EPA Toolbox

Manage Common Acid Peptic–related problems
The GI consultant should have an in-depth understanding of the physiology of gastric acid secretion, and the pathophysiology and etiopathogenesis of acid peptic diseases. The consultant should be able to extract appropriate history and physical examination findings to identify acid peptic diseases, apply investigative tests including endoscopy to diagnose and treat these diseases and their complications, and formulate appropriate management plans to manage these disorders and prevent complications.

Manage Common Functional GI Disorders
The GI consultant should be familiar with the concepts of visceral sensation, brain-gut axis, triggering of functional symptoms, and use of pharmacologic and non-pharmacologic approaches for control and management of functional symptoms. The consultant needs knowledge of judicious and limited use of diagnostic studies in functional gastrointestinal disorders, understand the impact of affective, organic and psychological stressors, and develop a compassionate and detail-oriented approach to management of functional gastrointestinal disorders.

Manage Common GI Motility Disorders
The GI consultant should develop an understanding of the physiology of the gastrointestinal muscle function, its neural regulation and common disorders arising from dysfunction. The consultant needs knowledge of the indications, and limitations of diagnostic motility studies and utilization of motility studies in diagnosis and management of motility disorders.

Manage Liver Diseases
Gastroenterologists diagnose and manage the broad spectrum of acute and chronic liver problems encountered in a typical gastroenterology practice. This includes an understanding of liver disease in general, with an ability to recognize, diagnose and treat routinely seen acute and chronic liver diseases.

Manage Complications of Cirrhosis
Gastroenterologists diagnose and manage the broad spectrum of liver problems encountered in a typical gastroenterology practice. This includes an understanding and management of the complications of cirrhosis, including portal hypertension and hepatic encephalopathy. Gastroenterologists must be able to recognize when to request consultative services and refer patients for liver transplant evaluation.

Perform Upper and Lower Endoscopic Evaluation of the Luminal GI Tract for Screening, Diagnosis, and Intervention
Endoscopy is a significant aspect of gastroenterology practice and gastroenterologists should be able to determine which patients are appropriate to undergo an endoscopic procedure, be able to perform a quality examination safely, and integrate the clinical presentation with the endoscopic findings in order to plan further management. Gastroenterologists must also be able to communicate endoscopic and pathological findings to the patient, family, and the referring doctor in a timely fashion.

Perform Endoscopic Procedures for the Evaluation and Management of GI Bleeding
Gastroenterologists should be able to determine when and which patients are appropriate to undergo endoscopic procedures that are diagnostic and potentially therapeutic. Consultants should be able to perform a quality endoscopic examination in a safe and efficient manner and should be able to perform effective endoscopic hemostasis.

Manage Biliary Disorders
The diagnosis and treatment of biliary disorders constitute a significant portion of the practice of gastroenterology. At the completion of training, a GI consultant should be able to obtain diagnostic information from patient history, physical exam and studies to evaluate biliary conditions, including those related to lithiasis, inflammatory or neoplastic etiologies.

Manage Pancreatic Diseases
Gastroenterologists should be able to obtain pertinent information through patient history, physical examination, laboratory, and imaging to evaluate the etiology, severity, complications, and basic management of pancreatic disease. The GI consultant should also recognize the indications for invasive testing of the pancreas including EUS and ERCP.

Manage Common GI Infections in Nonimmunosuppressed and Immunocompromised Populations
Gastroenterologists must understand the pathogenic entities that cause infections of the upper and lower GI tract including infectious diarrhea. Particular skill and attention are required to recognize that populations of patients, such as those who are immunocompromised or pharmacologically immunosuppressed, may have different susceptibilities to enteric pathogens.

Identify and Manage Patients with Noninfectious GI Luminal Disease
Gastroenterologists diagnose and manage patients with inflammatory bowel disease and other noninfectious luminal disease. The gastroenterologist should be able to formulate an assessment and plan that leads to the successful diagnosis of IBD, microscopic colitis, celiac disease, etc. and, once the diagnosis is made, begin an evidence-based treatment approach, including monitoring of therapy.

Manage Common GI and Liver Malignancies and Associated Extraintestinal Cancers
A gastroenterologist should be able to diagnose malignancies of the GI tract and hepatobiliary system. They should be able to discuss and offer appropriate screening tests for GI and liver malignancies, treat complications associated with these malignancies, and those related to the treatment of malignancies.

Assess Nutritional Status and Develop and Implement Nutritional Therapies in Health and Disease
A GI consultant should be able to obtain information from patient history, physical exam and studies to evaluate nutritional status, diagnose diseases of nutritional excess and deficiency, and identify nutritional complications from other chronic GI and liver disease. The gastroenterologist should be able to select appropriate parenteral and enteral options for nutrition therapy and understand how food and diet impact the presentation and management of GI symptoms.