This review evaluates the current evidence supporting the usefulness of gastrointestinal pathology specialists. Using the discovery of Helicobacter pylori as an example, we show that as new conditions are discovered and old ones are revisited and reclassified, an intimate alliance between clinicians, basic scientists, and pathologists is indispensable. Whilst specialised gastrointestinal pathologists (defined as someone who has received at least a year of training in a section of a pathology laboratory where only tissue from the alimentary tract and liver were examined, who has spent time in a clinical gastroenterology unit, and who has restricted his or her practice to such specimens) are usually well-represented in academic settings, their contribution is becoming increasingly recognised also in private practice. We contend that a more sophisticated or detailed diagnosis actually translate to better care, and provide numerous examples that show not only a clinical benefit to the patient and the gastroenterologist, but also a financial advantage for the payors (patients, insurances).