Venkatesan S, Lucke-Wold B. Mind the gut: Navigating the complex landscape of gastroprotection in neurosurgical patients. World J Gastroenterol 2025; 31(8): 102959 [DOI: 10.3748/wjg.v31.i8.102959]
Corresponding Author of This Article
Brandon Lucke-Wold, MD, PhD, Department of Neurosurgery, University of Florida, 1505 SW Archer Road, Gainesville, FL 32608, United States. brandon.lucke-wold@neurosurgery.ufl.edu
Research Domain of This Article
Neurosciences
Article-Type of This Article
Editorial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Feb 28, 2025; 31(8): 102959 Published online Feb 28, 2025. doi: 10.3748/wjg.v31.i8.102959
Mind the gut: Navigating the complex landscape of gastroprotection in neurosurgical patients
Subeikshanan Venkatesan, Brandon Lucke-Wold
Subeikshanan Venkatesan, Brandon Lucke-Wold, Department of Neurosurgery, University of Flordia, Gainesville, FL 32608, United States
Author contributions: Venkatesan S contributed to the discussion, the writing, editing the manuscript, and review of literature; Lucke-Wold B designed the overall concept and outline of the manuscript; all authors read and approved the final version of the manuscript to be published.
Conflict-of-interest statement: The authors declare no conflict of interest in publishing the manuscript.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Brandon Lucke-Wold, MD, PhD, Department of Neurosurgery, University of Florida, 1505 SW Archer Road, Gainesville, FL 32608, United States. brandon.lucke-wold@neurosurgery.ufl.edu
Received: November 4, 2024 Revised: January 7, 2025 Accepted: January 15, 2025 Published online: February 28, 2025 Processing time: 81 Days and 5.6 Hours
Abstract
Neurosurgical patients, including those with severe traumatic brain injury, spinal cord injury, stroke, or raised intracranial pressure, are at heightened risk for stress ulcers and aspiration pneumonitis, leading to significant morbidity and mortality. These patients are typically managed through both pharmacological interventions [e.g., proton pump inhibitors (PPIs), histamine 2 (H2) antagonists, sucralfate] and non-pharmacological measures (e.g., nasogastric decompression, patient positioning) to mitigate adverse outcomes. The pathogenesis of stress ulcers in neurosurgical patients is multifactorial, but the routine use of stress ulcer prophylaxis remains controversial. While gastric acid suppression with H2 receptor antagonists and PPIs is commonly employed, concerns have arisen regarding the association between elevated gastric pH, bacterial colonization, and ventilator-associated pneumonia. The lack of comprehensive data on gastroprotection in critically ill neurosurgical patients, who face a greater risk than non-neurosurgical counterparts, further complicates this issue. Recent studies, such as one by Gao et al on the efficacy of vonoprazan-amoxicillin dual therapy in elderly patients, highlight the potential of novel therapies, but the influence of pre-existing conditions like Helicobacter pylori infection remains unclear. Non-pharmacological interventions, including nasogastric decompression and early enteral nutrition, are critical in improving outcomes but require further research to refine strategies. This editorial underscores the need for tailored approaches and encourages further investigation into optimal gastroprotective strategies for neurosurgical patients.
Core Tip: Neurosurgical patients, particularly those with severe brain injury and elevated intracranial pressure, face heightened risk of stress ulcers and gastrointestinal complications. Effective management requires a combination of pharmacological and non-pharmacological strategies. While gastric acid suppression is common, its routine use may raise concerns about bacterial colonization and ventilator-associated pneumonia. Recent studies on therapies such as vonoprazan-amoxicillin for Helicobacter pylori as well as combined naso-gastric and naso-intestinal tube application emphasize the need for tailored gastroprotection highlighting critical gaps that warrant further research and individualized approaches in clinical practice.
