In a medium saucepan, bring the water to a boil. Gradually whisk in the grits, reduce heat, and simmer for 5-7 minutes or until thickened, stirring occasionally. Add butter, salt, and pepper and stir to combine. Remove from heat and keep warm.
In a large skillet, cook the sausage over medium-high heat until browned. Remove with a slotted spoon and set aside.
Add the shrimp to the same skillet and cook until pink, about 2-3 minutes per side. Remove with a slotted spoon and set aside.
Add the green bell pepper, onion, and garlic to the skillet and cook until tender, about 5 minutes.
Stir in the diced tomatoes, tomato paste, Creole seasoning, and hot sauce. Bring to a simmer and cook for 5-10 minutes or until slightly thickened, stirring occasionally.
Stir in the heavy cream, reserved sausage, and shrimp. Cook for 2-3 minutes or until heated through.
Serve the shrimp and sausage mixture over the grits, garnished with chopped parsley.