Amy Stewart, NP, is a GI Nurse Practitioner at Capital Digestive Care.

Amy Stewart, NP

Rectal examinations are a routine yet often underutilized component of physical assessment across a wide range of clinical settings. While they are frequently associated with prostate evaluation, particularly in men, their scope is much broader and extends to the detection of multiple anorectal conditions.

Despite their importance, many clinicians report limited training or discomfort with performing rectal exams, which can contribute to underuse and misinterpretation of findings, some of the most common of which include hemorrhoids, anal fissures, perianal abscesses, fistulas, and skin tags. Beyond these, rectal exams can also reveal more serious conditions such as anal cancer or precancerous lesions related to human papillomavirus (HPV).

When performed properly, rectal exams remain one of the most valuable bedside tools for differentiating between common and clinically significant anorectal disorders, as highlighted at the 

2025 Gastroenterology & Hepatology Advanced Practice Providers (GHAPP) conference

 by Amy Stewart, NP, a GI Nurse Practitioner at Capital Digestive Care.

For further insight into her session at GHAPP and some of the key takeaways for NPs and PAs, the editorial team of 

 spoke with Stewart for the following Q&A:

: What are the goals of and take home messages from this session?

: My fun titled topic is "Everything Anal: What's Going on Back There?"

I think in school for many of us NPs and PAs were taught how to do a very basic rectal exam, which usually focuses on the prostate. But that's not our goal of a rectal exam in practice, right? So in practice, we need to distinguish between hemorrhoids, fissures, abscesses, fistula, HPV, and anal cancer without anyone ever really teaching us how to do this exam.

My talk is about all of the different kinds of common anal rectal conditions that you see and how to clinically examine for them, what you need specifically to do on your exam, what you're looking for. It also includes a lot of pictures so people can really see what they might see in clinic. The goal is for participants to really leave that talk feeling much more confident about a rectal exam, which is a really key piece of our job as NPs and PAs.

: What are the most common misconceptions or misdiagnoses you see when it comes to rectal exams?

: So I would say in general, less so from GI APPs, but certainly from my colleagues who work in urgent care and primary care, if you don't do a lot of rectal exams, it can be hard to understand the pathology of what you're looking for. I see many skin tags that are treated as active hemorrhoids, and you can put all the steroid cream you want on a skin tag, but it's not going to change or go away. So a component of my talk is the difference between the two.

Anal fissures are also often really commonly misdiagnosed or missed on exam. You can see them, but you really have to get into all the nooks and crannies of that perianal skin in order to see them. There's a lot of really good clinical pearls, if you will, in what you're looking for and what you're going to see on exam.

: Are there any other key takeaways you would like to highlight?

: I think just some other things that sometimes GIs don't recognize as often is HPV. So looking for condylomas or pre-cancerous changes from HPV, as they also specialize in anal HPV, but also herpes lesions are often misdiagnosed as fissures too. So I also have some information about that, and really kind of the clinical picture of how that presents for people as well.

Villanueva Herrero JA, Abdussalam A, Kasi A. Rectal Exam. StatPearls. February 18, 2023. Accessed September 15, 2025. 

https://www.ncbi.nlm.nih.gov/books/NBK537356/ 

Videos

Stewart reviews clinical pearls for performing rectal exams and explains common mistakes and misdiagnoses as well as how to avoid them.

Beyond the Prostate: Expanding the Role of the Rectal Exam With Amy Stewart, NP

Updates in Eosinophilic GI Disease Management, With Amy Stewart, NP

Eosinophilic gastrointestinal (GI) diseases are gaining greater attention as both recognition and understanding of these conditions expand. Eosinophilic esophagitis (EoE) remains among the most well-studied, but related disorders like eosinophilic gastritis and enteritis, while still rare, are gaining traction.

, eosinophilic GI diseases took center stage as the meeting held its first-ever EoE Bootcamp, offering a broader overview of various rare but increasingly recognized eosinophilic disorders.

While estimates of its prevalence vary, recent research yielded a prevalence rate of 1 in 617 in 2022 in those < 65 years of age and 1 in 1562 in 2017 in those ≥ 65 years of age. Standardized to the US population, the overall prevalence was approximately 1 in 700, with associated annual costs estimated to be $1.3 billion in 2024 dollars.

In 2025, the American College of Gastroenterology released an update to the previous 2013 version of its EoE Clinical Guideline, recognizing paradigm shifts in disease diagnosis and management, increases in knowledge about EoE risk factors, natural history, and pathogenesis, and development of validated outcome metrics.

“I think for those of us in practice, it's always really exciting when we have guidelines to kind of guide our clinical practice and to help us make decisions, but also help with insurance authorizations and getting what we need for our patients based on the available data,” Amy Stewart, NP, a GI Nurse Practitioner at Capital Digestive Care, explained to 

She notes that an ongoing question in the field is whether EoE is truly becoming more prevalent or if clinicians are simply better at diagnosing it—likely a combination of both. A key gap in care, Stewart explains, is that nearly half of patients presenting to the emergency department with food impaction are lost to follow-up. However, the updated guidelines now recommend that gastroenterologists obtain biopsies during endoscopy at the time of impaction clearance, representing a major step forward in ensuring pathology results are available and patients are appropriately referred for treatment.

“Hopefully, if we are taking biopsies, if our GI colleagues are doing that, and then getting the pathology results back a week later, et cetera, that really helps stop the leak, if you will, and get patients to clinics so that they can be treated appropriately and not just recurring ER visits for food infections,” Stewart said.

Reflecting on her role as a new member of the GHAPP education committee and looking at what the rest of the 2025 GHAPP agenda has to offer, Stewart expresses enthusiasm about how well-rounded and flexible the meeting is, with boot camps for in-depth learning and workshop tracks designed to accommodate diverse practice needs.

“I'm really excited about the conference in general,” Stewart said. “I think we put together a really good, all encompassing agenda, and I'm also really excited about the expertise of our speakers this year in particular.”

Thel HL, Anderson C, Xue AZ, et al. Prevalence and Costs of Eosinophilic Esophagitis in the United States. 

Dellon ES, Muir AB, Katzka DA, et al. ACG Clinical Guideline: Diagnosis and Management of Eosinophilic Esophagitis. 

Stewart explains recent advances in eosinophilic gastrointestinal diseases and breaks down new ACG EoE guidelines.

Amy Stewart, NP

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