What to Expect at Your First Gastroenterologist Appointment

I remember when my general practitioner (GP) told me that I had Crohn’s more than 3 decades ago. I will never forget it. After the initial shock of it all, he mentioned he will make an appointment to see a gastroenterologist (GI). I didn't know what to expect at my first GI appointment.

First, I needed to ask him what that was, then wondered what they could do for me. Unlike today, I did not need to wait months to see him. But based on my first experience ever with a gastroenterologist, I never wanted to go back.

Finding the right GI

I was not prepared for the multiple questions and probing that I experienced and I contacted my GP to ask him if there was someone else I could see other than this GI. I felt uncomfortable at the appointment, he was aggressive and I felt like I was bothering him because I was there. I found out later that he did not specialize in inflammatory bowel disease (IBD) but was a general GI.

My GP made me an appointment with another GI and I was with her for 30 years. We had a great relationship until she retired, and now I have another GI I love. Over all this time with IBD, I have learned what to expect at my appointments. Here are some tips.

What to expect at first GI appointment

Be prepared

This is the first time seeing a GI, so don’t assume they know everything about you. You are probably going to have to answer lots of questions regarding your symptoms, like when did they start, severity, pain, location of pain or discomfort. Also be prepared to talk a lot about your bowel movements (it took me a bit of time to get over the embarrassment of talking about this). Is there a family history of IBD or any other gastrointestinal diseases? These are just a few initial topics.

A good idea is to get a notepad (comes in handy) and write down everything you can think of that they may ask being the first time meeting them. Write down any symptoms you have and any medications you are on. Have some questions for them as well. I know for a fact that you will have dozens to ask.

Physical examination

They may want to do a physical exam. My first time seeing a GI, I was not expecting to be poked and probed so expect it could happen.

They are going to want to check your abdomen, physically touching and listening for any bowel sounds. They are going to press on your abdomen in it's four sections (upper left and right, and lower left and right) checking for tenderness or masses, plus watching how you react as they press. Do not be brave. If it hurts, tell them, usually on a scale of 1 to 10.

The one I was not prepared for was the rectal exam. All I can suggest is to relax and push out as they push in. They are checking for masses, inflammation and signs of perianal disease.

Testing

After all that, they may ask you to get a bunch of tests on top of the usual blood work. I think I had them all. A few you may be asked to do are X-rays, CT scan, barium swallow (this is still I have not been able to do), colonoscopy or flexible sigmoidoscopy, stool testing or even an upper endoscopy (gastroscopy). The scopes (colonoscopy and gastroscopy) may have biopsies taken to testing.

The barium swallow (small bowel follow thru) is the only test I have not ever been able to complete. It involves drinking barium and I have never been able to hold it down, I always vomited it up.

Be prepared to complete a bowel prep for the colonoscopy. Depending on what the testing reveals, your GP or GI may contact you for further testing and maybe a follow up appointment or possible treatment (such as medication or diet changes).

Building a good relationship

Unfortunately with IBD, there will be a need to see a gastroenterologist eventually but you do not need to settle for one that does not make you feel comfortable. You should be able to talk to them freely. They are there to help you, not ignore you. You should be able to build a good rapport with them and if you are lucky, you will have a good relationship with them like I did with mine.

In my 35 years with Crohn’s I have only had 3 GIs, but one was for 31 years.

If you have questions, write them down, ask. No question is a stupid or irrelevant question. Be prepared. You got this.