Wernicke encephalopathy in non-alcoholic patients following gastrointestinal procedures: a systematic review

Wernicke encephalopathy (WE) is a serious neurological disorder often linked to alcohol use but can also occur under non-alcoholic conditions, particularly following gastrointestinal (GI) procedures. Existing reviews predominantly focus on bariatric surgery, leaving significant gaps regarding other major GI procedures.

This study aimed to systematically review and synthesize evidence on the incidence, clinical characteristics, diagnostic methods, management strategies, and outcomes of WE in non-alcoholic adults following gastrointestinal procedures.

A PRISMA-compliant systematic review was conducted. PubMed, Scopus, Web of Science, and Embase were searched for studies published between 2000 and 2025 that reported Wernicke encephalopathy in non-alcoholic adults following gastrointestinal procedures. Two reviewers independently screened and selected studies. Quality assessment was performed using the Newcastle-Ottawa Scale and Joanna Briggs Institute checklist.

The review included 13 studies involving 1,036 patients. Diverse procedures, including bariatric, oncologic, and emergency gastrointestinal surgeries, were associated with WE, with vomiting identified as the most common precipitating factor. The classical triad of confusion, ataxia, and oculomotor dysfunction appeared in only a minority of patients, while most patients presented with atypical features such as cognitive deficits and polyneuropathy. Magnetic resonance imaging demonstrated characteristic changes in the thalami, mammillary bodies, and periaqueductal gray in confirmed cases. Rates of mortality varied considerably across studies, ranging from 0.3% in bariatric cohorts to 40% in oncologic patients. Early intravenous thiamine was associated with favorable outcomes, although dosing protocols varied considerably across studies.

WE following gastrointestinal procedures presents significant diagnostic challenges. Prophylactic thiamine supplementation should be strongly considered in high-risk patients, particularly those with malnutrition, prolonged fasting, or persistent vomiting.

https://www.crd.york.ac.uk/PROSPERO/view/CRD420251164201, PROSPERO CRD420251164201.