Gastric Electrical Stimulation Is an Option for Patients with Refractory Cyclic Vomiting Syndrome

Abstract

Background/AimsCyclic vomiting syndrome (CVS) is a disabling migraine variant manifesting as severe episodes of nausea and vomiting and often refractory to many therapies. Gastric electrical stimulation (GES), which can reduce nausea and vomiting in gastroparesis, may provide symptomatic relief for drug-refractory CVS. This study assessed the utility GES in reducing the symptoms of CVS and improving the quality of life. MethodsA one-year, non-randomized, clinical study was conducted. Eleven consecutive patients with drug refractory, cyclic vomiting syndrome based on Rome III criteria and North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN), underwent treatment with temporary GES (Temp GES) and permanent GES (Perm GES). Post-treatment follow up was done up to one year after permanent gastric electrical stimulation therapy. ResultsTotal symptom score decreased by 68% and 40% after temporary and permanent GES therapies, respectively. Hospital admission events significantly decreased to 1.50 (± 1.00) events from 9.14 (± 7.21) annual admissions prior to treatment with permanent GES. Vomiting episodes fell by 83% post Temp GES and 69% after Perm GES treatments. Mucosal electrogram values also changed after temporary stimulation. ConclusionsIn a small group of drug-refractory CVS patients, treatments with temporary and permanent GES significantly reduced the severity of gastrointestinal symptoms and frequency of hospital admissions.

Pyloric distensibility measurement after gastric surgery: Which surgeries are associated with pylorospasm?

“…An assessment of each item was realized using a 5‐point Likert scale which varies from 0 (absent) to 4 (most severe symptoms). Total symptomatic score (TSS) was defined as the aggregation of individual symptom scores . A minimal TSS of eight for each patient was necessary for inclusion in the present study.…”

Endoscopic mucosal electrodes: New directions for recording and regulating gastric myoelectric activity

“…At the same time, the symptoms of vomiting and nausea were improved in all three subgroups. In 2016, Grover et al (20) conducted an one-year non-randomized clinical study. After 11 patients with intractable periodic vomiting syndrome received mucosal GES and permanent GES, the total symptom score decreased by 68% and 40%, respectively, and the number of hospitalization events decreased from 9.14 (±7.21) to 1.5 (±1.00) per year.…”

“…In addition, the mucosal electrodes can also be used for GES, and its effect is similar to that of the serosal electrode, but the trauma and cost are much less than that of the serosal electrodes (13). Some studies have applied endoscopic mucosal electrode technique to gastroparesis (14)(15)(16)(17), obesity (9, 18,19), drug refractory vomiting (20) and other diseases, and achieved good results. This review introduces gastric myoelectric activity, traditional serosal electrodes and cutaneous electrodes, endoscopic mucosal electrodes, mucosal electrogastrogram, mucosal gastric electrical stimulation and so on.…”