Gastroparesis syndromes: Response to electrical stimulation

Thomas L. Abell, Archana Kedar, Abigail Stocker, Karen Beatty, Lindsay McElmurray, Michael Hughes, Hani Rashed, William Kennedy, Gwen Wendelschafer-Crabb, Xiu Yang, Mostafa Fraig, Endashaw Omer, Ed Miller, Michael Griswold, Christina Pinkston

Research output: Contribution to journalArticlepeer-review

14 Scopus citations

Abstract

Background and Aims: Factors 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. Methods: We 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. Results: In 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. Conclusion: Patients 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).

Original languageEnglish (US)
Article numbere13534
JournalNeurogastroenterology and Motility
Volume31
Issue number3
DOIs
StatePublished - Mar 2019

Bibliographical note

Funding Information:
Funding information Primary funding for this work was from the NIH Diabetes Complication Consortium, U24DK076169. This work was also approved as an ancillary study of the NIH GpCRC (U01DK074007) (CTG Number: NCT03178370). The authors would like to thank the following: Bridget Cannon, Heather Barker, Leila Gobejishvili, Shirish Barve, Craig McClain, Tad Dryden, Cam Falkner, Marion McClain, Samir Vermani, Chirag Patel, Andy Patel, Shifat Ahmed, Kaartik Soota, Siva Cheetirala, Malathi Perugula, Jpriyanga Jayakumar, Pramod Kumar Savarapu, Sathya Krishnasamy, Hamza Hassan, Warren Starkebaum, and Steve Mahanes. The authors would like to thank the staff of Jewish Hospital including the GI Motility Clinic and the University of Louisville CTR/Liver Research Unit as well as the help of Catherine McBride in manuscript preparation. The authors would also like to thank Greg O'Grady for review of the manuscript.

Publisher Copyright:
© 2019 John Wiley & Sons Ltd

Keywords

  • abdominal pain
  • autonomic nervous system
  • electrophysiology
  • enteric nervous system
  • gastric emptying
  • gastroparesis
  • hormones
  • inflammation
  • nausea and vomiting

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