Gastric pacing improves emptying and symptoms in patients with gastroparesis

McCallum, Richard W.; Chen, Jian De Z.; Lin, Zhiyue; Schirmer, Bruce D.; Williams, Ronald D.; Ross, Robert A.

doi:10.1016/s0016-5085(98)70528-1

Cited by 396 publications

(340 citation statements)

References 8 publications

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“…Clinically and experimentally, various parameters of GES have been applied for inducing gastric sensory and motor effects (Abell and Minocha 2002;Familoni et al 1997;Forster et al 2001;Lin et al 2002;McCallum et al 1998;Sobocki et al 2003). The majority of these studies seem to indicate that GES with low frequency and high energy is able to entrain gastric slow waves and improve gastric emptying; whereas, GES with high frequency and low energy improves gastroparetic symptoms of nausea and vomiting without obvious improvement in gastric motility (Lin et al 2004).…”

Section: Effects Of Gesmentioning

confidence: 99%

Modulatory effects and afferent pathways of gastric electrical stimulation on rat thoracic spinal neurons receiving input from the stomach

Qin

Chen

Zhang

et al. 2007

Neuroscience Research

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Gastric electrical stimulation (GES) has been suggested as a potential therapy for patients with obesity or gastric motility disorders. The aim of this study was to investigate the spinal mechanism of GES effects on gastric functions. Extracellular potentials of single spinal (T9-T10) neurons were recorded in pentobarbital anesthetized, paralyzed, ventilated male rats (n=19). Gastric distension (GD) was produced by air inflation of a balloon. One pair of platinum electrodes (1.0-1.5 cm apart) was sutured onto the serosal surface of the lesser curvature of the stomach. GES with four sets of parameters was applied for one minute: GES-A (6 mA, 0.3 ms, 40 Hz, 2s on, 3s off), GES-B (6 mA, 0.3 ms, 14 Hz, 0.1s on, 5s off), GES-C (6 mA, 3 ms, 40 Hz, 2s on, 3s off), GES-D (6 mA, 200 ms, 12 pulses/min). 62/158 (39%) spinal neurons responded to GD (20, 40, 60 mmHg, 20s. Most GD-responsive neurons (n=43) had excitatory responses; the remainder had inhibitory (n=12) or biphasic responses (n=7). GES-A, -B, -C and -D affected activity of 12/33 (36%), 4/31 (13%), 22/29 (76%) and 13/30 (43%) GD-responsive neurons, respectively. Bilateral cervical vagotomy did not significantly alter mean excitatory neuronal responses to GD (n=5) or GES (n=6). Resiniferatoxin (2.0 μg/kg, i.v.), an ultrapotent agonist of vanilloid receptor-1, abolished excitatory responses to GD and GES in 4/4 neurons recorded in vagotomized rats. The results suggested that GES mainly had an excitatory effect on T9-T10 spinal neurons with gastric inputs; neuronal responses to GES were strengthened with stimulation at an increased pulse width and/or number of pulses. The modulatory effect of GES involved thoracic spinal (sympathetic) afferent fibers containing vanilloid receptor-1.

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Section: Effects Of Gesmentioning

confidence: 99%

Modulatory effects and afferent pathways of gastric electrical stimulation on rat thoracic spinal neurons receiving input from the stomach

Qin

Chen

Zhang

et al. 2007

Neuroscience Research

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“…Gastric electric stimulation (GES) has been investigated as a treatment for patients with medically refractory gastroparesis [1][2][3].…”

Section: Introductionmentioning

confidence: 99%

Predictive Factors for Clinical Improvement with Enterra Gastric Electric Stimulation Treatment for Refractory Gastroparesis

et al. 2007

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The objectives of this study were to determine the clinical response to Enterra gastric electric stimulation (GES) in patients with refractory gastroparesis and to determine factors associated with a favorable response.Methods-This study was conducted in patients undergoing Enterra GES for refractory gastroparesis. Symptoms were scored before and after GES implantation using the Gastroparesis Cardinal Symptom Index (GCSI) with additional questions about abdominal pain and global clinical response.Results-During an 18-month period, 29 patients underwent GES implantation. Follow-up data were available for 28 patients, with average follow-up of 148 days. At follow-up, 14 of 28 patients felt improved, 8 remained the same, and 6 worsened. The overall GCSI significantly decreased with improvement in the nausea/vomiting sub-score and the post-prandial subscore, but no improvement in the bloating subscore or abdominal pain. The decrease in GCSI was greater for diabetic patients than idiopathic patients. Patients with main symptom of nausea/vomiting had a greater improvement than patients with the main symptom of abdominal pain. NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript narcotic analgesics at the time of implant had a poorer response compared to patients who were not.Conclusions-GES resulted in clinical improvement in 50% of patients with refractory gastroparesis. Three clinical parameters were associated with a favorable clinical response: (1) diabetic rather than idiopathic gastroparesis, (2) nausea/vomiting rather than abdominal pain as the primary symptom, and (3) independence from narcotic analgesics prior to stimulator implantation. Knowledge of these three factors may allow improved patient selection for GES.

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“…Despite all these positive aspects, the method has also some deficiencies: the median gastric retention measured by a standardized 4-h scintigraphy of a solid meal was not significantly reduced at 12 months, indicating no special association between changes in symptoms and GE. The fact that other papers reported a significantly improved GE with the majority of gastroparesis patients (67%), getting back to normal levels and reversing gastric dysrhythmia with enhancement of the gastric slow waves [43], might depend on different stimulation parameters used. This suggests that in the future different stimulation parameters will be needed to reverse dysmotility in DGP.…”

Section: Medical Treatment and Gastric Electric Stimulationmentioning

confidence: 89%

Diabetic Gastrointestinal Neuropathy: Elusive Diagnosis and Difficult Treatment

Tatti¹,

Strollo²,

Barber³

2011

TOCTJ

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Diabetic Gastrointestinal Neuropathy is an elusive diagnosis and often overlooked. The affected patients do not connect the symptoms with diabetes and undergo a painstaking and expensive search for other disorders of the digestive tract. Diabetic Gastrointestinal Neuropathy additionally causes a baffling glucose instability that further aggravates the condition. The treatment is difficult. The less severe cases respond to prokinetic treatment, but when the disease is advanced the only available therapy is the insertion of a pacemaker.

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Gastric pacing improves emptying and symptoms in patients with gastroparesis

Cited by 396 publications

References 8 publications

Modulatory effects and afferent pathways of gastric electrical stimulation on rat thoracic spinal neurons receiving input from the stomach

Modulatory effects and afferent pathways of gastric electrical stimulation on rat thoracic spinal neurons receiving input from the stomach

Predictive Factors for Clinical Improvement with Enterra Gastric Electric Stimulation Treatment for Refractory Gastroparesis

Diabetic Gastrointestinal Neuropathy: Elusive Diagnosis and Difficult Treatment

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