Rural Population GI Health: The General Surgeon’s Role

(BPT) – Having access to adequate healthcare services is a critical factor in maintaining one’s health, but for the more than 60 million Americans living in rural areas of the country, medical resources are often limited. This means that general doctors, most often surgeons, are required to wear many hats and be experts across different branches of medical specialties.

One such specialty is gastroenterology (GI), the branch of medicine focused on the digestive system. In a rural setting, many patients visit their primary care physician for GI matters, and when needed, will schedule consultations with a general surgeon who is able to perform more complex endoscopic GI procedures. Endoscopic procedures utilize a patient’s natural body openings to diagnose conditions and perform minimally invasive procedures in the digestive system for conditions like gastroesophageal reflux disease (GERD), also known as heartburn.

When it comes to the diagnosis and management of GERD, a condition that impacts 20 percent of Americans, there are major differences between rural and urban treatment practices. Compared to their urban peers, most endoscopic procedures will be performed by a general surgeon in a rural setting versus a specialized gastroenterologist. However, endoscopic training may not be sufficient for rural general surgeons with respect to diagnostic (testing) and therapeutic GERD procedures.

“Endoscopic training for rural general surgeons presents a unique opportunity for them to play an integral role in the diagnosis and treatment of GERD patients,” said Dr. Medhat Fanous, general surgeon in Iron River, Michigan and recent winner of the 2018 Oweida scholarship. “To be able to work with a patient at different stages of their condition gives us exposure to the entire spectrum of GERD, and in doing so, can improve patient outcomes, and facilitate research in rural areas.”

A number of large medical societies are sensitive to the need for additional specialty education for rural general surgeons, offering scholarships and grants to help encourage and potentially subsidize training. One example is the scholarship awarded to Dr. Fanous, called the Nizar N. Oweida, MD FACS, Scholarship of the American College of Surgeons (ACS) which is given to surgeons who choose to practice in small towns or rural areas.

ACS awarded Dr. Fanous the scholarship for playing an essential role in developing an acid reflux management program at his hospital — a program that has helped more than 530 patients deal with chronic GERD.

Recent developments in GERD treatment are creating a shift for the future of antireflux surgery. First, many over-the-counter products (proton pump inhibitors, also known as PPIs) for treating GERD have been found to cause serious side effects, including osteoporosis, dementia and kidney disease. Second, there are many endoscopic treatments for GERD that have been found to be extremely effective and safe, including Transoral Incisionless Fundoplication (TIF 2.0 procedure), which is minimally invasive and reported to have an easy learning curve for endoscopically trained surgeons.

If you or a loved one is suffering from GERD please visit to learn more about the TIF 2.0 procedure, or to find a TIF 2.0 trained physician near you.


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