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Gastrointestinal issues are among the most common problems in older adults, who present a unique set of issues related to the aging gut. An integrative physician attends to these issues by avoiding polypharmacy, reducing overuse of invasive procedures and medications, optimizing nutritional recommendations, and supporting quality of life. This chapter describes a variety of approaches that include functional medicine, lifestyle, mind-body, bioenergetics, botanical, herbal, and other measures to improve gut health. Specific topics covered are gastroesophageal reflux disease, gastritis, ulcers, colon cancer, constipation, diarrhea, diverticulosis, irritable bowel syndrome, inflammatory bowel disease, and hemorrhoids. An illustrative case study is provided.