Hepatologist vs. Gastroenterologist
How They Differ and Who to See for Liver Disease Care
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Medically reviewed by Sonal Kumar, MD, MPH
The diseases hepatologists (liver doctors) and gastroenterologists treat have some overlap, and that's important to those with liver health concerns. Weighing the differences between a gastroenterologist and hepatologist can help you and your primary care provider decide who you should see to diagnose and help manage liver disease.
While a gastroenterologist diagnoses and treats diseases involving all components of the digestive tract, the liver being just one, a hepatologist's focus is limited to only the liver and the bile ducts. A decision between them also depends on your specific needs, such as whether you need to see a transplant specialist.
This article will help you to understand the benefits these specialists offer, the conditions they diagnose and treat with an eye toward liver health, and the situations in which you'd choose between them, or perhaps see one and be referred to another.
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Hepatologist vs. Gastroenterologist Training
Gastroenterologists and hepatologists learn about many of the same organ systems, but the specifics of their education and training are a little different depending on where their focus is.
Hepatologist
A hepatologist is trained to treat disorders of the liver and bile ducts. Most hepatologists do a gastroenterology fellowship but end up focusing their practice on liver diseases.
In addition, a transplant hepatologist is specially trained to manage advanced liver disease and liver transplants. Transplant hepatology involves a one-year fellowship after completing a general gastroenterology fellowship. It is an accredited board-certified fellowship.
Hepatologists are likely to diagnose and treat conditions such as:
Cirrhosis of the liver
Acute and chronic liver failure
Hepatitis
Chronic liver disease
Abnormal liver tests
Vascular liver disease
Liver cancers and tumors
Cholangiocarcinoma (bile duct cancer)
Gastroenterologist
A gastroenterologist is a provider who is board certified in both internal medicine and gastroenterology. To obtain the latter credential, they must complete a two- to three-year fellowship in gastroenterology, which involves an in-depth study of disorders of the digestive tract organs.
These organs include the liver and bile ducts, but a gastroenterologist also is trained to diagnose and manage conditions that affect the:
Esophagus (the tube connecting your mouth to your stomach)
Stomach
Small intestine
Large intestine
Pancreas
Gallbladder
Rectum
Anus
Some of these conditions would include irritable bowel syndrome (IBS), colorectal polyps, and cancers of the digestive tract like esophageal cancer.
Learn More: What Gastroenterologists Do
Common Procedures to Diagnose and Treat Liver Disease
You might assume that a provider who is trained in liver disorders is better suited to treat hepatitis, for example, but that’s not always the case.
A hepatologist will likely know more about current and experimental treatments for liver disease but it does not mean they are necessarily better at caring for patients with the disease than a gastroenterologist. Both providers use many of the same approaches to diagnosing and treating liver diseases.
Hepatologist
A hepatologist uses a number of tests, like bloodwork and imaging, to check your liver function, arrive at a diagnosis, and decide on a treatment plan. If they are a specialist in transplants, they may want to talk to you about a liver transplant if that's necessary.
A hepatologist may order or perform tests that include:
Blood tests to check liver enzymes
Liver biopsies
Scoping procedures, including upper endoscopy
Imaging scans such as an X-ray, ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI)
Gastroenterologist
A gastroenterologist can diagnose and treat liver problems, as well as other digestive organs that can be affected by them. They can use many of the same exams, blood tests, and imaging scans to look at your liver, see how it's functioning, and recommend treatment.
A gastroenterologist typically will perform procedures including a colonoscopy (routine or diagnostic scoping procedure to visualize the large intestines).
Read Next: How Do I Know If I Need a Liver Transplant?
Deciding Between a Hepatologist and a Gastroenterologist
Choosing a gastroenterologist vs. hepatologist will be based on your needs, not just the training, experience, and expertise of the provider. Certain people may benefit from a referral to see a hepatologist, especially after receiving abnormal liver test results.
This includes people who have been diagnosed with:
Obesity, which can be associated with chronic liver disease
Type 2 diabetes, often linked with non-alcoholic fatty liver disease
Drug-induced liver injury, for example, due to Tylenol (acetaminophen) toxicity
Genetic disorders, as with the rare Wilson's disease (which causes a buildup of copper in the liver)
Certain symptoms, such as jaundiced (yellowed) skin and eyes, or a swelling in the abdomen called ascites, may point to the need for a hepatologist. Other symptoms, such as frequent heartburn and changes in bowel habits, may suggest the need for a gastroenterologist.
In some cases you may need both specialists. For example, your gastroenterologist may be needed to treat symptoms or complications caused by a liver disease for which you see a hepatologist. Your primary care provider can help with referrals and communication with your healthcare team.
Questions to Ask Your Healthcare Provider
Did your training include a liver fellowship?
What percentage of your practice is devoted to liver disease?
How many liver patients have you treated?
How do you keep apprised of developing and/or experimental liver treatments?
Learn More: Causes and Risk Factors of Liver Disease
Other Members of Your Liver Care Team
It's likely that more than one practitioner will help you manage your liver disease and its impact on your overall health.
Even if your primary care provider refers you to a gastroenterologist or hepatologist, they will still be an important part of your care team. Other providers, such as an infectious disease specialist, also may play an important role.
The providers on your healthcare team may contribute to your care by:
Managing overall health, to help you best respond to liver disease treatment
Assisting you with mental health or social services
Providing treatment for substance use disorders
Providing antiretroviral therapy to treat HIV
Learn More: Does Hepatitis Cause Liver Failure?
Summary
If you have liver disease, including hepatitis, comparing a gastroenterologist vs. a hepatologist will probably be one of the first steps you take in your care. Your primary care provider can help you figure out which specialist you need to see—you may even work with both.
Whichever provider you choose, make sure that you feel comfortable with them. Ask them any questions you have about your treatment and care.
Frequently Asked Questions
When should I see a provider about my liver?
Tell your primary care provider if you have symptoms of liver disease, such as abdominal or leg swelling, easy bruising, color changes in stool and urine, and yellowing of the skin and whites of the eyes (jaundice). They can refer you to a specialist if needed.
What is a liver function test?
A liver function test shows how effectively your liver is doing its job. A liver enzyme blood test checks your levels of alanine transaminase (ALT), which is mostly found in your liver. A consistently high amount of the enzyme in the blood can be a sign of liver damage.
Read Next: What Do High Bilirubin Levels Mean for Your Liver?
