Showing posts with label hepatologist. Show all posts
Showing posts with label hepatologist. Show all posts

Tuesday, April 3, 2018

What Is A Hepatologist ? What Is A Gastroenterologist?

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Fatty Liver
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What Is A Hepatologist ? What Is A Gastroenterologist?
The study of gastroenterology and hepatology are often related to each other. A gastroenterologist is an internist who has completed specialty training in the treatment of digestive disorders. Digestive disorders include disorders of the esophagus, stomach, small and large intestines, pancreas, gallbladder, and liver.

In order to become board certified in gastroenterology, the doctor must first become board certified in internal medicine. In order to become eligible to even take the examination for board certification in gastroenterology, a gastrointestinal (GI) fellowship lasting an additional two to three years beyond an internal medicine residency must be completed.

During the course of their two to three years of training in gastroenterology, some gastroenterologists have little exposure to patients with liver disease.

On the other hand, some gastroenterologists have a great deal of exposure to patients with liver disease during the course of their gastroenterology specialty training.

Thus, the level of experience and expertise among gastroenterologists in diagnosing and treating liver disease varies greatly. It is important for the patient to determine the gastroenterologist's level of expertise in liver disease prior to establishing a long-term medical relationship with this type of doctor.

Clinical hepatology generally deals with the liver, its functions and its diseases. Most disorders of the liver are usually grouped together under hepatology. Examples of these diseases are liver cirrhosis, hemochromatosis, and hepatitis. Hepatitis is liver inflammation brought about by infection with several types of hepatitis virus, which include the hepatitis A virus and the hepatitis C virus, among many others.

What Is A Hepatologist ?
A hepatologist is the most experienced and qualified type of doctor to treat people with liver disease. Since there is currently no separate board certification examination in the field of hepatology, there is no official definition of a hepatologist. However, there are specialized training programs for doctors who are focused solely on liver disease. These are known as hepatology fellowships and typically last from one to two years. Over the course of a hepatology fellowship, a doctor receives comprehensive training in the diagnosis and treatment of liver disease. This specialty training typically includes extensive exposure to all liver diseases, including those that are rare and infrequently seen. This intense training in liver disease is rarely matched in a gastroenterology fellowship

A physician who successfully completes a hepatology fellowship is considered a hepatologist. Most hepatologists, although not all, are also gastroenterologists. These doctors have successfully completed both a hepatology and a gastroenterology fellowship. Occasionally, gastroenterologists who have not completed a fellowship in hepatology nonetheless focus their medical practice primarily on the diagnosis and treatment of people with liver disease. While these physicians do not have a separate diploma in the field of liver disease, they may also be considered hepatologists.

For many reasons, it is to the patient’s advantage to choose a hepatologist to treat his liver disease. The patient can be virtually assured that the hepatologist will have substantial experience in the diagnosis and treatment of the full range of liver diseases. Furthermore, hepatologists are likely to be the first to learn about the most up-to-date therapies—both FDA-approved and experimental—and to incorporate them into their practices. However, whether someone chooses to see a gastroenterologist or a hepatologist, it is important to find a doctor who is willing to work with him as an equal partner in the healing process.

What is a Gastroenterologist?
A Gastroenterologist is a physician with dedicated training and unique experience in the management of diseases of the gastrointestinal tract and liver.

What is Gastroenterology?
Gastroenterology is the study of the normal function and diseases of the esophagus, stomach, small intestine, colon and rectum, pancreas, gallbladder, bile ducts and liver. It involves a detailed understanding of the normal action (physiology) of the gastrointestinal organs including the movement of material through the stomach and intestine (motility), the digestion and absorption of nutrients into the body, removal of waste from the system, and the function of the liver as a digestive organ. It includes common and important conditions such as colon polyps and cancer, hepatitis, gastroesophageal reflux (heartburn), peptic ulcer disease, colitis, gallbladder and biliary tract disease, nutritional problems, Irritable Bowel Syndrome (IBS), and pancreatitis. In essence, all normal activity and disease of the digestive organs is part of the study of Gastroenterology.

What do all the letters after your doctor’s name mean?
Some Gastroenterologists receive special recognition from national societies when they demonstrate extraordinary achievement in research, teaching, or other unique service to the field of Gastroenterology. The American College of Gastroenterology and the American College of Physicians designate such physicians as “Fellows” and the suffixes FACG and FACP are added to denote these honors. This means that these physicians have fulfilled the respective organizations’ rigorous requirements to gain this added distinction

What makes Gastroenterologists different?
The unique training that Gastroenterologists complete provides them with the ability to provide high quality, comprehensive care for patients with a wide variety of gastrointestinal ailments. Gastroenterologists perform the bulk of research involving gastrointestinal endoscopic procedures as well as the interpretation of results, and are considered experts in the field. Studies have shown that Gastroenterologists perform higher quality colonoscopy examinations and comprehensive consultative services when compared to other physicians. This translates into more accurate detection of polyps and cancer by colonoscopy when performed by Gastroenterologists, fewer complications from procedures and fewer days in the hospital for many gastrointestinal conditions managed by trained gastroenterology specialists. It is this ability to provide more complete, accurate, and thorough care for patients with gastrointestinal conditions, which distinguishes Gastroenterologists

The Training
Gastroenterology fellowship training is an intense, rigorous program where future Gastroenterologists learn directly from nationally recognized experts in the field and develop a detailed understanding of gastrointestinal disA Gastroenterologist must first complete a three-year Internal Medicine residency and is then eligible for additional specialized training (fellowship) in Gastroenterology. This fellowship is generally 2-3 years long so by the time Gastroenterologists have completed their training, they have had 5-6 years of additional specialized education

They learn how to evaluate patients with gastrointestinal complaints, treat a broad range of conditions, and provide recommendations to maintain health and prevent disease. They learn to care for patients in the office as well as in the hospital.

Gastroenterologists also receive dedicated training in endoscopy (upper endoscopy, sigmoidoscopy, and colonoscopy) by expert instructors. Endoscopy is the use of narrow, flexible lighted tubes with built-in video cameras, to visualize the inside of the intestinal tract. This specialized training includes detailed and intensive study of how and when to perform endoscopy, optimal methods to complete these tests safely and effectively, and the use of sedating medications to ensure the comfort and safety of patients. Gastroenterology trainees also learn how to perform advanced endoscopic procedures such as polypectomy (removal of colon polyps), esophageal and intestinal dilation (stretching of narrowed areas), and hemostasis (injection or cautery to stop bleeding). Importantly, Gastroenterologists learn how to properly interpret the findings and biopsy results of these studies in order to make appropriate recommendations to treat conditions and/or prevent cancer

Some Gastroenterologists also receive directed training in advanced procedures using endoscopes such as endoscopic biliary examination (endoscopic retrograde cholangiopancreatography or ERCP), removal of tumors without surgery (endoscopic mucosal resection or EMR), placement of internal drainage tubes (stents) and endoscopic ultrasound (EUS). This provides them with the training necessary to non-surgically remove stones in the bile ducts, evaluate and treat tumors of the gastrointestinal tract and liver, and provide minimally invasive alternatives to surgery for some patients

The most critical emphasis during the training period is attention to detail and incorporation of their comprehensive knowledge of the entire gastrointestinal tract to provide the highest quality endoscopy and consultative services

The final product is a highly trained specialist with a unique combination of broad scientific knowledge, general Internal Medicine training, superior endoscopic skills and experience, and the ability to integrate these elements to provide optimal health care for patients. This advanced fellowship training is overseen by national societies committed to ensuring high quality and uniform education. These groups include the American Board of Internal Medicine, the American College of Gastroenterology, the American Gastroenterological Association, and the American Society for Gastrointestinal Endoscopy. These groups carefully scrutinize the educational experience of each program to ensure that every Gastroenterology trainee receives the highest quality training. Once fellows successfully complete their training they are considered “Board Eligible.” They are then qualified to take the Gastroenterology board certification test administered by the American Board of Internal Medicine. Once they have successfully completed this examination they are “Board Certified.” FACG, FACP —

Aside from diagnosing and treating patients with gastrointestinal problems, gastroenterology and hepatology specialists also usually conduct research. Most of this research is directed at finding newer methods to detect gastrointestinal diseases and prevent their development. These doctors also search for new and better drugs to be used for the treatment of gastroenterology and hepatology patients.

Wednesday, October 9, 2013

Will Evolving Hepatitis C Therapies Reduce the Need for Specialized Care?

Clinical Care Options - Clinical Thought

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Enter the Nonspecialist: Will Evolving Hepatitis C Therapies Reduce the Need for Specialized Care?

Graham R. Foster, FRCP, PhD - 10/8/2013  More from this author

When I first started treating hepatitis C, therapy was complicated primarily by interferon-associated adverse events such as flulike symptoms, thrombocytopenia, neutropenia, depression, and thyroiditis requiring a specialist to manage treatment. These specialists learned how to anticipate, manage, and work around these predictable adverse events to maximize adherence and outcomes. The addition of ribavirin and the anemia associated with its use resulted in hepatitis C treatment remaining firmly in the hands of specialists with experience in managing the complications of therapy. Nor did the availability of peginterferon alter the need for hepatitis C therapy to remain the purview of hepatologists, gastroenterologists, and infectious disease specialists. For the better part of 10 years, this standard of care remained unchanged.

The Direct-Acting Antivirals (DAAs) Evolution
In 2011, our field underwent an evolutionary leap forward with the introduction of the first DAAs, boceprevir and telaprevir. The addition of these new protease inhibitors to peginterferon and ribavirin finally allowed us to attack the virus directly and deliver to patients (at least those infected with genotype 1 hepatitis C) significant increases in sustained virologic response. However, the realities of adverse events, especially anemia, have persisted and nothing about the new protease inhibitor–based regimens have made treating patients any easier or less complex.

Hepatitis C treatment, therefore, has remained firmly in the hands of specialists. Nonspecialist, primary care physicians have been reluctant to take up these new tools, often due to limited or no exposure to them and to concerns about administering the complex treatment paradigms and managing the complex adverse event profiles. In some ways, their reluctance mirrors the reluctance I observed with the advent of potent hepatitis B therapies. Nonspecialists were properly concerned about their lack of familiarity with the new agents and were afraid of “getting it wrong” while using some very expensive drugs that had few alternatives if treatment failed. In addition, many patients influenced by the negative experiences and opinions of their peers have been skeptical about initiating treatment and even less willing to initiate treatment with anyone other than a hepatitis C specialist. Treatment uptake has been further limited by the recognition that patients with advanced or rapidly progressive liver disease experience reduced efficacy, tolerability, and potentially more severe adverse events requiring very careful consideration before initiating care and specialized management if care is initiated.

The Nonspecialist Future
For my part, I see positive change coming. Although the next wave of regimens for genotype 1 will continue to require interferon, before too long, I anticipate additional regimens that will remove the need for interferon. At some point thereafter, I expect ribavirin will go by the wayside, finally eliminating the last of the adverse events associated with the peginterferon/ribavirin-based regimens. Once this occurs, the numbers of patients initiating therapy will likely explode and the numbers and types of providers treating them will also increase significantly. This expansion of patients and providers will mirror improving efficacies and gentler adverse event profiles, but ongoing complexities of care probably will remain as a limiting factor for many nonspecialist providers. This is only likely to change with the introduction of a single-tablet regimen (STR) for HCV therapy—a development that will propel hepatitis C care to its future in nonspecialist providers offices. We must recognize that to take full advantage of these new agents, educating these providers and their patients must remain a priority. Information will be the key to overcoming preconceptions about adverse events and regimen complexities, finally allowing nonspecialists to take a central role in caring for HCV-infected patients.

After the advent of the STR, what will be the place of the specialist? We will take a step back as nonspecialists gradually assume a larger role managing patients with few comorbidities and little or no liver disease. For myself, I expect the face of my practice will change; 5 years from now, it will probably be composed entirely of a subset of very complicated patients who may need the benefits of interferon and the experience using it that a specialist provides. These patients, such as those with previous failure of the more straightforward treatment regimens, will require close monitoring and careful management as they navigate the complexities of a 5- or 6-drug regimen.

Your Thoughts?
I’m interested to hear your thoughts. Do you think the time is approaching when HCV therapy will be managed primarily by nonspecialists? Maybe you yourself are a nonspecialist who is already using the current HCV regimens without difficulty? How do you see the future unfolding?

Topics: HCV - Prognosis 

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