CISAPRIDE AS A TREATMENT FOR GASTROPARESIS IN TRAUMATIC BRAIN INJURY

Gastroparesis is a well-documented finding among patients with severe traumatic brain injuries. The treatment of choice has been metoclopram ide, but it is less than ideal given its central dopaminergic blocking activity. Cisapride is a newer prokinetic agent without side effects on the central nervous system and might be a superior treatment. The c ase of a healthy 22-year-old man who suffered a severe traumatic brain injury and multiple trauma in a motor vehicle accident is reported. T he patient required gastrostomy tube placement but developed recurrent aspiration pneumonia once feeding were initiated. Despite receiving m etoclopramide, barium studies revealed gastroparesis, a significant de crease in gastric peristalsis, and reflux. A jejunostomy tube was plac ed to prevent further aspiration. The administration of cisapride was begun, and 2 days later the patient was changed back to G-tube feeding s with no evidence of residual aspirates. Repeat barium study showed d efinite improved in peristalsis. The case of demonstrates the potentia l usefulness of cisapride in patients with traumatic brain injury. Alt hough further research is necessary, efficacy without central dopamine blockage may make cisapride the treatment of choice for gastroparesis and reflex in traumatic brain injury. (C) 1996 by the American Congre ss of Rehabilitation Medicine and the American Academy of Physical Med icine and Rehabilitation