.043. Epub 2023 Feb 10. PMID: 36775722.
^Costantino A, Bortoluzzi F, Giuffrè M, Vassallo R, Montalbano LM, Monica F, Canova D, Checchin D, Fedeli P, Marmo R, Elli L. Correct use of telemedicine in gastroenterology, hepatology, and endoscopy during and after the COVID-19 pandemic: Recommendations from the Italian association of hospital gastroenterologists and endoscopists (AIGO). Dig Liver Dis. 2021 Oct;53(10):1221-1227. doi: 10.1016/j.dld.2021.06.032. Epub 2021 Jul 24. PMID: 34312103.
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^"ACG at 90 Booklet"(PDF).www.gi.org. The American College of Gastroenterology. Retrieved16 December 2022.
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