Gastrointestinal complications in patients with aneurysmal subarachnoid hemorrhage: a systematic review with meta-analysis of gastrointestinal bleeding incidence
- 1Department of Neurosurgery, The Second Affiliated Hospital of Nanchang University
- 2Department of Neurosurgical Intensive Care Unit, The Second Affiliated Hospital of Nanchang University
Abstract
Background: Gastrointestinal complications following aneurysmal subarachnoid hemorrhage (aSAH) are reported using heterogeneous definitions. We systematically reviewed their occurrence, associated factors, and prognostic associations, with meta-analysis restricted to gastrointestinal bleeding incidence.
Methods: Nine databases (PubMed, Embase, Cochrane Library, CINAHL, Web of Science, CNKI, Wanfang, VIP, and SinoMed) were searched from inception to 15 June 2026, without language restrictions. Eligible designs included cohort studies, cross-sectional studies, and case series with separately extractable data for adults with aSAH. Two reviewers independently selected studies, extracted data, and assessed methodological quality using the Newcastle–Ottawa Scale for cohort reports and design-specific JBI checklists for other reports. Study-defined inpatient gastrointestinal bleeding incidence was pooled using a DerSimonian–Laird random-effects model with Freeman–Tukey double-arcsine transformation. Sensitivity analyses varied study inclusion and the statistical model. Other outcomes and associations were synthesized narratively. Certainty of evidence for the pooled incidence was assessed using GRADE.
Results: Sixteen reports were included. Five independent cohort studies involving 2,824 patients and 145 bleeding events yielded a pooled incidence of 4.07% (95% CI 0.52%–10.53%; I ² = 97.74%). Excluding two studies whose definitions included occult blood positivity yielded 2.45% (95% CI 0.43%–5.90%; I ² = 90.67%). A binomial-normal generalized linear mixed model using the same five studies as the primary analysis yielded 2.96% (95% CI 0.79%–9.80%). Reported associations with bleeding included cerebral vasospasm, elevated intracranial pressure, impaired renal function, and treatment modality; these observational findings do not establish causality. Evidence on constipation, diarrhea, composite gastrointestinal dysfunction, and prognosis was limited and heterogeneous. Certainty of evidence for the pooled bleeding incidence was very low.
Conclusion: The pooled incidence of gastrointestinal bleeding after aSAH should be interpreted cautiously given the small number of studies, methodological limitations, wide confidence intervals, and persistent heterogeneity. Prospective multicenter studies using standardized outcome definitions and ascertainment methods are needed.
Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261425017 , PROSPERO CRD420261425017.
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BibTeX
@article{wu2026gastrointestinal,
title = {{Gastrointestinal complications in patients with aneurysmal subarachnoid hemorrhage: a systematic review with meta-analysis of gastrointestinal bleeding incidence}},
author = {Taohong Wu and Hongping Yang and Minzhi Cao and Chao Huang and Ting He and Yanyan Gong},
journal = {Frontiers in Neurology},
year = {2026},
month = nov,
doi = {10.3389/fneur.2026.1956555},
url = {https://www.frontiersin.org/articles/10.3389/fneur.2026.1956555/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Gastrointestinal complications in patients with aneurysmal subarachnoid hemorrhage: a systematic review with meta-analysis of gastrointestinal bleeding incidence
AU - Taohong Wu
AU - Hongping Yang
AU - Minzhi Cao
AU - Chao Huang
AU - Ting He
AU - Yanyan Gong
PY - 2026
DA - 2026/11/09
JO - Frontiers in Neurology
DO - 10.3389/fneur.2026.1956555
UR - https://www.frontiersin.org/articles/10.3389/fneur.2026.1956555/full
AB - Background: Gastrointestinal complications following aneurysmal subarachnoid hemorrhage (aSAH) are reported using heterogeneous definitions. We systematically reviewed their occurrence, associated factors, and prognostic associations, with meta-analysis restricted to gastrointestinal bleeding incidence. Methods: Nine databases (PubMed, Embase, Cochrane Library, CINAHL, Web of Science, CNKI, Wanfang, VIP, and SinoMed) were searched from inception to 15 June 2026, without language restrictions. Eligible designs included cohort studies, cross-sectional studies, and case series with separately extractable data for adults with aSAH. Two reviewers independently selected studies, extracted data, and assessed methodological quality using the Newcastle–Ottawa Scale for cohort reports and design-specific JBI checklists for other reports. Study-defined inpatient gastrointestinal bleeding incidence was pooled using a DerSimonian–Laird random-effects model with Freeman–Tukey double-arcsine transformation. Sensitivity analyses varied study inclusion and the statistical model. Other outcomes and associations were synthesized narratively. Certainty of evidence for the pooled incidence was assessed using GRADE. Results: Sixteen reports were included. Five independent cohort studies involving 2,824 patients and 145 bleeding events yielded a pooled incidence of 4.07% (95% CI 0.52%–10.53%; I ² = 97.74%). Excluding two studies whose definitions included occult blood positivity yielded 2.45% (95% CI 0.43%–5.90%; I ² = 90.67%). A binomial-normal generalized linear mixed model using the same five studies as the primary analysis yielded 2.96% (95% CI 0.79%–9.80%). Reported associations with bleeding included cerebral vasospasm, elevated intracranial pressure, impaired renal function, and treatment modality; these observational findings do not establish causality. Evidence on constipation, diarrhea, composite gastrointestinal dysfunction, and prognosis was limited and heterogeneous. Certainty of evidence for the pooled bleeding incidence was very low. Conclusion: The pooled incidence of gastrointestinal bleeding after aSAH should be interpreted cautiously given the small number of studies, methodological limitations, wide confidence intervals, and persistent heterogeneity. Prospective multicenter studies using standardized outcome definitions and ascertainment methods are needed. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261425017 , PROSPERO CRD420261425017.
SN - 1664-2295
ER -