In most instances, gastrointestinal biopsies and surgical specimens represent common diseases that display common histomorphologic patterns, and are accurately evaluated and classified by adept general pathologists. Similar to many aspects of medicine, not all gastrointestinal tissue specimens require sub-specialist review for the accurate diagnosis to be rendered. Internal medicine physicians treat many gastrointestinal conditions without referral to a gastroenterologist specialist. Similarly, many gastrointestinal tissue biopsies and surgical specimens are accurately diagnosed without referral to a gastrointestinal pathologist. Certain diseases are histologically subtle or the differential diagnosis is complicated or complex. In such cases a close working relationship between the pathologist and gastroenterologist with correlation of clinical, endoscopic, and biopsy findings may be of great benefit to the submitting physician and to the patient.