Gastrointestinal Dysfunction in Stroke

Abstract

Gastrointestinal (GI) complications are seen in over 50% of ischemic stroke survivors; the most common complications are dysphagia, constipation, and GI bleeding. The bidirectional relationship of the gut–brain axis and stroke has recently gained traction, wherein stroke contributes to gut dysbiosis (alterations in the normal host intestinal microbiome) and gut dysbiosis perpetuates poor functional neurologic outcomes in stroke. It is postulated that the propagation of proinflammatory cells and gut metabolites (including trimethylamine N-oxide and short-chain fatty acids) from the GI tract to the central nervous system play a central role in gut–brain axis dysfunction. In this review, we discuss the known GI complications in acute ischemic stroke, our current knowledge from experimental stroke models for gut–brain axis dysfunction in stroke, and emerging therapeutics that target the gut–brain axis.

Association between gastroesophageal reflux disease and stroke: a bidirectional Mendelian randomization study

“…First, dysphagia after IS decreased esophageal sphincter muscle tone, and impairment of normal gastrointestinal motility function are important risk factors leading to the occurrence and aggravation of GERD. In addition, stroke can also exacerbate gastrointestinal symptoms such as dysphagia by affecting nutritional factors and neural centers regulating intestinal motility and appetite, such as the sympathetic and parasympathetic medulla and hypothalamic center, thereby further increasing the risk of GERD ( 4 ). Second, recent studies have found that the normal microbiota of the intestinal mucosa of mice is destroyed after brain injury caused by stroke.…”

“…Some past studies have found that nearly 50% of stroke patients will develop gastrointestinal complications such as dysphagia and gastrointestinal bleeding after the disease ( 4 ). In addition, because of the close connection between the esophagus and the left atrium, GERD is thought to have an intimate role in atrial fibrillation, and some studies have linked GERD to an increased risk of atrial fibrillation, which increases the risk of stroke ( 5 ).…”

Prevalence and influencing factors of malnutrition in stroke patients with bulbar paralysis: a cross-sectional study in China

“…Previous research has established a significant association between stroke and malnutrition ( 9 ). Specifically, stroke substantially increases feelings of fatigue, impairs digestive function, and leads to negative psychological states, ultimately resulting in individual malnutrition ( 10 , 11 ). Moreover, dysphagia in Stroke Patients with Bulbar Paralysis (SPBP) is typically severe ( 12 ).…”