Nutrition and GI: Still Hand in Hand?

The connection between nutrition and gastroenterology should be intuitive given that gastroenterology involves the study of the organ system responsible for the digestion and absorption of nutrients. However, in my experience, nutrition is often an afterthought, being considered only after disease has negatively impacted an individual’s nutritional status. In the early years of gastroenterology, Dr. William Beaumont reported his observations on gastric physiology and digestion after a series of experiments where he inserted food particles into the stomach via a gastrocutaneous fistula from a young fur trapper’s musket wound. Beaumont’s findings that gastric digestion depends on a combination of factors, including gastric acid, mechanical churning, temperature and what was later described as pepsin, were groundbreaking.1 Though the early days of gastroenterology focused on alimentary physiology, primarily the digestive process, our current practice is quite different.

It is unclear where the connection between nutrition and gastroenterology diverged. Over time, the field of GI has evolved into subspecialties while concomitantly the focus in GI training programs has shifted to endoscopic proficiency and acute care.2 GI fellowship programs devote minimal time, if any, to nutrition in their curricula.3,4 I find that there is an unfortunate misconception that nutrition in clinical gastroenterology practice is solely restricted to nutrition support (e.g., parenteral and enteral nutrition). To the contrary, I agree with Mulder and colleagues who write: “There is a need for training in nutrition and nutrition-related issues because it lies at the core of gastrointestinal functioning and is very relevant to hepatogastroenterology practice.”5

As a gastroenterologist, I find that nutrition is an integral component of my daily assessment of patients with gastrointestinal symptoms. A detailed history often reveals that symptoms may be provoked by ingesting certain foods and alleviated by avoiding certain foods. Similarly, weight loss is well recognized as an alarm symptom that signals discordance between energy intake and expenditure that may reflect organic disease of the alimentary tract. Furthermore, there are numerous examples of where diet and nutritional counseling are crucial to the management of the disease.

Celiac disease is an example of a disease for which diet is the cause of and treatment for the ailment. Similarly, nonalcoholic fatty liver disease (NAFLD), which is poised to overtake hepatitis C as the leading indication for liver transplant in the future, is another illustration of how nutrition is critical to gastroenterology practice. Given that the cornerstone of therapy for NAFLD remains behavioral modification via healthy diet and exercise, gastroenterologists should be equipped with basic skills to provide nutritional counseling to their patients. Lastly, consider bariatric surgery, which is performed commonly, and intentionally alters the structure and function of the GI tract for the purpose of weight loss. An understanding of the fundamentals of nutrient digestion is essential to proper long-term care in this patient population.

Nutrition and GI certainly do go hand in hand. It is essential that GI training programs reintroduce nutrition training into their curricula to ensure that the future of gastroenterology has a sound understanding of the fundamentals of nutrition and the mutual influence that nutrition and GI disease have on one another. Hopefully I have convinced the reader that gastroenterologists practice nutrition every day, and we all should embrace our inner nutritionist.

Dr. Pickett-Blakely has no conflicts to disclose.

References

1. Dubois A, Johnson LF. William Beaumont: frontier physician and founding father of gastric physiology. J Clin Gastroenterol 1985;7:472–474.

2. Singla MB, Law R. Gastroenterology fellowship programs: the fellows’ perspective. Clin Transl Gastroenterol 2015;6:e83.

3. Scolapio JS, Buchman AL, Floch M. Education of gastroenterology trainees: first annual fellows’ nutrition course. J Clin Gastroenterol 2008;42:122–127.

4. Raman M, Violato C, Coderre S. How much do gastroenterology fellows know about nutrition? J Clin Gastroenterol 2009;43:559-564.

5. Mulder CJ, Wanten GJ, Semrad CE, et al. Clinical nutrition in the hepatogastroenterology curriculum. World J Gastroenterol 2016;22:1729–1735.

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