Gastric myoelectric activity in patients with closed head brain injury

Traumatic brain injury (TBI) constitutes a major public health problem. Most of the acute disturbances of autonomic nervous system activity seen in clinical practice resulting from head injury are due to increased intracranial pressure (ICP), which precipitates a complex set of changes causing lack of food tolerance. The aim of our study was to evaluate the effects of TBI on gastric myoelectric activity in coma patients.

24 patients (23 male, 1 female; mean age 43.6 +/- 7 yr.) hospitalized for TBI in the Department of Neurotraumatology were included in the study. Gastric myoelectric activity was recorded using the Synectics system (Sweden) on the 1st and 2nd day after injury. The control group consisted of healthy volunteers matched for age and gender.

In the control group, electrogastrography (EGG) showed the percentage of time with bradygastria, normogastria and tachygastria to be 9.7 +/- 6.4, 88.3 +/- 7.6 and 2.0 +/- 3.5 respectively. The amplitude of the signal was 181 +/- 11.5 [micro V2]. In TBI patients, the percentage of time with bradygastria and tachygastria increased to 46.5 +/- 21.8 (p=0.03) and 5.5 +/- 11.8 (p=0.001) respectively, while the duration of normogastria decreased to 47.2 +/- 20.4 (p=0.001). Highly significant changes were observed in signal amplitude, which increased to 766 +/- 550 [micro V2] (p=0.0007). There was positive correlation between GCS and normogastria (r=0.66, p<0.001) and negative correlation between GCS and bradygastria (r=-0.77, p<0.001).

In patients with brain trauma and coma, the functional brain-gut link is altered, causing gastric dysrrhythmias and intolerance to feeding. Prokinetics during enteral feeding are recommended.