Zhao X, Zhang W, Zhang Y, Liu XA. Gastrointestinal dysfunction after brain injury: Mechanisms and the role of the brain-gut axis. World J Gastroenterol 2026; 32(10): 115731 [DOI: 10.3748/wjg.v32.i10.115731]
Corresponding Author of This Article
Xing-An Liu, Department Three of Brain Disease Rehabilitation, Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, No. 33 Beiling Street, Huaigu District, Shenyang 110032, Liaoning Province, China. liuxing_an@126.com
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Gastroenterology & Hepatology
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Review
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Mar 14, 2026 (publication date) through Mar 2, 2026
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World Journal of Gastroenterology
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1007-9327
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Zhao X, Zhang W, Zhang Y, Liu XA. Gastrointestinal dysfunction after brain injury: Mechanisms and the role of the brain-gut axis. World J Gastroenterol 2026; 32(10): 115731 [DOI: 10.3748/wjg.v32.i10.115731]
World J Gastroenterol. Mar 14, 2026; 32(10): 115731 Published online Mar 14, 2026. doi: 10.3748/wjg.v32.i10.115731
Gastrointestinal dysfunction after brain injury: Mechanisms and the role of the brain-gut axis
Xia Zhao, Wei Zhang, Ying Zhang, Xing-An Liu
Xia Zhao, Wei Zhang, Department Five of Brain Disease Rehabilitation, Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang 110032, Liaoning Province, China
Ying Zhang, Department of Ultrasound, Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang 110032, Liaoning Province, China
Xing-An Liu, Department Three of Brain Disease Rehabilitation, Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang 110032, Liaoning Province, China
Author contributions: Zhao X contributed to the conceptualization, data curation, methodology, and writing - original draft; Zhang W and Zhang Y participated in the formal analysis, project administration, software, and visualization; Liu XA contributed to the investigation, supervision, validation, and writing - review & editing.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Xing-An Liu, Department Three of Brain Disease Rehabilitation, Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, No. 33 Beiling Street, Huaigu District, Shenyang 110032, Liaoning Province, China. liuxing_an@126.com
Received: October 23, 2025 Revised: November 18, 2025 Accepted: January 12, 2026 Published online: March 14, 2026 Processing time: 130 Days and 2.9 Hours
Abstract
Brain injury (BI) encompasses traumatic BI and stroke, and is a leading cause of mortality and morbidity worldwide. In addition to primary brain damage, BI can cause a series of sequelae, of which gastrointestinal (GI) dysfunction is one of the most important affecting patient outcomes. GI dysfunction, including delayed gastric emptying, increased intestinal permeability, and gut dysbiosis, is common among patients with BI. GI dysfunction not only impairs nutrient absorption and increases the risk for infection, but also enhances secondary BI by aggravating the systemic inflammatory response. The brain-gut axis refers to the bidirectional communication network between the central nervous system and enteric nervous system. This article provides an overview of the mechanisms underlying GI dysfunction after BI and the close relationship with the brain-gut axis. Furthermore, the potential mechanisms underlying brain-gut modulation by probiotics, fecal microbiota transplantation, and vagus nerve stimulation are discussed, which may provide new insights into the treatment of GI dysfunction in patients with BI. An in-depth understanding of the interaction between the brain and GI system is essential to develop more effective therapeutic strategies to alleviate patient suffering and improve survival and quality of life.
Core Tip: Brain injury, including traumatic injury and stroke, frequently leads to gastrointestinal dysfunction, manifesting as dysmotility, increased permeability, and dysbiosis. This dysfunction impairs nutrition, increases infection risk, and exacerbates secondary brain damage via systemic inflammation. The brain-gut axis is central to this bidirectional interaction. Investigating interventions like probiotics and vagus nerve stimulation, which modulate this axis, offers promising therapeutic strategies for improving brain injury patient outcomes.
