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Gastroenterology is a field of internal medicine dedicated to the study and treatment of diseases of the gastrointestinal tract from the mouth to the anus and accessory organs such as the gallbladder, pancreas and liver. Certification in gastroenterology requires completion of two years of post-graduate training following the core internal medicine residency. Gastroenterology is deeply rooted in an understanding of the normal anatomy and physiology of the digestive organs and how the body handles nutrient and waste exchange. The spectrum of diseases that a gastroenterologist manages include functional disorders of the gut such as IBS, inflammatory bowel diseases, autoimmune diseases such as celiac disease and infectious processes such as viral induced hepatitis. The discipline is therefore highly varied, broad and dynamic due to the wide spectrum of etiologies implicated in diseases of the digestive tract and accessory organs.

Gastroenterologists are able to work in both community and academic centers with some specialists maintaining outpatient clinics. Their practice includes a large component of procedural work such as upper endoscopy, colonoscopy and sigmoidoscopy. These techniques are utilized in surveillance such as screening for colorectal cancer, diagnosis of disease and for therapeutic intervention as seen in polypectomies, dilations and coagulation of active bleeds. Endoscopic interpretation of findings during the procedure and the results of the biopsy are an important core of the practice. Advanced training allows for biliary examination (ERCP), stent placements and endoscopic ultrasound. Gastroenterologists are therefore highly trained specialists with broad knowledge in the physiology and pathology of the GI tract and are highly capable at both the medical and procedural management of their patients.

Common Disease and Disorders

Inflammatory Bowel Disease (IBD)
IBD is an autoimmune disease which can occur in various presentation. The two most common inflammatory bowel diseases are Crohn’s disease and ulcerative colitis which affect the gastrointestinal tract in different manners and are managed differently. While Crohn’s disease can impact any area of the gastrointestinal tract from the mouth to anus and presents with characteristic skip lesions, ulcerative colitis is typically restricted to the colon and begins perianally migrating proximally. The types of lesions that these two classes cause as well as their extra-intestinal associations also differ.

Irritable Bowel Disease
Considered a functional gut disorder in that there is no organic cause for disease (anatomic, physiologic or otherwise). It is likely due to an abnormality in the manner in which the brain and GI tract communicate. IBS often begins after an infection or stressful life event. There are multiple classifications of IBS based on the symptom complex, these are either diarrhea predominate, constipation predominate or alternating type. Diagnosis is based on symptoms after other diagnoses are ruled out.

Inflammation of the liver which can occur in either acute or chronic settings. Viral hepatitis is the most common cause of liver inflammation but other etiologies include the ingestion of toxic substances like alcohol and certain medications. Acute hepatitis can lead to acute liver failure or progress to chronic hepatitis which can be insidious in nature and have no symptoms. Overtime, the progression to fibrosis (scarring) and cirrhosis can occur which increases the risk of liver failure and developing hepatocellular carcinoma.

Gastrointestinal Reflux Disease (GERD)
Chronic reflux of stomach acid contents into the esophagus can lead to mucosal damage. This may be due to an abnormally lax lower esophageal sphincter or a herniation. GERD can lead to esophagitis, strictures, Barrett’s esophagus (a metaplastic change in the epithelial lining of the esophagus) and cancer. Treatment to control GERD is therefore important and typically involves lifestyle changes and the addition of medications such as proton pump inhibitors and antacids. Surgery to restore sphincter strength is considered in patients who do not respond to medical therapy.

Peptic Ulcer Disease (PUD)
Ulcerations can occur in the stomach, the small intestine or lower esophagus. Ulcerations in the stomach are known as gastric ulcers while those in the duodenum are duodenal ulcers. The presentations between these two types of ulcers is different and the symptoms, including their timing with eating vary. Common etiologies include H. pylori infection and chronic use of NSAID drugs. Treatment includes reigning in control of stomach acid, discontinuing the use of NSAIDs, smoking and alcohol and adding on medical therapies such as proton pump inhibitors, H2 blockers and antibiotics.

Further Advanced Training Opportunities

Once the core internal medicine and subsequent general gastroentrology residency/fellowship is completed, practicing physicians may choose to pursue advanced training opportunities throughout the country and around the world. These include fellowships designed to further expertise in areas such as gastroscopy, colonoscopy, esophageal manometry, capsule endoscopy, ERCP, endoscopic ultrasound and variceal band ligation to name a few.

Gender Breakdown
59 responses (2014 National Survey Results)

Age Breakdown
59 responses (2014 National Survey Results)
Hours Breakdown (Excluding on-call activities)
50 responses (2014 National Survey Results)

Activity Hours Worked (mean)
Direct patient care without a teaching component 28.07
Direct patient care with a teaching component 5.83
Teaching/ educating without direct patient care 1.52
Indirect patient care 6.02
Health facility committees .77
Administration 1.07
Research 1.89
Managing your practice 1.38
CME/ CPD (Continuing Professional Development) 2.73
Other actvities .05
Total Hours 49.33

Average number of on-call work hours per month: 99.73
49 responses; reported as mean (2014 National Survey Results)

Adult Gastroenterology Programs in Canada

Contact information for Program Directors can be accessed on the Royal College’s website here: Open in new tab

University of British Columbia
Vancouver, British Columbia

Queen’s University
Kingston, Ontario

University of Calgary
Calgary, Alberta

University of Ottawa
Ottawa, Ontario

University of Alberta
Edmonton, Alberta

McGill University
Montréal, Quebec

Université de Montréal
Montréal, Quebec

University of Manitoba
Manitoba, Winnipeg

Université de Sherbrooke
Sherbrooke, Quebec

Université Laval
Laval, Québec

Western University
London, Ontario

Dalhousie University
Halifax, Nova Scotia

McMaster University
Hamilton, Ontario

University of Toronto
Toronto, Ontario

Page Author(s): John Haddad (2017)
© 2021 Internal Medicine Interest Group (IMIG) - Schulich School of Medicine and Dentistry