What is a Gastrointestinal (GI) transitional diet?

Gastrointestinal (GI) Transitional Diet

A GI transitional diet is a structured dietary approach used to gradually advance nutrition in patients transitioning between different feeding methods or care settings, particularly for patients with chronic digestive diseases moving from pediatric to adult care services. 1

Key Components of GI Transitional Diets

• GI transitional diets are most commonly implemented for patients with inflammatory bowel disease (IBD), chronic liver disease, and increasingly for patients with coeliac disease 1
• These diets are tailored to accommodate the documented variations in prognosis and clinical course when GI diseases present in childhood compared to adulthood 1
• Transitional diets consider the differences in diagnostic and therapeutic management between pediatric and adult care, such as the higher use of exclusive enteral nutrition in children with Crohn's disease 1

Patient Populations Requiring GI Transitional Diets

• Patients with IBD, coeliac disease, and chronic liver disease benefit most from formal transition arrangements including dietary transitions 1
• Patients with complex nutritional needs, including those requiring enteral or parenteral nutrition support, represent a growing population needing specialized transitional dietary approaches 1
• Children with complex motility disorders require formal transitioning into adult care with multidisciplinary support due to their complex symptomatology, nutritional support needs, and psychological comorbidities 1

Implementation of GI Transitional Diets

• For post-surgical patients, traditional transitional diets begin with monitoring return of bowel function, followed by clear liquids advancing to regular solid food as tolerated 2
• Evidence shows that early enteral nutrition is safe and well-tolerated, reducing wound morbidity, septic complications, and improving protein kinetics 2
• For patients with intestinal failure, transition from elemental formulas to tube feeding formulas with real food ingredients has shown improvement in stooling patterns 3

Disease-Specific Considerations

• For Crohn's disease patients, elemental enteral formulas or TPN are used during active phases to ensure optimal nutritional status and bowel rest, with hyperalimentation during remission 4
• For coeliac disease, transitional diets must maintain strict avoidance of gluten from wheat, rye, barley, and oats, with careful attention to hidden sources of gluten 4
• For functional GI disorders, dietary modification is a key component of management alongside patient education and elimination of triggers 5

Challenges and Considerations

• The demand for specialist nutrition for pediatric GI and surgical disorders has increased, suggesting more patients survive and require transition to adult services 1
• Complex enteral nutrition patients significantly outnumber those requiring parenteral nutrition support 1
• Traditional clear liquid diets as first postoperative meals fail to provide adequate nutrients, whereas advancement to a regular diet as the initial meal has been shown to be well tolerated and more nutritious 2

Best Practices for Implementation

• Healthcare professionals involved in managing adolescents and young persons should be aware of differences between classification, diagnostic methods, treatment, and natural history of relevant pediatric and adult chronic GI and liver diseases 1
• Nutritional care and diet therapy are critical because malnutrition is an expected sequela to most GI diseases or disorders 4, 6
• The amount of food, its form, frequency of feeding, and composition each have important effects on GI function and may help ameliorate signs of GI disease 6