What are advantages and disadvantages of seeing Hepatologist as against those of seeing Gastroenterologist?

I have observed that in many postings on this site when answering questions raised by people newly diagnosed with liver disease it is advocated that the person raising the question must make sure they see a Hepatologist and not a Gastroenterologist and I am left wondering why this aspect seems to be so important? Is it a just because it makes you feel better inside?

Some people have no other choice but to be seen by a Gastroenterologist and it is sad to see them undermined as some inferior or make do option.

I was under the impression that a Hepatologist is in fact a Gastroenterologist but as the description implies he or she is one that specializes specifically on the liver. I am also under the a further impression,perhaps an incorrect one, that whoever is dealing with the matter the same protocol and guidelines etc are followed. To me it seems a Gastroenterologist ( not a Registrar) at say an NHS General hospital may see liver disease patients virtually every day and have just as much experience and expertise as a Hepatologist even though he or she is not described as such? Liver disease does of course also extend beyond the actual liver itself to affect other organs in the gastroenterinal system as well as the heart and lungs and even the kidneys and urinary tract etc

Personally I have always been seen by the same senior Gastroenterologist from the team at my local General Hospital (albeit a very large Hospital) and from the number of people he sees at his Clinics and the liver related procedures that he appears to organizes etc I am confident he is extremely experienced and very capable of advising me properly as well as guiding me to fight the disease. I have occasionally checked things he has advised and prescribed against the Protocol and Guidelines and he has always been spot on.

Hence my reason to question why for many people it seems to be important to see a Hepatologist rather than a Gastroenterologist particularly when so many patients have no other realistic choice ?

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  • Hi there, my hubby saw a gastroenterologist at our local hospital when he was first admitted via A&E to hospital after a bleed from varices, up until that point we never even knew he had any underlying condition. He went onto a general medical ward whilst they sorted out the complications from the bleed and banded the varices as a matter of emergency.

    Further tests were taken and done i.e. ultra sound and biopsy and this revealed cirrhosis with unknown cause as hubby is and always has been tee-total. The biopsy sample was sent to Liver Specialists at the Edinburgh Royal Infirmary for further exam as gastroenterologist locally didn't have the expertise on the liver to say one way or the other and sadly a year on the cause hasn't been 100% identified as the sample taken locally was actually too small a sample and hadn't been taken from deep enough into the liver. Scottish Liver Unit have said they will probably repeat this procedure.

    We have gone a year plus without any treatment for the actual liver condition, just treatment of varices repeatedly. In January at a consultation with gastroenterologist and on discussing the additional signs and symptoms of hubbies liver condition (severe lethargy, sleeplessness, hormonal issues) Doctor himself said he thought it was time to refer us to the liver specialists at Edinburgh which we are mightily happy about feeling that a gastroenterologist is yes an expert on the gastric system but not the liver in particular and it is such a complicated organ that we want to see someone who actually specialises just in the liver and its problems and possible treatments. Sadly doctor then went off sick and the referral never came until we chased it up and we got referred late May and got an appointment June to go to see a hepatologist at the Scottish Liver Transplant Unit in Edinburgh for an initial consultation. We saw a brilliant doctor there and hubby has been added to her caseload and whilst there we got a lot of answers, saw a specialist liver dietician and his varices obliteration has been taken over by them, they are also now co-ordinating all of hubbies care. Since going to Edinburgh he has been put onto Iron Tablets to try and treat anemia which no one had done anything about before, has organised a colonoscopy which local man had talked about doing or had said "hadn't ruled out" but never done it. All in all we seem to have gotten more appropriate care and more knowledgeable treatment from the liver team and we are happier being under their care with local stuff being co-ordinated by liver specialists. Indeed we had a consultation locally last week with the gastroenterologist who said he was glad we were under Edinburgh now as hubby deserves the best treatment for his condition, locally he was lucky to have seen doctor who had an 'interest' in the liver but most of the other registrars etc. had little knowledge of the liver specifically and although happy to be kept the loop should local need arise he said Edinburgh being the top liver unit in Scotland was absolutely the right place to be getting treated. He said as a Doctor in Harrogate he would pass liver cases to St. James's Leeds as local small hospitals are not always the best place to treat such a diverse organ as the liver.

    If you feel that your care is being appropriately handled locally by a doctor with sufficient knowledge then that is great but the liver is a very complicated organ and i'd rather my hubby was under the care of a doctor who knew it inside and out and would pick up on even minor changes which would indicate a worsening of his condition. Our care locally was the best that doctor could do with the tools available but specialist liver doctors and at major units can only be better. Indeed the SLTU says it is better to be referred early than too late. They might only co-ordinate local care but its being done from a liver angle. We are going back and forth to Edinburgh every 4 weeks now for varices obliteration and for a consultation in October so they obviously feel they want to treat hubby rather than just passing his care back to the local (small albeit University Hospital).

    All the best everyone, but I would urge folks who don't think they are getting the appropriate treatment to push to see a liver specialist.

    Katie & Hubby

  • I have seen both and both were appropriate at the time of consultation: the gastroenterologist when he was addressing some general issues (up to an including the diagnosis of cirrhosis) and the hepatologist when the gastroenterologist diagnosed liver cancer and I needed consideration of transplant surgery. My experience led me to assumed that one doctor is aware of the limits of competence, at which point an appropriate referral is made. If you suspect (and I am not suggesting you do) that one is holding back in some way, either in terms of diagnosis or treatment options, I think it would be reasonable to ask for further referral as Katie and her husband did.

    Best wishes

    Mike

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