Symptomatic Management of Gastroparesis

Navas, Christopher M.; Patel, Nihal; Lacy, Brian E.

doi:10.1016/j.giec.2018.08.005

Cited by 15 publications

(26 citation statements)

References 75 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…30 Domperidone has been associated with QT prolongation and ventricular tachycardia and is available in the United States only through an Food and Drug Administration (FDA) investigational drug application. 31,32 Erythromycin has been shown to improve gastric motility but exert little effects on symptoms. 33 Antiemetic therapies such as metoclopramide, a D2receptor antagonist, is the only FDA-approved medication for the treatment of nausea and vomiting in gastroparesis.…”

Section: Discussionmentioning

confidence: 99%

“…33 Antiemetic therapies such as metoclopramide, a D2receptor antagonist, is the only FDA-approved medication for the treatment of nausea and vomiting in gastroparesis. 32 Although a variety of other medications (scopolamine, aprepitant, and tricyclic antidepressants) are available for treating nausea and vomiting in other diseases, the data available behind their use for gastroparesis is very limited. To date, metoclopramide is the only available medication serves as both prokinetic and antiemetic, however it is not potent in accelerating gastric emptying and usage in a long run (> 12 weeks) has a severe side effect such as the risk of tardive dyskinesia.…”

Section: Discussionmentioning

confidence: 99%

“…As stated earlier, although a number of prokinetics, such as metoclopramide, domperidone, erythromycin, azithromycin, cisapride, and tegaserod, have been developed or applied for treating gastric dysmotility, they were not available in the USA or not practically used in clinical settings due to their severe side-effects. 11,32,[64][65][66] Due to its autonomic mechanisms, the proposed SCS may also exert ameliorating effects on other pathophysiologies of gastroparesis, such as impaired gastric accommodation and visceral pain. Gastric accommodation is known to be mediated via the vagal and nitrinergic mechanisms and the SCS-induced enhancement in vagal activity may, therefore, improve gastric accommodation, which deserves further investigation.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

A Novel Approach in Spinal Cord Stimulation for Enhancing Gastric Motility: A Preliminary Study on Canines

Gharibani

Yang

et al. 2020

J Neurogastroenterol Motil

View full text Add to dashboard Cite

Background/AimsGastroparesis is commonly seen in patients with diabetes and functional dyspepsia with no satisfactory therapies. Dysautonomia is one of the main reasons for the imbalanced motility. We hypothesized that spinal cord stimulation (SCS) is a viable therapy for gastroparesis via the autonomic modulation to improve gastric motility. The aim is to find an optimal method of SCS for treating gastroparesis. MethodsEight healthy-female dogs were implanted with a gastric cannula, a duodenal cannula, 2 multi-electrode spinal leads, and an implantable pulse generator. Gastric motility index (MI) was used to determine the best stimulation location/parameters of SCS. Optimized SCS was used to improve glucagon-induced gastroparesis. ResultsWith fixed parameters, SCS at Thoracic 10 (T10) was found most effective for increasing gastric MI (37.8%, P = 0.013). SCS was optimized with different parameters (pulse width: 0.05-0.6 msec, frequency: 5-500 Hz, motor threshold: 30-90%) on T10. Our findings revealed that 0.5 msec, 20 Hz with 90% motor threshold at T10 were the best parameters in increasing MI. Glucagon significantly delayed gastric emptying, and this inhibitory effect was partially blocked by SCS. Gastric emptying at 120 minutes was 25.6% in the control session and 15.7% in glucagon session (P = 0.007 vs control), while it was 22.9% with SCS session (P = 0.041 vs glucagon). SCS with the optimal parameters was found to maximally enhance vagal activity and inhibit sympathetic activity assessed by the spectral analysis of heart rate variability. ConclusionsSCS with optimized stimulation location and parameters improves gastric motility in healthy-dogs and accelerates gastric emptying impaired by glucagon via enhancing vagal activity. (J Neurogastroenterol Motil 2020;26:147-159)

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

A Novel Approach in Spinal Cord Stimulation for Enhancing Gastric Motility: A Preliminary Study on Canines

Gharibani

Yang

et al. 2020

J Neurogastroenterol Motil

View full text Add to dashboard Cite

show abstract

“…Opioids may worsen gastric emptying, increase the risk of narcotic bowel syndrome, and potentially cause addiction, tolerance, and/ or overdose. 26 They also are associated with poor quality of life, increased hospitalization, and increased use of antiemetic and pain modulator medications compared with non-use. 27 Unfortunately, at least 31%-50% of adults with GP are prescribed opioids for their abdominal pain.…”

Section: Narcotic Usagementioning

confidence: 99%

Childhood gastroparesis is a unique entity in need of further investigation

Febo‐Rodriguez

Chumpitazi

Shulman

2019

Neurogastroenterology Motil

View full text Add to dashboard Cite

Background Despite increasing knowledge regarding gastroparesis (GP) in adults, little is known regarding the incidence, prevalence, and natural history of childhood GP. Exacerbating the knowledge gap in pediatric GP is both the lack of normative data for gastric emptying scintigraphy in children and lack of GP‐specific pediatric reported outcome measures. Purpose The aim of this article was to review the available literature on pediatric GP and identify similarities and differences with studies in adults. We performed a comprehensive search in MEDLINE and Google Scholar from inception to April 2019 for articles published in English using the following combination of keywords: gastroparesis, pediatric gastroparesis, outcomes, metoclopramide, erythromycin, domperidone, cisapride, and gastric neurostimulator. The limited available pediatric data, often retrospective, suggest marked differences between adult and pediatric GP in several aspects including etiology, concomitant co‐morbidities (eg, psychiatric disorders), clinical symptom presentation, diagnostic evaluation, response to therapies, and clinical outcome. Further research in pediatric GP is needed and holds the promise to further elucidate the mechanisms of this disorder in children and lead to pediatric‐focused therapies.

show abstract

“…In the USA, approved therapy is restricted to a single prokinetic dopamine‐2 receptor antagonist (metoclopramide) that carries a black box warning, as chronic use (>12 weeks) may lead to extrapyramidal side effects and potential irreversible tardive dyskinesia . Therefore, gastroenterologists resort to a combination of nutritional recommendations, herbal therapy, off‐label antiemetics, prokinetics and antidepressants, and endoscopic pyloric interventions (botox injections or myotomies) to best manage and prevent symptom flares . Currently, several agents are under various stages of clinical trials including selective serotonin 5‐HT4 receptor agonists, neurokinin‐1 receptor antagonists, and ghrelin receptor agonists .…”

Section: Discussionmentioning

confidence: 99%

Open‐label pilot study: Non‐invasive vagal nerve stimulation improves symptoms and gastric emptying in patients with idiopathic gastroparesis

Gottfried-Blackmore

Adler

Fernandez‐Becker

et al. 2019

Neurogastroenterology Motil

View full text Add to dashboard Cite

Background Gastroparesis, a chronic motility disorder characterized by delayed gastric emptying, abdominal pain, nausea, and vomiting, remains largely unexplained. Medical therapy is limited, reflecting the complex physiology of gastric sensorimotor function. Vagus nerve stimulation is an attractive therapeutic modality for gastroparesis, but prior methods required invasive surgery. In this open‐label pilot study, we aimed to assess the benefit of non‐invasive vagal nerve stimulation in patients with mild to moderate idiopathic gastroparesis. Methods Patients self‐administered the gammaCore vagal nerve stimulator for 4 weeks. The gastroparesis cardinal symptom index daily diary (GCSI‐dd) was assessed during a two‐week run‐in period, ≥4 weeks of therapy, and 4 weeks after therapy was completed. Gastric emptying and autonomic function testing were also performed. The primary endpoint was an absolute reduction in CGSI‐dd of 0.75 after nVNS. Results There was a total improvement in symptom scores (2.56 ± 0.76 to 1.87 ± 1.05; P = .01), with 6/15 (40%) participants meeting our primary endpoint. Therapy was associated with a reduction in gastric emptying (T1/2 155 vs 129 minutes; P = .053, CI −0.4 to 45). Therapy did not correct autonomic function abnormalities, but was associated with modulation of reflex parasympathetic activity. Conclusions Short‐term non‐invasive vagal nerve stimulation led to improved cardinal symptoms and accelerated gastric emptying in a subset of patients with idiopathic gastroparesis. Responders had more severe gastric delay at baseline and clinical improvement correlated with duration of therapy, but not with improvements in gastric emptying. Larger randomized sham‐controlled trials of greater duration are needed to confirm the results of this pilot study.

show abstract

Symptomatic Management of Gastroparesis

Cited by 15 publications

References 75 publications

A Novel Approach in Spinal Cord Stimulation for Enhancing Gastric Motility: A Preliminary Study on Canines

A Novel Approach in Spinal Cord Stimulation for Enhancing Gastric Motility: A Preliminary Study on Canines

Childhood gastroparesis is a unique entity in need of further investigation

Open‐label pilot study: Non‐invasive vagal nerve stimulation improves symptoms and gastric emptying in patients with idiopathic gastroparesis

Contact Info

Product

Resources

About