Neurogastroenterology in spinal cord dysfunction

Abstract

The devastating losses of motor and sensory function are sequelae of traumatic spinal cord injury (SCI) and nontraumatic SCI. Cumulatively, these two categories of SCI are referred to as spinal cord dysfunction. The latter type of SCI has been related to spinal cord injury due to benign or malignant tumor compression, vascular or hemorrhagic injuries, radiation myelopathies, and hereditary and acquired inflammatory or immunologically induced lesions. In this chapter, spinal cord dysfunction will be used interchangeably with SCI when referring to both traumatic and nontraumatic SCI to align with current terminology. It is often less well recognized that individuals frequently present with disorders of the autonomic nervous system which includes gastric, colonic, and anorectal dysfunction. These challenges are widely recognized clinically, yet physicians and caregivers are rarely presented with consistent, evidence-based strategies for successful management of gastrointestinal comorbidities. In the acute stages following traumatic injury, gastrointestinal health is often associated with a more favorable patient outcome during intensive care. Clinically, the most common symptoms relate to diminished gastrointestinal transit, constipation, rectal evacuation difficulties, fecal incontinence, or some combination of these. Additional comorbidities often accompany higher level injuries which may have a major negative effect on quality of life. One additional complication of high-level injury at and above the T6 level is autonomic dysreflexia, a potentially life- threatening paroxysmal hypertension induced by noxious stimuli. Gastrointestinal dysfunction can trigger autonomic dysreflexia. This chapter reviews the anatomy, physiology, function, and neural control of the gastrointestinal tract and the derangements encountered following SCI. The limited preclinical data following experimental SCI is discussed throughout with particular emphasis on identifying both evidence-based therapies and areas for focused research.