Gastroparesis syndromes: Response to electrical stimulation

• DOI: 10.1111/nmo.13534
• Publication Date: 2019-02-01T01:11:15Z
• Authors: Thomas L. Abell; Archana Kedar; Abigail Stocker; Karen Beatty; Lindsay McElmurray; Michael Hughes; Hani Rashed; William Kennedy; Gwen Wendelschafe...; Xiu Yang; Mostafa Fraig; Endashaw Omer; Ed Miller; Michael Griswold; Christina Pinkston
• Keywords: Adult; Inflammation; Male; Gastroparesis; Vomiting; Arrhythmias, Cardiac; Electric Stimulation Therapy; Middle Aged; Autonomic Nervous System; Hormones; Abdominal Pain; 3. Good health; 03 medical and health sciences; Treatment Outcome; 0302 clinical medicine; Gastric Emptying; Heart Rate; Diabetes Mellitus; Quality of Life; Cytokines; Humans; Female; Aged

AbstractBackground and AimsFactors underlying gastroparesis are not well defined, nor is the mechanism of action of gastric electrical stimulation (GES). We hypothesized that GES acts via several mechanisms related to underlying disordered pathophysiology.MethodsWe studied 43 consecutive eligible patients with gastroparetic symptoms, previously evaluated by two methods in each of five core areas: inflammatory, autonomic, enteric, electrophysiologic, and hormonal; and also categorized by GI symptoms, metabolic status, illness quantification, and gastric physiology. We then studied 41 patients who underwent temporary GES for 5‐7 days. Thirty‐six of those patients were implanted and 30 were followed up at 6 months after permanent GES.ResultsIn previous but separately reported work, patients had similar GI symptoms regardless of baseline gastric emptying or diabetic/idiopathic status and all patients demonstrated abnormalities in each of the five areas studied. After GES, patients showed early and late effects of electrical stimulation with changes noted in multiple areas, categorized by improvement status.ConclusionPatients with symptoms of gastroparesis have multiple abnormalities, including systemic inflammation and disordered hormonal status. GES affects many of these abnormalities. We conclude electrical stimulation improves symptoms and physiology with (a) an early and sustained anti‐emetic effect; (b) an early and durable gastric prokinetic effect in delayed emptying patients; (c) an early anti‐arrhythmic effect that continues over time; (d) a late autonomic effect; (e) a late hormonal effect; (f) an early anti‐inflammatory effect that persists; and (g) an early and sustained improvement in health‐related quality of life.This study is registered with Clinicaltrials.gov under study # NCT03178370 (https://clinicaltrials.gov/ct2/show/NCT03178370).