GI System Challenges and Recommendations

Many people with Parkinson’s experience gut symptoms, like constipation, bloating or nausea. These are called gastrointestinal, or GI, symptoms. These symptoms are not only uncomfortable, they can also impact how well medication works, what you eat or don’t eat and whether you exercise or not. GI symptoms can happen throughout the course of Parkinson’s, but constipation commonly happens years or decades before motor symptoms and diagnosis. For more on this topic, watch my conversation with GI doc and researcher, Wael El-Nachef at https://shorturl.at/caYg6.   GI symptoms can be tough to treat. A recent paper, published in Parkinsonism Related Disorders, provides consensus guidelines and a framework to help clinicians diagnose and manage GI symptoms in people with Parkinson’s. The article, authored by Delaram Safarpour and colleagues as part of the Parkinson Study Group non-motor features Working Group, rightfully, also calls for more research into better treatments for these symptoms. Read the paper: https://bit.ly/4d5gujK   Key takeaways: Clinicians: As the authors state, optimal care of a person living with Parkinson’s requires prompt recognition and treatment of GI symptoms. Ask about these symptoms at every visit (especially if medication benefit seems to be changing or waning) and be quick to engage other care team members (e.g., gastroenterologists, speech therapists, etc.) who can help.    People living with PD: Don’t be shy about bringing these symptoms up. There are treatments, tools and other care providers who can help ease the symptoms and help you feel better. 

Nutritional Management in GI Conditions 1. Gastroesophageal Reflux Disease (GERD) Nutrition Advice: Avoid trigger foods: caffeine, alcohol, chocolate, spicy/fatty foods, citrus. Smaller, more frequent meals. Avoid eating 2–3 hours before lying down. 2. H. pylori Gastritis / Peptic Ulcer Nutrition Advice: Incorporate: green tea, broccoli sprouts, garlic (anti-H. pylori potential). Avoid alcohol, NSAIDs, spicy food. Add probiotics during eradication therapy (e.g., Lactobacillus, Saccharomyces boulardii). 3. Pancreatitis Acute (mild–moderate): Early oral feeding with low-fat diet once tolerated. Severe: Enteral nutrition (NG/ND tube preferred over TPN). Chronic: Low-fat, high-protein diet; pancreatic enzyme replacement therapy (PERT). Monitor fat-soluble vitamins. 4. Cholecystitis Nutrition Advice: Low-fat, moderate-fiber diet post-acute phase. Avoid fried/processed foods; encourage fruits, vegetables, whole grains. 5. Appendicitis Nutrition Advice (Post-surgical): Gradual return to normal diet post-op. High-fiber diet to prevent constipation during recovery. 6. Crohn’s Disease & Ulcerative Colitis (IBD) Active Phase: Low-residue/low-fiber diet if strictures or diarrhea. May need enteral nutrition (especially in pediatrics). Remission: Mediterranean-style diet with anti-inflammatory foods. Correct deficiencies: iron, B12, folate, D, calcium. 7. Diverticulitis Acute Phase: Clear liquids or low-fiber until inflammation subsides. Post-recovery: High-fiber diet (>25g/day); fluids >2L/day. Probiotics may help prevent recurrence. 8. Toxic Megacolon Nutrition Advice: NPO (nothing by mouth) during acute phase. Parenteral/enteral support under ICU supervision. Long-term (IBD-related): Similar to IBD management with focus on anti-inflammatory, balanced intake. 9. Diabetic Ketoacidosis (DKA) Nutrition Advice (Recovery phase): Return to balanced, consistent carbohydrate diet. Reinforce carbohydrate counting and insulin timing. Hydration critical. 10. Gastroenteritis During illness: ORS (Oral Rehydration Solution) with correct sodium/glucose ratio. BRAT diet not evidence-based; better to include complex carbs, lean protein, low-lactose. Recovery: Resume full diet early. Probiotics shorten diarrhea duration (e.g., Lactobacillus GG). 11. Bowel Obstruction / Adhesions / Hernia Acute Obstruction: NPO or tube feeding as indicated. Post-op Recovery: Gradual reintroduction starting with clear liquids. High-fiber diet post-recovery to prevent adhesions/constipation. 12. Perforation / Abscess Nutrition Advice: NPO until surgically managed or infection controlled. Enteral nutrition if prolonged recovery. Monitor micronutrient status post-op. #ESPEN #ClinicalNutrition #LinkedIn GI conditions with their clinical definitions and nutritional interventions based on current global guidelines (ESPEN, ACG, WHO, ASPEN, etc.).

📍The May 2025 ACG Clinical Guideline challenges how we think about nutrition in gastroenterology. What this guideline underscores is simple but critical: Nutrition is not supportive care. It’s clinical care. Key takeaways: 🔖Screen every patient with GI disease—not just once, but at meaningful timepoints (diagnosis, flare, hospitalization). 🔖 Use clinical tools like the nutrition-focused physical exam (NFPE) to detect signs often missed in routine labs. 🔖Think in steps: oral supplementation first, then tube feeding, and parenteral only when necessary. 🔖Micronutrient depletion is common—especially in IBD, chronic liver disease, and pancreatic insufficiency—and needs active monitoring and repletion. 🔖Registered dietitians should be part of the care team from the start, not as a last resort. This is not a “one-size-fits-all” algorithm. It’s a call to elevate how we assess, prioritize, and act on nutrition—before complications arise. #ACG2025 #Gastroenterology #Malnutrition #GIHealth #NutritionSupport #IBD #Cirrhosis #MedicalEducation #Hepatology #ClinicalGuidelines #PatientCare