Purpose Major burn injury is associated with significant physiological stress and instability. Gastrointestinal (GI) complications occurring in the context of such severe physiological insult can be associated with significant morbidity and mortality. This study aims to determine the incidence of GI morbidity in severely burn injured patients and investigate associated risk factors to identify potential opportunities for further prophylaxis. Methodology We performed a retrospective review of all patients with >20% total burn surface area (TBSA) burn injury admitted to the National Burn Centre (NBC) for New Zealand (2017-2023). All patients with GI complications requiring consultation by another specialty were included. These comprised stasis, pancreatitis, ulceration, perforation, and requirement for investigations including endoscopy and laparotomy. Results A GI complication was identified in 21 of 154 patients. Six patients (3.8%) required at least 1 laparotomy. Five patients (3.2%) required endoscopy. Five of the 21 patients died as a sequela of the GI complication (4 required laparotomies and 1 abdominal decompression) and 1 died from sequela of the burn injury (multi-organ failure). The GI complications included: 5 ischaemic gut, 3 abdominal compartment syndrome, 4 rectal bleeding, 3 upper GI bleed, 2 perforation, 2 pseudo-obstruction, 2 ileus, and 1 pancreatitis with portal vein thrombosis. Conclusion All major burn patients receive antacid prophylaxis, however, a proportion of major burn patients still develop GI complications, which can be associated with significant morbidity and mortality. Patient groups at particular risk include those with a history of ulceration, age >70 years, and those over-resuscitated.