Gastrointestinal disorders in traumatic brain injury: pathophysiology, risk factors, and interventions

Traumatic brain injury (TBI) impacts over 69 million people annually worldwide and causes significant disability. Gastrointestinal (GI) dysfunction is becoming increasingly recognized as post-TBI sequelae, however best practices for their detection and management remain lacking. The current review aimed to improve the understanding of the epidemiology, pathophysiology, risk factors, and interventions of GI disorders after TBI in order to advance clinical diagnosis and treatment.

A comprehensive literature search was conducted using the PubMed database between 1996 and 25 January 2025 pertaining to post-TBI GI disorders. Special focus was given to relevant reports on the pathophysiology, epidemiology, risk factors, and management for GI disorders.

Post-TBI GI dysfunction occurs primarily due to autonomic dysfunction, increased intracranial pressure, and systemic inflammation, causing intestinal dysmotility and malabsorption, which commonly present as feeding intolerance and malnutrition. Proposed diagnostic criteria include increased gastric residual volume (with/without concurrent GI symptoms), decreased weight, body mass index, and albumin. Standardized nutritional screening methodologies, prokinetic agents, and small bowel and transpyloric feeding have shown benefits in symptomatic management and recovery of GI function, and represent targets for formal study in prospective trials.

Post-TBI GI dysfunction is prevalent and can progress to further systemic injuries, impairment, and long-term disability. Early recognition of autonomic and GI system dysfunction, early implementation of formalized nutritional support and multidisciplinary consultation, and inclusion of prokinetic medications and autonomic nervous system modulators are promising avenues for prevention and treatment of post-TBI feeding intolerance, dysmotility, and malnutrition to improve outcomes.