IBS specialists and gastroenterologists are very different specialties. IBS specialists are experts in irritable bowel syndrome (IBS). Gastroenterologists are specialists in performing colonoscopies, upper endoscopies, and managing severe diseases of the digestive tract. To them IBS is a diagnosis made when other problems have have been ruled out. A gastroenterologist may diagnose IBS, but that doesn’t help you cure it. It is still just a label telling you that your bowel irritates you. Solving IBS can involve one of hundreds of different causes of IBS. Gastroenterologists may address one two of these causes, but that is it.
Both IBS specialists and gastroenterologists can diagnose IBS, but after that, their approach and their success rate for treating IBS are very different.
The Approach of the IBS Specialist
The IBS specialist focuses diagnosing the cause of your irritated bowel, not on evaluating the structural integrity of the digestive tract with a scope. To the IBS specialist, the label of IBS primarily serves as a starting point for further investigation.
Rather than focusing on the patient’s symptoms, or simply treating the symptoms, the IBS specialist is devoted to identifying the underlying condition or conditions in the patient that are causing the symptoms.
There are literally hundreds of different causes of IBS and the digestive symptoms associated with IBS. Patients with identical symptoms may have radically different causes for those symptoms. An IBS specialist does not yet know how they will treat an IBS patient when they first meet that patient. A significant amount of detective work, beyond that done by the gastroenterologist, is 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 also involves evaluating enzyme production, acid production, special inflammatory markers, and the overall functioning of the processes of the digestive system.
The Approach of a Gastroenterologist
Gastroenterology is primarily a specialty in assessing the structure of the digestive tract. Gastroenterologists are experts in evaluating how the digestive tract looks and in very specific diseases of the digestive tract, not syndromes or symptoms that can only be described by the patient but not seen by the doctor.
Gastroenterologists primarily focus on the visual inspection of the digestive tract, like performing colonoscopies and upper endoscopies. They also do other imaging work of the GI tract, such as an ultrasound, CT scan, MRI, x-rays, and even “pill cameras.”
They may also perform studies that assess the motility of the digestive tract. Therefore, if you go to a gastroenterologist, your diagnosis will be based on these types of testing.
Gastroenterologists are focused on diagnosing ulcers, polyps, cancers, and other physically and visually apparent abnormalities of the digestive tract. This is a very important specialty, and their significance cannot be overstated. However, this does not mean that they are experts in everything related to digestion.
Gastroenterologists have no special training in immunology even though the digestive tract is the single most concentrated area of immune activity in the body, nor do they have any special training in diet or nutrition, or most types of reactions to foods. They also do not have any special training in the use of different types of probiotics, different types of enzymes, or the treatment of deficiencies of stomach acid.
Stool Testing is very different for IBS Specialists and Gastroenterologists
Both IBS specialists and gastroenterologists do stool testing, but often for different reasons and they perform very different types of stool testing.
A gastroenterologist may run a stool test for specific organisms such as giardia, salmonella, Clostridium difficile, and hemorrhagic E. coli. These are important because they detect the most life threatening infections of the digestive tract. And H. pylori may be assessed via a biopsy done during an endoscopy.
IBS specialists utilize more detailed stool testing to map the ecosystem of the digestive tract. They want to know about all of the organisms in the gi tract, not just the deadly ones. And they need to know exactly what type of good bacteria (probiotics) you have, and in what amounts. They also want to know about the presence of other bacteria, yeast, or parasites, even ones that are considered harmless. This is because everything in this ecosystem plays a role in how you digest your food.
Confusion About Colonoscopies
The use of the colonoscopy is widely misunderstood. Although it is an important tool, its ability to cure patients of common digestive problems such as chronic diarrhea, constipation, or abdominal pain is extremely limited.
For the most part, a colonoscopy is a viewing procedure, not a treatment. It is the process of looking at the inside of the colon. The colonoscopy involves introducing a fiber optic scope into the rectum and up into the colon. This allows the doctor to see any possible problems such as polyps, ulcers, tumors, and damaged tissue that is bleeding, which are all potentially serious issues.
During a colonoscopy, doctors cannot see bacteria, yeast, or most parasites, nor can doctors diagnose celiac disease or any other food reaction. These problems are often the cause of your digestive issues.
One of the most significant benefits of a colonoscopy is the identification and removal of polyps. Polyps do not usually cause digestive problems, however removing them is important because polyps increase the risk for developing colon cancer. Removing the polyp dramatically reduces this risk. This is the impetus for a screening colonoscopy at the age of 50 and regular screenings after that.
For the average person suffering from constipation, diarrhea, or abdominal pain, the colonoscopy is unlikely to have any immediate or long-term impact on the symptoms, regardless of age. It is highly unlikely you will come away from a colonoscopy feeling any better than you did before you had the colonoscopy. If there is relief, it may come from the prep process for the colonoscopy that will clean you out and will temporarily relieve your constipation.
It is important to have a colonoscopy to rule out ulcers, tumors, and the like, but you should not get your hopes up that it will solve your digestive problems. You will likely come away with a clean bill of health, maybe having had a polyp or two removed, but you will still have the same digestive symptoms you went in with.
This is the scenario we hear from patients every day at the IBS Treatment Center. People with life-altering digestive problems are often surprised to learn everything basically looked fine on their colonoscopy, yet they still have symptoms. If you suffer from Irritable Bowel Syndrome, you need an IBS specialist.
No matter where you live, the specialists at the IBS Treatment Center can help you. We treat people near and far, regardless of where they live. We have a telemedicine option, testing kits that can be shipped to you, and doctor consults that happen via video conference, like Skype. All of these options can get you feeling better and help you get your life back. You’re never too far away to be helped by one of our doctors. Thousands of our patients have been successfully treated this way, and we routinely work with people from other countries.
IBS and Gastroenterologist FAQs
What Can a Gastroenterologist Do For IBS?
Gastroenterologists will likely do several tests, including a colonoscopy and stool test. After they rule out other conditions, they often diagnose IBS. They may prescribe a medication to treat symptoms, but will not fix the cause of the IBS.
A gastroenterologist might test for and treat SIBO. If it doesn’t solve your IBS, then you may be out of options from a gastroenterologist. Any dietary advice is likely to center around the latest IBS diet, which most recently has been the fodmaps diet.
What is an IBS Specialist?
An IBS specialist knows that there is no one cause of IBS, but hundreds of causes. After testing to discover the cause, the IBS specialist will create a detailed and customized approach to treating you. Treatments, including diets, are specific to each individual.
A true IBS specialist is not satisfied until your problem has been cured.
Should I See a Gastroenterologist For IBS?
Gastroenterologists are not the best at treating IBS since they are specialists in life threatening digestive conditions. For serious symptoms like severe abdominal pain, bloody diarrhea, or severe watery diarrhea, you should see a gastroenterologist in order to rule out other problems.
Once that has happened the gastroenterologist may diagnose you with IBS and may provide you with some type of treatment. If that is not successful in curing your IBS, then you should see an IBS specialist.
How Does a Gastroenterologist Diagnose IBS?
A gastroenterologist diagnoses IBS based on the symptoms present and the length of time you’ve had those symptoms. They also rule out other problems, and once that has been done, they use the process of elimination to diagnose IBS.
Questions to Ask Your Gastroenterologist About IBS?
Ask your gastroenterologist the following questions. Do you believe IBS can be cured?
How often do you find it curable? What is the cause of IBS? If they do not know the cause and do not believe IBS is curable, keep looking for help.
Dr. Wangen is the founder and medical director of the IBS Treatment Center, the award winning author of two books, and a nationally recognized speaker on digestive disorders. He has been on ABC, NBC, and Fox as well as public radio, and was named one of Seattle’s Top Doctors by Seattle Magazine.