Gastric electrical stimulation improves symptoms and need for supplemental nutrition in children with severe nausea and vomiting: A ten‐year experience

Abstract

Background Gastric electrical stimulation (GES) is a promising therapy for children with severe nausea and vomiting, but information on long‐term outcomes is limited. We sought to evaluate the long‐term efficacy and safety of GES and to describe patient benefit and satisfaction. Methods Using a prospective registry, we identified patients aged <21 years treated with GES at our institution between 2009 and 2019. Encounters were selected at baseline prior to GES and at follow‐up at 1 month, 12 months, and the most recent visit. We compared symptoms, route of nutrition, and medication usage at baseline to follow‐up timepoints. Factors associated with improvement were evaluated. We recorded complications and need for battery replacement. We contacted families to administer the Glasgow Children's Benefit Inventory (GCBI) and a parent satisfaction questionnaire. Key Results Eighty‐five patients (68.2% female, median age 15.8 years) completed a trial of temporary GES due to severe nausea and vomiting. Seventy‐seven (90.6%) had a positive response and underwent permanent stimulator placement. Use of tube feeding or parenteral nutrition (PN) decreased from 72.7% at baseline to 29.9% at the most recent follow‐up (p < 0.001). Higher baseline vomiting severity was associated with the ability to stop supplemental nutrition by 1 month (p < 0.05). Fourteen patients (18.2%) had complications, primarily due to stimulator‐associated discomfort, and 29 (37.7%) required battery replacement. Median GCBI was +52.1, indicating health‐related benefit. Conclusions and Inferences Children with severe nausea and vomiting treated with GES experienced significant and durable improvement in symptom severity and their ability to tolerate oral nutrition.

Children with functional gastrointestinal disorders with and withoutco‐existingnausea: A comparison of clinical and psychological characteristics

“…Moreover, in the current study, burps, acid reflux, regurgitation, and a bloated feeling were more prevalent in children with nausea, suggesting that an altered gastric motility indeed plays a role in the pathophysiology of nausea. At the same time, gastric electrical stimulation can improve symptoms in children with severe nausea 27,28 . Since the vagal nerve influences gastric emptying, dysfunction of the parasympathetic nervous system it likely plays a role in the pathogenesis of nausea 17,29,30 .…”

“…At the same time, gastric electrical stimulation can improve symptoms in children with severe nausea. 27,28 Since the vagal nerve influences gastric emptying, dysfunction of the parasympathetic nervous system it likely plays a role in the pathogenesis of nausea. 17,29,30 Physiological testing in pediatric patients with chronic unexplained nausea has indeed shown a decreased heart rate variability, suggesting reduced parasympathetic tone and underlying dysfunction.…”

Skills or Pills: Randomized Trial Comparing Hypnotherapy to Medical Treatment in Children With Functional Nausea

“…Chronic abdominal pain is caused by visceral hypersensitivity, while chronic nausea is likely the result of a change in gut motility. [37][38][39] It is known, however, that hypnosis can affect both hypersensitivity and motility. Lowén et al 16 showed, using a barostat for rectal distensions and functional magnetic resonance imaging, that abnormal processing and enhanced perception of visceral stimuli in IBS can be normalized after hypnotherapy.…”

Functional Nausea Is Real and Makes You Sick

“…Cannabinoids have been studied extensively for prevention and treatment of nausea and vomiting associated with chemotherapy (42), but their chronic use may also cause dyspeptic symptoms including nausea and protracted emesis (43). Finally, there is increasing evidence that neuromodulation with implantation of a gastric pacemaker improves drug-refractory nausea, regardless of the effect of this device on gastric emptying (44). The mechanism by which such improvement is triggered is not yet fully clarified and is likely to include modulation of central, autonomic, and enteric pathways.…”