Gastrointestinal Problems in Neurocritical Care

In the pathogenesis of acute cerebral injury, the state of the gastrointestinal tract is of great importance. The formation of concomitant systemic disorders significantly worsens the course and prognosis of patients with initially isolated acute cerebral injury. Up to 50% of patients with brain lesions have gastrointestinal (GI) complications [1]. Adverse effects include gastrointestinal dysfunction, which can manifest itself as functional disorders of internal organs, limiting the absorption of nutrients, increasing intestinal permeability, provoking translocation of bacterial flora, and developing infectious complications. Frequent complications of the critical condition are erosive gastritis, “stress ulcers” of the upper gastrointestinal tract, and gastroduodenal bleeding (Table 33.1). Intensive therapy of critical conditions with active use of antibacterial drugs and gastroprotectors increases the risk of antibiotic-associated lesions of the large intestine in the patient. A frequent complication is reactive pancreatitis, which, in patients in critical condition, may be masked and have no clinical manifestations. Special attention is paid to the state of the intestinal microbiota and ways to restore it.