Gastroparesis following traumatic brain injury and response to metoclopramide therapy

Most studies on nutrition in patients with traumatic brain injury (TBI) have focused on the hypermetabolic state immediately after trauma, or the swallowing disorders that frequently follow acute TBI. A less well-known sequela, however, is gastroparesis, which generally manifests itself when patients have advanced from nasogastric to oral feeding programs. Case histories of four patients are reported, all of whom responded to therapeutic intervention with metoclopramide. Results of a radionuclide gastric emptying study, before and after metoclopramide therapy, are presented. The etiologic and physiologic mechanisms behind this disorder are unclear, but demonstration of this disorder and other clinical trials with metoclopramide appear to deserve further consideration in the nutritionally compromised TBI patient.