Nutrition and diet play a central role in managing many gastrointestinal (GI) conditions, making collaboration between gastroenterologists and registered dietitian nutritionists (RDNs) a natural fit. Such partnerships not only improve patient care but can also ease the time burden on gastroenterologists.

Many gastroenterology practices, whether in academic or nonacademic settings, have recognized this for years, incorporating GI-specialized RDNs into their teams. These clinicians bring specialized training and expertise in managing conditions such as irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), eosinophilic esophagitis, celiac disease, and liver disease.

More recently, the Commission on Dietetic Registration introduced a new board-certified credential called the Certified Specialist in Digestive Health (CSDH). Applicants must document their relevant practice experience and pass an examination. In December 2025, 49 of 56 examinees (88%) passed, according to the commission.

Medscape Medical News spoke with three gastroenterologist-GI RDN teams, including a pioneer who has been partnering with GI RDs for nearly two decades, about the value of these partnerships, their logistics, and their patient response.

Gambling on a Partnership That Paid Off

“We started our GI RD program in 2007,” said William D. Chey, MD, chief of gastroenterology and hepatology at Michigan Medicine, University of Michigan, Ann Arbor. It was a gamble, he said, but an educated one informed by growing recognition of diet’s role in GI disease

Chey was exposed to programs with integrated dietitians at Northwestern University. Additionally emerging research on interventions such as the low-FODMAP (Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols) diet helped shape the initiative.

Today, his group includes five dietitians and receives referrals from physicians within the division.

“We see IBS, IBD, gastroesophageal reflux disease, celiac, among other conditions,” said Amanda Lynett, MS, RDN, who has worked with Chey since 2018 and leads the program’s dietitian team.

Initial visits incorporating a full evaluation typically last 60 minutes, with 30-minute follow-up visits scheduled every 1-2 months, depending on patient needs. In contrast, most gastroenterologists spend less than 10 minutes in nutritional counseling for IBS patients.

Gastroenterologists determine which patients to refer, Chey said. Referral rates vary by conditions, from 100% for celiac disease to approximately 60% for IBS.

“There is a growing list of conditions where diet and nutrition play a foundational role in management,” said Chey, who is also president of the American College of Gastroenterology.

Close communication is essential. Chey and Lynett regularly exchange information often about patients and their progress.

“We are equal partners,” Chey said. “Physicians have more responsibility, that’s the reality. At the same time, I very much rely on Amanda and her colleagues for their opinions regarding the right [dietary] therapy.”

The collaboration also improves efficiency.

“It takes a tremendous amount off your plate,” he added.

The partnership even extended to a recent journal article, “Incorporating a GI Dietitian Into Your GI Practice.” In it, Chey, Lynett, and colleagues outline implementation strategies, including billing, salary, and insurance details.

Patients Are Often Receptive

Referrals to an experienced GI RDN “are not a very hard sell,” said Darren M. Brenner, MD, professor of medicine and surgery at Northwestern University’s Feinberg School of Medicine, Chicago.

He has worked with Bethany Doerfler, MS, RDN, senior clinical research dietitian, for nearly 17 years. Doerfler also helped develop the new CSDH certification, and she plans to take the exam in June.

They noted that patients often arrive already trying to manage their GI symptoms through diet. Many report having tried gluten-free, lactose-free, or other dietary strategies.

As a result, referrals are rarely not accepted. Brenner noted that some patients have even told him, “I want to see your dietitian, and you are the gateway.”

Dietitians also have more time to provide detailed counseling.

“We get an hour with our patients,” Doerfler said.

However, lack of insurance coverage remains a major barrier.

“That’s the biggest hindrance,” Brenner said, even for conditions like celiac disease, where diet is the only treatment.

“They may not cover for a GI disorder, but they will for a metabolic disease like heart disease, diabetes, obesity,” Doerfler added, noting that she often frames care more broadly to improve the likelihood of coverage.

This model is facilitated by their academic setting, where integrated care teams (gastroenterologists, physician assistants, behavioral therapists, and RDNs) collaborate closely, including monthly multidisciplinary meetings.

Brenner acknowledged that such partnerships may be more difficult to implement in smaller or private practices.

Challenges in Nonacademic Settings

Outside academic centers, integrating GI RD teams can be more challenging.

Tauseef Ali, MD, executive medical director of SSM Health St. Anthony Digestive Care and medical director of the Crohn’s and Colitis Center in Oklahoma City, Oklahoma, practices in a community-based setting affiliated with SSM Health St. Anthony Hospital.

He noted that reimbursement challenges and the costs of hiring and retaining dietitians can be significant barriers.

Ali works with Kendall Brown, PA-C, RD, LD, who serves as both a physician assistant and registered dietitian. When appropriate, Ali refers patients directly for dietitian consultation, often preferring in-person visits.

Brown conducts a 1-hour initial assessment and 45-minute follow-ups.

“We do a comprehensive assessment with a lot of listening,” Brown said.

She often sees patients hoping to manage disease with diet alone. Although she validates their perspective, she also explains that diet is never a replacement for necessary medication.

In one case, a patient with Crohn’s disease initially refused medication but agreed after several months of counseling and education with Brown.

Ali and Brown communicate often through a shared clinic space and an electronic health messaging chat feature.

Ali advises a targeted approach for practices looking to adopt similar models.

“Start with the high-impact patient groups,” he said, “like those with IBD, IBS, and celiac disease.”

Chey reports stock options in ModifyHealth. Lynett, Brenner, Doerfler, Ali, and Brown have no disclosures.