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Paskaranandavadivel N, OGrady G, Cheng LK. Time-Delay Mapping of High-Resolution Gastric Slow-Wave Activity. IEEE Trans Biomed Eng 2016; 64:166-172. [PMID: 27071158 DOI: 10.1109/tbme.2016.2548940] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
GOAL Analytic monitoring of electrophysiological data has become an essential component of efficient and accurate clinical care. In the gastrointestinal (GI) field, recent advances in high-resolution (HR) mapping are now providing critical information about spatiotemporal profiles of slow-wave activity in normal and disease (dysrhythmic) states. The current approach to analyze GI HR electrophysiology data involves the identification of individual slow-wave events in the electrode array, followed by tracking and clustering of events to create a spatiotemporal map. This method is labor and computationally intensive and is not well suited for real-time clinical use or chronic monitoring. METHODS In this study, an automated novel technique to assess propagation patterns was developed. The method utilized time delays of the slow-wave signals which was computed through cross correlations to calculate velocity. Validation was performed with both synthetic and human and porcine experimental data. RESULTS The slow-wave profiles computed via the time-delay method compared closely with those computed using the traditional method (speed difference: 7.2% ± 2.6%; amplitude difference: 8.6% ± 3.5%, and negligible angle difference). CONCLUSION This novel method provides rapid and intuitive analysis and visualization of slow-wave activity. SIGNIFICANCE This techniques will find major applications in the clinical translation of acute and chronic HR electrical mapping for motility disorders, and act as a screening tool for detailed detection and tracking of individual propagating wavefronts, without the need for comprehensive standard event-detection analysis.
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Bornhorst GM, Gouseti O, Wickham MS, Bakalis S. Engineering Digestion: Multiscale Processes of Food Digestion. J Food Sci 2016; 81:R534-43. [DOI: 10.1111/1750-3841.13216] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Accepted: 12/16/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Gail M. Bornhorst
- Dept. of Biological and Agricultural EngineeringUniv. of California Davis, 1 Shields Avenue Davis Calif. U.S.A
| | - Ourania Gouseti
- School of Chemical EngineeringUniv. of Birmingham Birmingham UK
| | | | - Serafim Bakalis
- School of Chemical EngineeringUniv. of Birmingham Birmingham UK
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Abstract
OPINION STATEMENT Gastroparesis (GP) is a syndrome characterized by delayed gastric emptying in association with symptoms of epigastric pain, nausea, and vomiting in the absence of mechanical obstruction. The prevalence of gastroparesis has been estimated at 24 per 100,000, with women more commonly affected than men. Diabetes appears to be the underlying cause in approximately 25 % of patients, while connective tissue disorders, autoimmune disorders, prior gastric surgery, ischemia, and medications make up a smaller percentage of the remaining identifiable causes. However, the largest group of GP patients falls into the idiopathic category (~50 %); many of these patients likely develop GP as a result of a prior viral infection. Symptoms of gastroparesis develop due to a number of different pathophysiologic processes, including disorders of fundic accommodation, antroduodenal dyscoordination, a weak antral pump, gastric dysrhythmias, abnormal duodenal feedback, and enhanced visceral sensation. Once the diagnosis of GP is made, the clinician has a number of different treatment options. For patients with mild to moderate symptoms, dietary modifications in conjunction with or without prokinetics and antiemetics are often all that is required. However, many patients with severe symptoms who fail to respond to standard therapy may benefit from neuroenteric stimulation (gastric electrical stimulation). This monograph will review the role of the neuroenteric stimulator therapy for gastroparesis, discuss possible mechanisms of action of neuroenteric stimulation, review data from recently published studies on its efficacy, and discuss patient selection and adverse events.
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Affiliation(s)
- Brian E Lacy
- Division of Gastroenterology & Hepatology, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH, 03756, USA.
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54
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Oh JH. Expanding Indications of Gastric Electrical Stimulation. J Neurogastroenterol Motil 2015; 21:455-6. [PMID: 26424035 PMCID: PMC4622126 DOI: 10.5056/jnm15144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 09/10/2015] [Accepted: 09/13/2015] [Indexed: 01/17/2023] Open
Affiliation(s)
- Jung Hwan Oh
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Jin H, Liu J, Foreman RD, Chen JDZ, Yin J. Electrical neuromodulation at acupoint ST36 normalizes impaired colonic motility induced by rectal distension in dogs. Am J Physiol Gastrointest Liver Physiol 2015; 309:G368-76. [PMID: 26113299 DOI: 10.1152/ajpgi.00467.2014] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 06/17/2015] [Indexed: 01/31/2023]
Abstract
Electroacupuncture (EA) has been shown to improve impaired gastric motility and slow waves in both humans and animals. However, its effects on colonic motility have rarely been investigated. The aim of this study was to investigate the effects and underlying mechanisms of EA on impaired colonic motility induced by rectal distension (RD)in dogs. Colon contractions and transit were measured in various sessions with and without EA in hound dogs chronically placed with a colonic cannula. Colonic contractile activity was assessed by motility index (MI). Autonomic functions were determined by the spectral analysis of the heart rate variability derived from the electrocardiogram. It was found 1) RD suppressed colonic motility by 40.5% (10.8 ± 0.9 with RD vs. 6.4 ± 0.8 at baseline, P < 0.002). EA at ST36 normalized colonic contractions suppressed by RD (12.9 ± 2.8, P < 0.002 vs. RD and P = 0.1 vs. control). 2) Administration of atropine blocked the ameliorating effect of EA on colon motility. 3) RD also delayed colonic transit (65.0 ± 2.0% with RD vs. 86.0 ± 1.9% without RD, P < 0.001) that was restored with EA (84.0 ± 1.9%, P = 0.178 vs. control). 4) EA increased vagal activity suppressed by RD (0.37 ± 0.07 with RD + EA vs. 0.09 ± 0.03 with RD without EA, P < 0.001). In conclusion, RD inhibits colonic contractions and delays colonic transit in dogs; EA at ST36 restores the RD-induced impairment in both colonic contraction and transit by enhancing vagal activity and mediated via the cholinergic pathway.
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Affiliation(s)
- Haifeng Jin
- Veterans Research and Education Foundation, Veterans Affairs Medical Center, Oklahoma City, Oklahoma; Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; The First Affiliated Hospital of Zhejiang Chinese Medicine University, Hangzhou, China
| | - Jiemin Liu
- Veterans Research and Education Foundation, Veterans Affairs Medical Center, Oklahoma City, Oklahoma; Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; Guizhou Provincial People's Hospital, Guizhou, Guiyang, China
| | - Robert D Foreman
- Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Jiande D Z Chen
- Veterans Research and Education Foundation, Veterans Affairs Medical Center, Oklahoma City, Oklahoma; Ningbo Pace Translational Research Center, Beilun, Ningbo, China; and Division of Gastroenterology and Hepatology, Johns Hopkins Center for Neurogastroenterology, Baltimore, Maryland
| | - Jieyun Yin
- Veterans Research and Education Foundation, Veterans Affairs Medical Center, Oklahoma City, Oklahoma; Division of Gastroenterology and Hepatology, Johns Hopkins Center for Neurogastroenterology, Baltimore, Maryland
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56
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Abstract
Obesity is a growing health problem worldwide with a major impact on health and healthcare expenditures. Medical therapy in the form of diet and pharmacotherapy has limited effect on weight. Standard bariatric surgery is effective but is associated with morbidity and mortality, creating an unmet need for alternative therapies. One such therapy, the application of electrical stimulation to the stomach, has been studied extensively for the last two decades. Though pulse parameters differ between the various techniques used, the rationale behind this assumes that application of electrical current can interfere with gastric motor function or modulate afferent signaling to the brain or both. Initial studies led by industry failed to show an effect on body weight. However, more recently, there has been a renewed interest in this therapeutic modality with a number of concepts being evaluated in large human trials. If successful, this minimally invasive and low-risk intervention would be an important addition to the existing menu of therapies for obesity.
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Affiliation(s)
- Jenny D Chiu
- Department of Medicine, Division of Gastroenterology, Keck School of Medicine at USC, 1520 San Pablo Street, Los Angeles, CA, 50033, USA
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57
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O'Grady G, Wang THH, Du P, Angeli T, Lammers WJEP, Cheng LK. Recent progress in gastric arrhythmia: pathophysiology, clinical significance and future horizons. Clin Exp Pharmacol Physiol 2015; 41:854-62. [PMID: 25115692 DOI: 10.1111/1440-1681.12288] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 07/11/2014] [Accepted: 07/14/2014] [Indexed: 01/27/2023]
Abstract
Gastric arrhythmia continues to be of uncertain diagnostic and therapeutic significance. However, recent progress has been substantial, with technical advances, theoretical insights and experimental discoveries offering new translational opportunities. The discoveries that interstitial cells of Cajal (ICC) generate slow waves and that ICC defects are associated with dysmotility have reinvigorated gastric arrhythmia research. Increasing evidence now suggests that ICC depletion and damage, network disruption and channelopathies may lead to aberrant slow wave initiation and conduction. Histological and high-resolution (HR) electrical mapping studies have now redefined the human 'gastric conduction system', providing an improved baseline for arrhythmia research. The application of HR mapping to arrhythmia has also generated important new insights into the spatiotemporal dynamics of arrhythmia onset and maintenance, resulting in the emergence of new provisional classification schemes. Meanwhile, the strong associations between gastric functional disorders and electrogastrography (EGG) abnormalities (e.g. in gastroparesis, unexplained nausea and vomiting and functional dyspepsia) continue to motivate deeper inquiries into the nature and causes of gastrointestinal arrhythmias. In future, technical progress in EGG methods, new HR mapping devices and software, wireless slow wave acquisition systems and improved gastric pacing devices may achieve validated applications in clinical practice. Neurohormonal factors in arrhythmogenesis also continue to be elucidated and a deepening understanding of these mechanisms may open opportunities for drug design for treating arrhythmias. However, for all translational goals, it remains to be seen whether arrhythmia can be corrected in a way that meaningfully improves organ function and symptoms in patients.
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Affiliation(s)
- Gregory O'Grady
- Department of Surgery, The University of Auckland, Auckland, New Zealand; Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
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58
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Qi H, Chen JDZ. Effects of intestinal electrical stimulation on postprandial small-bowel motility and transit in dogs. Am J Surg 2015; 192:e55-60. [PMID: 18070725 DOI: 10.1016/j.amjsurg.2006.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Intestinal electrical stimulation (IES) with long pulses has been reported to inhibit motility as well as accelerate transit of continuous infusion. However, it is unknown whether there is a correlation between the IES-induced alterations in motility and transit and whether there is a difference in transit during IES between continuous infusion and bolus infusion. METHODS The study was performed in 2 postprandial sessions (control and stimulation) in dogs with 2 pairs of serosal electrodes and 2 intestinal cannulas. Intestinal motility and transit with and without IES were measured by manometry and phenol red, respectively. RESULTS IES significantly decreased intestinal motility and increased transit time. There was a significant correlation between motility index and transit during IES. CONCLUSIONS IES inhibits both intestinal bolus motility and transit. There is correlation between motility and transit during IES.
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Affiliation(s)
- Huibin Qi
- University of Texas Medical Branch, Division of Gastroenterology, Route 0632, Room 221 Microbiology Bldg., 1108 The Strand, Galveston, TX 77555-0632, USA
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59
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Sathar S, Trew ML, OGrady G, Cheng LK. A Multiscale Tridomain Model for Simulating Bioelectric Gastric Pacing. IEEE Trans Biomed Eng 2015; 62:2685-92. [PMID: 26080372 DOI: 10.1109/tbme.2015.2444384] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
GOAL Gastric motility disorders have been associated with abnormal slow wave electrical activity (gastric dysrhythmias). Gastric pacing is a potential therapy for gastric dysrhythmias; however, new pacing protocols are required that can effectively modulate motility patterns, while being power efficient. This study presents a novel comprehensive 3-D multiscale modeling framework of the human stomach, including anisotropic conduction, capable of evaluating pacing strategies. METHODS A high-resolution anatomically realistic mesh was generated from CT images taken from a human stomach. Principal conduction axes were calculated and embedded within this model based on a modified Laplace-Dirichlet rule-based algorithm. A continuum-based tridomain formulation was implemented and evaluated for performance and used to model the slow-wave propagation, which takes into account the two main cell types present in gastric musculature. Model parameters were found by matching predicted normal slow-wave activity to experimental observation and data. These simulation parameters were applied while modeling an external pacing event to entrain slow-wave patterns. RESULTS The proposed formulation was found to be two times more efficient than a previous formulation for a normal slow-wave simulation. Convergence analysis showed that a mesh resolution of [Formula: see text] is required for an accurate solution process. CONCLUSION The effect of different pacing frequencies on entrainment demonstrated that the pacing protocols are limited by the frequency of the native propagation and the refractory period of the cellular activity. SIGNIFICANCE The model is expected to become an important tool in studying pacing protocols for both efficiency and effectiveness.
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60
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O'Grady G, Abell TL. Gastric arrhythmias in gastroparesis: low- and high-resolution mapping of gastric electrical activity. Gastroenterol Clin North Am 2015; 44:169-84. [PMID: 25667031 PMCID: PMC4323584 DOI: 10.1016/j.gtc.2014.11.013] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Gastric arrhythmias occur in gastroparesis but their significance is debated. An improved understanding is currently emerging, including newly-defined histopathologic abnormalities in gastroparesis. In particular, the observation that interstitial cells of Cajal are depleted and injured provides mechanisms for arrhythmogenesis in gastroparesis. Electrogastrography has been the dominant clinical method of arrhythmia analysis, but is limited by summative nature, low signal quality, and incomplete sensitivity and specificity. Recently, high-resolution (HR; multi-electrode) mapping has emerged, providing superior spatial data on arrhythmic patterns and mechanisms. However, HR mapping is invasive, and low-resolution approaches are being assessed as bridging techniques until endoscopic mapping is achieved.
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Affiliation(s)
- Gregory O'Grady
- Department of Surgery, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Thomas L Abell
- Division of Gastroenterology, GI Motility Clinic, University of Louisville, 220 Abraham Flexner Way, Suite 300, Louisville, KY 40202, USA.
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61
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Surgical approaches to treatment of gastroparesis: gastric electrical stimulation, pyloroplasty, total gastrectomy and enteral feeding tubes. Gastroenterol Clin North Am 2015; 44:151-67. [PMID: 25667030 DOI: 10.1016/j.gtc.2014.11.012] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Gastric electrical stimulation (GES) is neurostimulation; its mechanism of action is affecting central control of nausea and vomiting and enhancing vagal function. GES is a powerful antiemetic available for patients with refractory symptoms of nausea and vomiting from gastroparesis of idiopathic and diabetic causes. GES is not indicated as a way of reducing abdominal pain in gastroparetic patients. The need for introducing a jejunal feeding tube means intensive medical therapies are failing, and is an indication for the implantation of the GES system, which should always be accompanied by a pyloroplasty to guarantee accelerated gastric emptying.
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62
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Yin J, Chen JDZ. Gastrointestinal Electrical Neuromodulation for Functional Gastrointestinal Diseases, Obesity and Diabetes. Bioelectron Med 2015. [DOI: 10.15424/bioelectronmed.2015.00002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Abell TL, Chen J, Emmanuel A, Jolley C, Sarela AI, Törnblom H. Neurostimulation of the gastrointestinal tract: review of recent developments. Neuromodulation 2015; 18:221-7; discussion 227. [PMID: 25581846 DOI: 10.1111/ner.12260] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 10/09/2014] [Accepted: 11/03/2014] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Neurostimulation is one manifestation of neuromodulation of the gastrointestinal (GI) tract. This manuscript reviews the history of neurostimulation of the GI tract with emphasis on current methods of stimulation. MATERIALS AND METHODS A review was completed of the current research on GI neurostimulation methods with an emphasis on their clinical applications. RESULTS Upper GI disorders can be modulated with both temporary (placed endoscopically or surgically) or permanent (placed surgically) gastric electrical stimulation (GES) devices. The current GI neurostimulation of stomach (GES) devices have been used in both children and adults, and some patients have been followed in excess of 15 years with good long-term results. Similar GES devices also have been used for a variety of lower GI disorders, including constipation and fecal incontinence, for a number of years. CONCLUSIONS GI neurostimulation, as a type of neuromodulation, has been demonstrated to function at several locations in the GI tract for a variety of disorders. The future of neurostimulation in the GI tract will likely be influenced by a better understanding of pathophysiology as well as the development of new techniques and devices for neuromodulation.
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Affiliation(s)
- Thomas L Abell
- Department of Internal Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Louisville, Louisville, KY, USA
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64
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Gastric Electrical Stimulation Optimized to Inhibit Gastric Motility Reduces Food Intake in Dogs. Obes Surg 2014; 25:1047-55. [DOI: 10.1007/s11695-014-1491-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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65
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Saurabh S, Lee GO, Chong HS. Robotic gastric electrical stimulator placement: technique and literature review. J Robot Surg 2014; 8:285-7. [PMID: 27637692 DOI: 10.1007/s11701-013-0440-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 11/23/2013] [Indexed: 11/27/2022]
Abstract
Gastroparesis in a chronic setting is a disorder that results in diminished quality of life. Laparoscopic gastric electrical stimulator (GES) placement is now being performed in patients with medically refractory gastroparesis. During this procedure, a significant amount of suturing is required to anchor the electrodes to the gastric wall. Robotic surgery may provide surgeons with several technical and ergonomic advantages during this procedure, when compared with a standard laparoscopic approach. The aim of this study is to present a case and review the technique and literature for robotic placement of GES. This report demonstrates the safety and feasibility of robotic GES placement.
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Affiliation(s)
- Shireesh Saurabh
- Department of Surgery, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA.
| | - Grant O Lee
- Department of Surgery, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Hui Sen Chong
- Department of Surgery, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA
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66
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Koch KL. Gastric dysrhythmias: a potential objective measure of nausea. Exp Brain Res 2014; 232:2553-61. [DOI: 10.1007/s00221-014-4007-9] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 05/27/2014] [Indexed: 12/30/2022]
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From ischochymia to gastroparesis: proposed mechanisms and preferred management of dyspepsia over the centuries. Dig Dis Sci 2014; 59:1088-98. [PMID: 24715546 DOI: 10.1007/s10620-014-3144-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 03/26/2014] [Indexed: 12/12/2022]
Abstract
Dyspeptic symptoms are common with most patients suffering functional disorders that remain a therapeutic challenge for medical practitioners. Within the last three decades, gastric infection, altered motility, and hypersensitivity have gained and lost traction in explaining the development of functional dyspepsia. Considering these shifts, the aim of this review was to analyze changing understanding of and approaches to dyspepsia over a longer time period. Monographs, textbooks, and articles published during the last three centuries show that our understanding of normal gastric function has improved dramatically. With increased insight came new ideas about disease mechanisms, diagnostic options, and treatments. Despite shifts over time, the importance of functional abnormalities was recognized early on and explained in the context of societal influences and stressors, anxieties, and biological influences, thus resembling the contemporary biopsychosocial model of illness. Symptoms were often attributed to changes in secretion, motility, and sensation or perception with technological innovation often influencing proposed mechanisms and treatments. Many of the principles or even agents applied more than a century ago are still part of today's approach. This includes acid suppression, antiemetics, analgesics, and even non-pharmacologic therapies, such as gastric decompression or electrical stimulation of the stomach. This historical information does not only help us understand how we arrived at our current state of knowledge and standards of care, it also demonstrates that enthusiastic adoption of various competing explanatory models and the resulting treatments often did not survive the test of time. In view of the benign prognosis of dyspepsia, the data may function as a call for caution to avoid the potential harm of overly aggressive approaches or treatments with a high likelihood of adverse effects.
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Yang W, Wang N, Shi X, Chen J. Synchronized dual pulse gastric electrical stimulation induces activation of enteric glial cells in rats with diabetic gastroparesis. Gastroenterol Res Pract 2014; 2014:964071. [PMID: 24860604 PMCID: PMC4003764 DOI: 10.1155/2014/964071] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 03/09/2014] [Accepted: 03/10/2014] [Indexed: 12/23/2022] Open
Abstract
Objective. The aims of this study were to investigate the effects of synchronized dual pulse gastric electrical stimulation (SGES) on gastric motility in different periods for diabetic rats and try to explore the possible mechanisms of the effects. Methods. Forty-six rats were used in the study. Gastric slow waves were recorded at baseline, 7-14-day diabetes and 56-63-day diabetes before and after stimulation and the age-matched control groups. SGES-60 mins and SGES-7 days (60 mins/day) were performed to test the effects on gastric motility and to evaluate glial marker S100B expression in stomach. Results. (1) Gastric emptying was accelerated in 7-14-day diabetes and delayed in 56-63-day diabetes. (2) The S100B expression in 56-63-day diabetes decreased and the ultrastructure changed. (3) The age-associated loss of EGC was observed in 56-63-day control group. (4) SGES was able to not only accelerate gastric emptying but also normalize gastric slow waves. (5) The S100B expression increased after SGES and the ultrastructure of EGC was partially restored. The effect of SGES-7 days was superior to SGES-60 mins. Conclusions. Delayed gastric emptying due to the growth of age may be related to the EGC inactivation. The effects of the SGES on gastric motility may be associated with EGC activation.
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Affiliation(s)
- Wei Yang
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Nian Wang
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Xue Shi
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Jie Chen
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
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69
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Abstract
Gastric electrostimulation by a pulse generator is an area of intense interest for the treatment of obesity. The concept of a rhythmic electrical current applied to neural or myal tissues has been established for the treatment of major problems in many areas of the body or is being investigated.
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70
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Sun Y, Tan Y, Song G, Chen JDZ. Effects and mechanisms of gastric electrical stimulation on visceral pain in a rodent model of gastric hyperalgesia secondary to chemically induced mucosal ulceration. Neurogastroenterol Motil 2014; 26:176-86. [PMID: 24165025 DOI: 10.1111/nmo.12248] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Accepted: 09/21/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND Gastric electrical stimulation (GES) has been suggested as a potential treatment for patients with gastric motility disorders. The aim of this study was to examine the effects and mechanisms of GES on visceral pain in awaken rats. METHODS Under anesthesia, acetic acid was injected into the submucosal layer of the stomach wall in Sprague-Dawley (SD) male rats. Each rat was chronically placed with an intragastric balloon and two pairs of electrodes on gastric serosa for GES and at the neck muscles for electromyography (EMG) recordings respectively. The study was composed of four experiments. Exp 1 was designed to determine optimal GES parameters in reducing EMG response to gastric distention (GD). Exp 2 was performed to investigate the effect of GES on gastric tone/accommodation. Exp 3 was to investigate if the opioid pathway was involved in the analgesic effects of GES. Exp 4 was to assess the effectiveness of GES on the spinal cord neurons (T9-T10) responding to GD. KEY RESULTS (i) Gastric electrical stimulation with a train on of 0.1 s and off of 0.4 s, 0.25 ms, 100 Hz, and 6 mA significantly reduced GD-induced EMG responses at GD 40, 60, and 80 mmHg. (ii) The inhibitory effects of GES on the GD-induced EMG responses were blocked by Naloxone. (iii) GES inhibited 90% of high-threshold (HT) spinal neurons in response to GD. However, GES with the same parameters only suppressed 36.3% low-threshold (LT) neuronal response to GD. CONCLUSIONS & INFERENCES Gastric electrical stimulation with optimal parameters inhibits visceral pain; the analgesic effect of GES on visceral pain is mediated via the endogenous opioid system and the suppression of spinal afferent neuronal activities.
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Affiliation(s)
- Y Sun
- Veterans Research and Education Foundation, VA Medical Center, Oklahoma City, OK, USA; Department of Internal Medicine, Texas Tech University Health Science Center, El Paso, TX, USA
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71
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Horváth VJ, Izbéki F, Lengyel C, Kempler P, Várkonyi T. Diabetic gastroparesis: functional/morphologic background, diagnosis, and treatment options. Curr Diab Rep 2014; 14:527. [PMID: 25005121 DOI: 10.1007/s11892-014-0527-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The regulation of gastrointestinal motility mainly involves the smooth muscle, neural (extrinsic and intrinsic), and hormonal elements, the glial cells, and the interstitial cells of Cajal. An orchestrated function of all these components is required for the appropriate propulsive movement of the food in the gastrointestinal tract. Gastroparesis, a pathological slowing-down of gastric emptying, is a result of the damage to the tissue elements involved in the regulation of motility. Gastroparesis is one of the well-known complications of long-standing diabetes mellitus. Although it is rarely a life-threatening complication, it has a deteriorating effect on the quality of life, leads to unpredictable oscillation of the blood glucose level, and increases the time required for the absorption of food and medicines. This review describes the clinical characteristics of diabetic gastroparesis and summarizes the organic and functional motility abnormalities caused by this complication. Finally, the currently available and potential future therapeutic approaches are summarized.
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Affiliation(s)
- Viktor J Horváth
- 1st Department of Medicine, Semmelweis University, Koranyi Sandor utca 2/a, 1081, Budapest, Hungary,
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72
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Sathar S, Trew ML, Du P, O'Grady G, Cheng LK. A biophysically based finite-state machine model for analyzing gastric experimental entrainment and pacing recordings. Ann Biomed Eng 2013; 42:858-70. [PMID: 24276722 DOI: 10.1007/s10439-013-0949-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 11/19/2013] [Indexed: 12/14/2022]
Abstract
Gastrointestinal motility is coordinated by slow waves (SWs) generated by the interstitial cells of Cajal (ICC). Experimental studies have shown that SWs spontaneously activate at different intrinsic frequencies in isolated tissue, whereas in intact tissues they are entrained to a single frequency. Gastric pacing has been used in an attempt to improve motility in disorders such as gastroparesis by modulating entrainment, but the optimal methods of pacing are currently unknown. Computational models can aid in the interpretation of complex in vivo recordings and help to determine optimal pacing strategies. However, previous computational models of SW entrainment are limited to the intrinsic pacing frequency as the primary determinant of the conduction velocity, and are not able to accurately represent the effects of external stimuli and electrical anisotropies. In this paper, we present a novel computationally efficient method for modeling SW propagation through the ICC network while accounting for conductivity parameters and fiber orientations. The method successfully reproduced experimental recordings of entrainment following gastric transection and the effects of gastric pacing on SW activity. It provides a reliable new tool for investigating gastric electrophysiology in normal and diseased states, and to guide and focus future experimental studies.
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Affiliation(s)
- Shameer Sathar
- Auckland Bioengineering Institute, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
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Harrison NS, Williams PA, Walker MR, Nikitini Y, Helling TS, Abell TL, Lahr CJ. Evaluation and treatment of gastric stimulator failure in patients with gastroparesis. Surg Innov 2013; 21:244-9. [PMID: 24056201 DOI: 10.1177/1553350613503735] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE This study evaluates treatment of gastroparesis patients refractory to gastric electrical stimulation (GES) therapy with surgical replacement of the entire GES system. SUMMARY BACKGROUND DATA Some patients who have symptomatic improvement with GES later develop recurrent symptoms. Some patients improve by simply altering pulse parameter settings. Others continue to have symptoms with maximized pulse parameters. For these patients, we have shown that surgical implantation of a new device and leads at a different gastric location will improve symptoms of gastroparesis. METHODS This study evaluates 15 patients with recurrent symptoms after initial GES therapy who subsequently received a second GES system. Positive response to GES replacement therapy is evaluated by symptoms scores for vomiting, nausea, epigastric pain, early satiety, and bloating using a modified Likert score system, 0 to 4. RESULTS Total symptom scores improved for 12 of 15 patients with GES replacement surgery. Total score for the replacement group decreased from 17.3 ± 1.6 to 13.6 ± 3.7 with a difference of 3.6 (P value = .017). This score is compared with that of the control group with a preoperative symptom score of 15.8 ± 3.6 and postoperative score of 12.3 ± 3.5 with a difference of 3.5 (P value = .011). The control group showed a 20.3% decrease in mean total symptoms score, whereas the study group showed a 22.5% decrease in mean with an absolute reduction of 2.2. CONCLUSION Reimplantation of a GES at a new gastric location should be considered a viable option for patients who have initially failed GES therapy for gastroparesis.
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Affiliation(s)
| | | | - Micah R Walker
- University of Mississippi Medical Center, Jackson, MS, USA
| | - Yana Nikitini
- University of Mississippi Medical Center, Jackson, MS, USA
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74
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Zhao X, Yin J, Wang L, Chen JDZ. Diffused and sustained inhibitory effects of intestinal electrical stimulation on intestinal motility mediated via sympathetic pathway. Neuromodulation 2013; 17:373-79; discussion 380. [PMID: 23924055 DOI: 10.1111/ner.12099] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 06/05/2013] [Accepted: 06/19/2013] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The aims were to investigate the energy-dose response effect of intestinal electrical stimulation (IES) on small bowel motility, to compare the effect of forward and backward IES, and to explore the possibility of using intermittent IES and mechanism of IES on intestinal motility. MATERIALS AND METHODS Five dogs implanted with a duodenal cannula and one pair of intestinal serosal electrodes were studied in five sessions: 1) energy-dose response study; 2) forward IES; 3) backward IES; 4) intermittent IES vs. continuous IES; 5) administration of guanethidine. The contractile activity and tonic pressure of the small intestine were recorded. The duration of sustained effect after turning off IES was manually calculated. RESULTS 1) IES with long pulse energy dose dependently inhibited contractile activity and tonic pressure of the small intestine (p < 0.001). 2) The duration of sustained inhibitory effect of IES on the small intestine depended on the energy of IES delivered (p < 0.001). 3) The potency of the inhibitory effect was the same between forward and backward IES. 4) The efficacy of intermittent IES was the same as continuous IES in inhibiting motility of the small intestine. 5) Guanethidine blocked the inhibitory effect of IES on intestinal motility. CONCLUSIONS IES with long pulses inhibits small intestinal motility; the effect is energy-dose dependent, diffused, and sustained. Intermittent IES has the same efficacy as the continuous IES in inhibiting small intestinal motility. Forward and backward IES have similar inhibitory effects on small bowel motility. This IES-induced inhibitory effect is mediated via the sympathetic pathway.
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Affiliation(s)
- Xiaotuan Zhao
- Division of Gastroenterology, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
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75
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Stevens JE, Jones KL, Rayner CK, Horowitz M. Pathophysiology and pharmacotherapy of gastroparesis: current and future perspectives. Expert Opin Pharmacother 2013; 14:1171-86. [PMID: 23663133 DOI: 10.1517/14656566.2013.795948] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Gastroparesis is an important clinical disorder characterised by delayed gastric emptying in the absence of mechanical outlet obstruction. Idiopathic, diabetes and postsurgical causes represent the most common aetiologies. The condition commonly manifests as upper gastrointestinal symptoms, including nausea, vomiting, postprandial fullness, early satiety, abdominal pain and bloating. AREAS COVERED This paper provides a review of the prevalence, pathophysiology and clinical features associated with gastroparesis, with a particular focus on current pharmacological management options and novel and emerging therapies. A literature search was undertaken using the search terms: gastroparesis, diabetic gastroparesis, idiopathic gastroparesis, gastric emptying, prokinetic, metoclopramide, domperidone, erythromycin, motilin, alemcinal, KC11458, mitemcinal, ghrelin, TZP-101, TZP-102, RM-131, tegaserod, prucalopride, naronapride, velusetrag, levosulpiride, itopride, botulinum toxin, gastric electrical stimulation, Enterra. EXPERT OPINION Strategies for the management of gastroparesis include correction of malnutrition, dehydration and electrolyte imbalance, relief of symptoms by appropriate use of prokinetic and antiemetic agents and, in patients with gastroparesis associated with diabetes or critical illness-induced hyperglycaemia, optimisation of glycaemic control. Conventional prokinetic agents form the mainstay of treatment. While novel pharmacotherapies are in development, compelling evidence for their efficacy, particularly in symptom relief, remains to be established.
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Affiliation(s)
- Julie E Stevens
- University of South Australia, School of Pharmacy and Medical Sciences, Adelaide, Australia.
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76
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Electrogastrography in adults and children: the strength, pitfalls, and clinical significance of the cutaneous recording of the gastric electrical activity. BIOMED RESEARCH INTERNATIONAL 2013; 2013:282757. [PMID: 23762836 PMCID: PMC3677658 DOI: 10.1155/2013/282757] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 05/13/2013] [Indexed: 12/12/2022]
Abstract
Cutaneous electrogastrography (EGG) is a non-invasive technique to record gastric myoelectrical activity from the abdominal surface. Although the recent rapid increase in the development of electrocardiography, EGG still suffers from several limitations. Currently, computer analysis of EGG provides few reliable parameters, such as frequency and the percentage of normal and altered slow wave activity (bradygastria and tachygastria). New EGG hardware and software, along with an appropriate arrangement of abdominal electrodes, could detect the coupling of the gastric slow wave from the EGG. At present, EGG does not diagnose a specific disease, but it puts in evidence stomach motor dysfunctions in different pathological conditions as gastroparesis and functional dyspepsia. Despite the current pitfalls of EGG, a multitasking diagnostic protocol could involve the EGG and the (13)C-breath testing for the evaluation of the gastric emptying time-along with validated gastrointestinal questionnaires and biochemical evaluations of the main gastrointestinal peptides-to identify dyspeptic subgroups. The present review tries to report the state of the art about the pathophysiological background of the gastric electrical activity, the recording and processing methodology of the EGG with particular attention to multichannel recording, and the possible clinical application of the EGG in adult and children.
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Keller DS, Parkman HP, Boucek DO, Sankineni A, Meilahn JE, Gaughan JP, Harbison S. Surgical outcomes after gastric electric stimulator placement for refractory gastroparesis. J Gastrointest Surg 2013; 17:620-6. [PMID: 23358845 DOI: 10.1007/s11605-013-2147-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 01/09/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Gastric electric stimulation (GES) is used for refractory gastroparesis symptoms. Although symptomatic improvement has been reported with GES, few studies describe the need for additional surgery after placement. Our goal was to evaluate the outcomes of a large series of GES at a single institution. METHODS A retrospective review was performed for patients undergoing Enterra GES (Medtronic, Inc.) placement for refractory gastroparesis from October 2000 to October 2011. The main outcome measures were the need/indications for additional procedures and symptom improvement. RESULTS A total of 266 patients had a GES implanted; 233 had complete records and were included in the analysis. Fifty-eight percent (n = 135) required an additional procedure after GES placement. Nutrition access (45 patients requiring 77 procedures) and subcutaneous pocket issues (n = 21) were the most common indications for subsequent procedures. Twelve percent (n = 29) had the GES explanted, mainly for continued gastroparetic symptoms (n = 11), mechanical issues (n = 9), or infection (n = 4). Ninety patients had subsequent hospitalizations, mainly for gastroparetic flares. Mortality during the follow-up period was 2.1 %. BMI was predictive of additional surgical procedure: when overweight, the risk of pocket revision increased 4.45 times (OR = 4.452). Of 74 most recent patients with prospective long-term outcome data, 70 % reported improved symptoms of pain, bloating, and nausea. CONCLUSIONS Although most patients reported symptomatic improvement after GES implantation, there is often a need for additional surgical procedures as well as associated complications after GES placement. Additional procedures were most frequent for surgical nutrition and subcutaneous pocket issues; pocket revisions were more frequent in obese patients. From our results, we amended our practice to add a jejunostomy tube in malnourished patients and suture the stimulator to the subcutaneous pocket fascia. Further studies will determine if these changes reduce the rate of complications and additional procedures after GES placement.
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Affiliation(s)
- Deborah S Keller
- Department of Surgery, Temple University School of Medicine, Philadelphia, PA 19140, USA
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78
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Timratana P, El-Hayek K, Shimizu H, Kroh M, Chand B. Laparoscopic gastric electrical stimulation for medically refractory diabetic and idiopathic gastroparesis. J Gastrointest Surg 2013; 17:461-70. [PMID: 23288718 DOI: 10.1007/s11605-012-2128-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2012] [Accepted: 07/19/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND Gastric electrical stimulator (GES) implantation is effective in certain patients with gastroparesis; however, laparotomy is often employed for placement. The aim of this study is to review outcomes of patients who underwent laparoscopic GES therapy for diabetic and idiopathic gastroparesis at a large referral center. METHODS Patients who underwent GES (Enterra Therapy System; Medtronic, Minneapolis, MN) implantation with subsequent interrogation and programming between March 2001 and November 2011 were analyzed. RESULTS A total of 113 patients underwent GES placement or revision during the study period. One hundred eleven patients underwent primary GES at our institution, while two patients underwent GES generator revision at our institution. Primary operations were completed laparoscopically in 110 of 111 cases, with one conversion to laparotomy due to severe adhesions. At a mean follow-up of 27 months (1-113), symptom improvement was achieved in 91 patients (80 %) and was similar for both the diabetic and idiopathic subgroups. Need for supplemental nutrition (enteral and/or parental) decreased in both groups. CONCLUSIONS GES placement is feasible using a laparoscopic approach. Medical refractory gastroparesis in the diabetic and idiopathic groups had significant symptom improvement with no difference between the two groups. Need for supplemental nutrition is decreased following GES.
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Affiliation(s)
- P Timratana
- Cleveland Clinic, Bariatric and Metabolic Institute, Cleveland, OH 44195, USA.
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79
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Gastric electrical stimulation for the treatment of obesity: from entrainment to bezoars-a functional review. ISRN GASTROENTEROLOGY 2013; 2013:434706. [PMID: 23476793 PMCID: PMC3582063 DOI: 10.1155/2013/434706] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 01/08/2013] [Indexed: 12/29/2022]
Abstract
GROWING WORLDWIDE OBESITY EPIDEMIC HAS PROMPTED THE DEVELOPMENT OF TWO MAIN TREATMENT STREAMS: (a) conservative approaches and (b) invasive techniques. However, only invasive surgical methods have delivered significant and sustainable benefits. Therefore, contemporary research exploration has focused on the development of minimally invasive gastric manipulation methods featuring a safe but reliable and long-term sustainable weight loss effect similar to the one delivered by bariatric surgeries. This antiobesity approach is based on placing external devices in the stomach ranging from electrodes for gastric electrical stimulation to temporary intraluminal bezoars for gastric volume displacement for a predetermined amount of time. The present paper examines the evolution of these techniques from invasively implantable units to completely noninvasive patient-controllable implements, from a functional, rather than from the traditional, parametric point of view. Comparative discussion over the available pilot and clinical studies related to gastric electrical stimulation outlines the promises and the fallacies of this concept as a reliable alternative anti-obesity strategy.
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80
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Sarosiek I, Forster J, Lin Z, Cherry S, Sarosiek J, McCallum R. The addition of pyloroplasty as a new surgical approach to enhance effectiveness of gastric electrical stimulation therapy in patients with gastroparesis. Neurogastroenterol Motil 2013; 25:134-e80. [PMID: 23113904 DOI: 10.1111/nmo.12032] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Improvement of gastroparesis (GP) symptoms has been documented in patients treated with gastric electrical stimulation (GES), but acceleration of gastric emptying (GET) is unpredictable. The aim of our study was to evaluate the advantage of adding surgical pyloroplasty (PP) to GES for improvement of GET and control of symptoms in diabetes mellitus (DM), idiopathic (ID), and postvagotomy (P-V) GP. METHODS A total of 49 (17 - DM, 9 - ID, 23 - P-V) consecutive GP patients: 38 female; mean age 42 (21-73 years); mean weight 158 lbs (102-245), underwent GES implantation, and 26 (53%) additionally received PP. Total Symptoms Score, 4-h GET, adverse events (AEs), and days of hospitalizations were captured at baseline and at the last visit. KEY RESULTS The mean follow-up was 7 months. Total Symptoms Score in patients who received Enterra and PP or GES alone significantly improved compared to their baseline scores (P < 0.001). GET improved by 64% at 4 h (P < 0.001) in patients with Enterra and PP, compared to 7% observed after GES therapy alone (ns). The most impressive acceleration of GET was seen in the P-V group, who received both therapies (P = 0.004) and 8 (60%) of them normalized GET. No AEs accompanied the addition of PP to the Enterra surgery. CONCLUSIONS & INFERENCES (i) In drug-refractory GP the addition of PP to GES substantially accelerated GET; (ii) The GET response in P-V group was the most impressive; (iii) Significant symptom reductions were achieved by both procedures; and (iv) PP added to GES may sustain better long-term symptoms control particularly in the P-V setting.
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Affiliation(s)
- I Sarosiek
- Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA.
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81
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Long-term effects of gastric stimulation on gastric electrical physiology. J Gastrointest Surg 2013; 17:50-5; discussion p.55-6. [PMID: 22956404 PMCID: PMC5089842 DOI: 10.1007/s11605-012-2020-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2012] [Accepted: 08/21/2012] [Indexed: 01/31/2023]
Abstract
INTRODUCTION This study evaluates the modeling of gastric electrophysiology tracings during long-term gastric electrical stimulation for gastroparesis. We hypothesized that serosal electrogastrogram may change over time representing gastric remodeling from gastric stimulation. PATIENTS Sixty-five patients with gastroparesis underwent placement of gastric stimulator for refractory symptoms. Mean age at initial stimulator placement was 44 years (range, 8-76), current mean age was 49, and the majority of the subjects were female (n = 51, 78 %). Only a minority had diabetes-induced gastroparesis (n = 16, 25 %); the remainder were either idiopathic or postsurgical. METHODS At the time of stimulator placement, electrogastrogram was performed after the gastric leads were placed but before stimulation was begun. Patients underwent continuous stimulation until pacer batteries depleted. At the time of replacement, before the new pacemaker was attached, electrogastrogram was again performed. RESULTS After a mean of 3.9 years of stimulation therapy, the mean of baseline frequency before stimulation therapy was 5.06 cycles/min and declined to 3.66 after replacement (p = 0.0000002). The mean amplitude was 0.33 mV before stimulation therapy and decreased to 0.31 mV (p = 0.73). The frequency/amplitude ratio was 38.4 before stimulation therapy and decreased to 21.9 (p = 0.001). CONCLUSION Long-term gastric electrical stimulation causes improvement in basal unstimulated gastric frequency to near normal.
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Varghese RT, Mahesh DM, Oommen R, Prasad JHD, Unnikrishnan LS, Thomas N. Emesis in diabetes mellitus. Prim Care Diabetes 2012; 6:337-340. [PMID: 22944318 DOI: 10.1016/j.pcd.2012.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Revised: 08/06/2012] [Accepted: 08/08/2012] [Indexed: 11/25/2022]
Abstract
It is estimated that 20-40% of patients with diabetes, particularly those with prolonged duration of type 1 diabetes mellitus with other complications develop gastroparesis .We present in a picture quiz format the interesting case of an elderly lady presenting with diabetic gastroparesis in a tertiary care hospital in India.
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Affiliation(s)
- Ron Thomas Varghese
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India
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83
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Abstract
Similar to cardiac pacing, gastrointestinal (GI) pacing is an attractive idea and may become a promising therapy, as the GI organs, like the heart, have their own natural pacemakers. Over the past 10 years, electrical stimulation of the gut has received increasing attention among researchers and clinicians. Several clinical studies have shown that gastric electrical stimulation (GES) with short pulses is able to reduce nausea and vomiting in patients with gastroparesis and that GES with long pulses is able to pace the intrinsic gastric slow waves and thus normalize gastric dysrhythmia. However, possible placebo effects cannot be ruled out, although recent animal studies have revealed various peripheral and central mechanisms involved with GES. Electrical stimulation of the small intestine, colon, or anal sphincter also has been reported for the treatment of dumping syndrome, constipation, and fecal incontinency. Similarly, there is a lack of placebo-controlled studies. In our opinion, pacing of the gut has great potential for the treatment of various GI motor disorders. However, none of the commercially available devices is designed for pacing the gut. The lack of well-suited devices and the invasive nature of gut pacing slow down the progress and clinical applications of gut pacing.
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Affiliation(s)
- Jing Zhang
- Division of Gastroenterology, University of Texas Medical Branch, 1108 The Strand, Room 221, Galveston, TX 77555-0632, USA.
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O'Grady G, Angeli TR, Du P, Lahr C, Lammers WJEP, Windsor JA, Abell TL, Farrugia G, Pullan AJ, Cheng LK. Abnormal initiation and conduction of slow-wave activity in gastroparesis, defined by high-resolution electrical mapping. Gastroenterology 2012; 143:589-598.e3. [PMID: 22643349 PMCID: PMC3429650 DOI: 10.1053/j.gastro.2012.05.036] [Citation(s) in RCA: 227] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Revised: 05/12/2012] [Accepted: 05/16/2012] [Indexed: 12/19/2022]
Abstract
BACKGROUND & AIMS Interstitial cells of Cajal (ICC) generate slow waves. Disrupted ICC networks and gastric dysrhythmias are each associated with gastroparesis. However, there are no data on the initiation and propagation of slow waves in gastroparesis because research tools have lacked spatial resolution. We applied high-resolution electrical mapping to quantify and classify gastroparesis slow-wave abnormalities in spatiotemporal detail. METHODS Serosal high-resolution mapping was performed using flexible arrays (256 electrodes; 36 cm(2)) at stimulator implantation in 12 patients with diabetic or idiopathic gastroparesis. Data were analyzed by isochronal mapping, velocity and amplitude field mapping, and propagation animation. ICC numbers were determined from gastric biopsy specimens. RESULTS Mean ICC counts were reduced in patients with gastroparesis (2.3 vs 5.4 bodies/field; P < .001). Slow-wave abnormalities were detected by high-resolution mapping in 11 of 12 patients. Several new patterns were observed and classified as abnormal initiation (10/12; stable ectopic pacemakers or diffuse focal events; median, 3.3 cycles/min; range, 2.1-5.7 cycles/min) or abnormal conduction (7/10; reduced velocities or conduction blocks; median, 2.9 cycles/min; range, 2.1-3.6 cycles/min). Circumferential conduction emerged during aberrant initiation or incomplete block and was associated with velocity elevation (7.3 vs 2.9 mm s(-1); P = .002) and increased amplitudes beyond a low base value (415 vs 170 μV; P = .002). CONCLUSIONS High-resolution mapping revealed new categories of abnormal human slow-wave activity. Abnormalities of slow-wave initiation and conduction occur in gastroparesis, often at normal frequency, which could be missed by tests that lack spatial resolution. Irregular initiation, aberrant conduction, and low amplitude activity could contribute to the pathogenesis of gastroparesis.
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Affiliation(s)
- Gregory O'Grady
- Department of Surgery, University of Auckland, Auckland, New Zealand; Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand.
| | - Timothy R Angeli
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Peng Du
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Chris Lahr
- Division of Gastroenterology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Wim J E P Lammers
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand; Department of Physiology, UAE University, United Arab Emirates
| | - John A Windsor
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Thomas L Abell
- Division of Gastroenterology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Gianrico Farrugia
- Division of Enteric Neurosciences, Mayo Clinic, Rochester, Minnesota
| | - Andrew J Pullan
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand; Department of Surgery, Vanderbilt University, Nashville, Tennessee
| | - Leo K Cheng
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand; Department of Surgery, Vanderbilt University, Nashville, Tennessee
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Ong C, Logarajah V. Gastric Pacing in a Child with Severe Gastroparesis and Review of the Literature. PROCEEDINGS OF SINGAPORE HEALTHCARE 2012. [DOI: 10.1177/201010581202100309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Gastroparesis is a disorder characterised by symptoms of and evidence for gastric retention in the absence of mechanical obstruction. Symptoms include nausea and vomiting, early satiety, postprandial fullness, regurgitation and abdominal pain. Common causes of gastroparesis are diabetes, post-surgical and idiopathic. In some patients, gastroparesis can be very severe and refractory to medical therapy including anti-emetics, anti-reflux and pro-kinetic medications. Gastric electrical stimulation represents a novel treatment for severe gastroparesis by regulating gastric electrical dysfunction with a neurostimulator. In adult studies, vomiting frequency has been reduced by up to 81% from baseline. We report a case of a 13-year-old girl with life-long severe idiopathic gastroparesis who was successfully treated by gastric pacing.
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86
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O'Grady G, Pullan AJ, Cheng LK. The analysis of human gastric pacemaker activity. J Physiol 2012; 590:1299-300; author reply 1301-2. [PMID: 22399822 DOI: 10.1113/jphysiol.2011.224014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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87
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Soffer EE. Gastric electrical stimulation for gastroparesis. J Neurogastroenterol Motil 2012; 18:131-7. [PMID: 22523722 PMCID: PMC3325298 DOI: 10.5056/jnm.2012.18.2.131] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2012] [Revised: 03/17/2012] [Accepted: 03/24/2012] [Indexed: 12/16/2022] Open
Abstract
Gastric electrical stimulation (GES) for gastroparesis has been in use for more than a decade. Multiple publications, consisting almost entirely of open label single center studies, reported a beneficial effect on symptoms, quality of life and nutritional status. Some predictors of better response to GES have been lately identified, primarily diabetic etiology and nausea and vomiting as the predominant symptoms. However, individual response to GES remains difficult to predict. The mechanism of action of GES remains poorly understood. Stimulation parameters approved in clinical practice do not regulate gastric slow wave activity and have inconsistent effect on gastric emptying. Despite such limitations, gastric electrical stimulation remains a helpful intervention in some patients with severe gastroparesis who fail to respond to medical therapy.
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Affiliation(s)
- Edy E Soffer
- Cedars Sinai Medical Center, Los Angeles, CA, USA
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Yin J, Abell TD, McCallum RW, Chen JD. Gastric Neuromodulation With Enterra System for Nausea and Vomiting in Patients With Gastroparesis. Neuromodulation 2012; 15:224-31; discussion 231. [DOI: 10.1111/j.1525-1403.2012.00429.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Abstract
Extracellular electrical recordings underpin an important literature of basic and clinical motility science. In the November 2011 edition of Neurogastroenterology and Motility, Sanders and colleagues reported that contraction artifacts could be recorded from in vitro murine gastric tissues using extracellular electrodes, and that true extracellular bioelectrical activity could not be detected when the contractions were suppressed. The authors interpret their findings to mean that previous extracellular studies have generally assayed contraction artifacts, rather than bioelectrical activity, and suggest that movement suppression is an obligatory control for extracellular experiments. If their interpretation is correct, these claims would be significant, requiring a reinterpretation of many studies, and posing major challenges for future in vivo and especially clinical work. However, a demonstration that motion artifacts can be recorded from murine in vitro tissue does not necessarily mean that other extracellular studies also represented artifacts. This viewpoint evaluates a recently published by Sanders and colleagues in light of the competing literature, and finds a considerable volume of evidence to support the veracity of GI extracellular electrical recordings. It is reasoned from biophysical principles, technical considerations, and experimental studies that motion artifacts cannot explain GI extracellular electrical recordings in general, and that bioelectrical fact and artifact can be readily and reliably distinguished in most contexts. Calls for obligatory motion suppression for extracellular studies are therefore not supported. However, the artifacts recorded by Sanders and colleagues nevertheless serve as a reminder that educated caution is needed when recording, filtering and interpreting extracellular data.
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Affiliation(s)
- Gregory O’Grady
- Dept of Surgery, The University of Auckland, Auckland New Zealand,Auckland Bioengineering Institute, The University of Auckland, New Zealand
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90
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Bielefeldt K. Gastroparesis: concepts, controversies, and challenges. SCIENTIFICA 2012; 2012:424802. [PMID: 24278691 PMCID: PMC3820446 DOI: 10.6064/2012/424802] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 07/25/2012] [Indexed: 05/05/2023]
Abstract
Patients with gastroparesis often present a challenge to the treating physician. Postprandial symptoms with nausea and vomiting may not only lead to nutritional and metabolic consequences, but also cause significant disruptions to social activities that often center around food. While the definition of gastroparesis focuses on impaired gastric emptying, treatment options that affect gastric function are limited and often disappointing. The female predominance, the mostly idiopathic nature of the illness with a common history of abuse, and coexisting anxiety or depression show parallels with other functional disorders of the gastrointestinal tract. These parallels provided the rationale for some initial studies investigating alternative therapies that target the brain rather than the stomach. This emerging shift in medical therapy comes at a time when clinical studies suggest that gastric electrical stimulation may exert its effects by modulating visceral sensory processing rather than altering gastric motility. Physiologic and detailed anatomic investigations also support a more complex picture with different disease mechanisms, ranging from impaired accommodation to apparent visceral hypersensitivity or decreased interstitial cells of Cajal to inflammatory infiltration of myenteric ganglia. Delayed gastric emptying remains the endophenotype defining gastroparesis. However, our treatment options go beyond prokinetics and may allow us to improve the quality of life of affected individuals.
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Affiliation(s)
- Klaus Bielefeldt
- Division of Gastroenterology, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213, USA
- *Klaus Bielefeldt:
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91
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Heetun ZS, Quigley EMM. Gastroparesis and Parkinson's disease: a systematic review. Parkinsonism Relat Disord 2011; 18:433-40. [PMID: 22209346 DOI: 10.1016/j.parkreldis.2011.12.004] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Revised: 12/06/2011] [Accepted: 12/08/2011] [Indexed: 12/16/2022]
Abstract
Some of the gastrointestinal (GI) symptoms commonly experienced by patients with Parkinson's disease (PD) have been attributed to gastroparesis; however, the precise prevalence and relevance of gastric emptying delay in PD is unclear. The definition of gastroparesis varies; currently the most widely accepted definition (from the National Institute of Diabetes and Digestive and Kidney Diseases Gastroparesis Clinical Research Consortium) is the presence of appropriate symptoms (including nausea, retching, vomiting, stomach fullness, and inability to finish a meal) for ≥ 12 weeks, together with delayed gastric emptying on scintigraphy and the absence of any obstructive lesions on upper GI endoscopy. In PD patients, gastroparesis has the potential to affect nutrition and quality of life, as well as the absorption of PD medications, including L-dopa. This reduced absorption of L-dopa has implications for the control of the PD motor symptoms for which it is administered. We performed a systematic review of the literature on gastroparesis in PD with the aim of developing an evidence-based approach to its management. Based on this review, we conclude that while gastric emptying has been reported to be frequently delayed in PD, the existing data do not permit definitive conclusions concerning its true prevalence, relationship to the underlying disease process, relevance to PD management, or the optimal therapy of related GI symptoms. Further study of these important issues is, therefore, required.
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Affiliation(s)
- Zaid S Heetun
- Alimentary Pharmabiotic Centre, Department of Medicine, University College Cork, Cork, Ireland
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92
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Quigley EMM, O'Mahony S, Heetun Z. Motility disorders in the patient with neurologic disease. Gastroenterol Clin North Am 2011; 40:741-64. [PMID: 22100115 DOI: 10.1016/j.gtc.2011.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Gastrointestinal symptoms are common in the patient with chronic neurologic disease and may loom large in terms of impact on quality of life and on nutrition and mobility. A knowledge of the range of gastrointestinal disorders associated with a given neurologic disease, together with an understanding of the risks and benefits of various therapeutic options and approaches, should aid gastroenterologists in their efforts to contribute to the care of these patients. In most instances a multidisciplinary team (neurologist/neurosurgeon, gastroenterologist, nutritionist, therapist, specialist nurse) aware of the wishes and needs of the family and their carers and mindful of the nature and the natural history of the underlying disease process are best placed to assess and manage these problems.
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Affiliation(s)
- Eamonn M M Quigley
- Department of Medicine, Alimentary Pharmabiotic Centre, University College Cork, Cork, Ireland.
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93
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Lin Z, Sarosiek I, Forster J, Ross RA, Chen JD, McCallum RW. Two-channel gastric pacing in patients with diabetic gastroparesis. Neurogastroenterol Motil 2011; 23:912-e396. [PMID: 21806741 PMCID: PMC3217315 DOI: 10.1111/j.1365-2982.2011.01754.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Our primary goals were to investigate the effects of two-channel gastric pacing on gastric myoelectrical activity, and energy consumption with the secondary intent to monitor gastric emptying and symptoms in patients with severe diabetic gastroparesis. METHODS Four pairs of temporary pacing wires were inserted on the serosa of the stomach at the time of laparotomy to place the Enterra™ System in 19 patients with severe gastroparesis not responding to standard medical therapies. Two of the pairs were for electrical stimulation and the other two for recording. Five days after surgery the optimal pacing parameters for the entrainment of gastric slow waves in each patient were identified by serosal recordings. Two-channel gastric pacing was then initiated for 6 weeks using a newly developed external multi-channel pulse generator. Electrogastrogram (EGG), Total Symptom Score (TSS), and a 4-h gastric emptying test were assessed at baseline and after 6 weeks of active gastric pacing. Enterra™ device was turned OFF during the duration of this study. KEY RESULTS Two-channel gastric pacing at 1.1 times the intrinsic frequency entrained gastric slow waves and normalized gastric dysrhythmia. After 6 weeks of gastric pacing, tachygastria was decreased from 15 ± 3 to 5 ± 1% in the fasting state and from 10 ± 2 to 5 ± 1% postprandially (P < 0.05), mean TSS was reduced from 21.3 ± 1.1 to 7.0 ± 1.5 (P < 0.05) and mean 4-h gastric retention improved from 42 to 28% (P = 0.05). CONCLUSIONS & INFERENCES Two-channel gastric pacing is a novel treatment approach which is able to normalize and enhance gastric slow wave activity as well as accelerate gastric emptying in patients with diabetic gastroparesis with a goal safety profile.
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Affiliation(s)
- Zhiyue Lin
- University of Kansas Medical Center, Kansas City, KS
| | - Irene Sarosiek
- Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, TX
| | | | | | - Jiande D.Z. Chen
- Division of Gastroenterology, University of Texas Medical Branch, Galveston, TX
| | - Richard W. McCallum
- Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, TX
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94
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Gerson LB, Kahrilas PJ, Fass R. Insights into gastroesophageal reflux disease-associated dyspeptic symptoms. Clin Gastroenterol Hepatol 2011; 9:824-33. [PMID: 21699806 DOI: 10.1016/j.cgh.2011.05.015] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2011] [Revised: 04/28/2011] [Accepted: 05/11/2011] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Patients with GERD frequently report dyspeptic-like symptoms, including nausea, vomiting, early satiety, bloating, and belching. The purpose of this review was to define the epidemiology and underlying mechanisms for dyspeptic symptoms in GERD patients. METHODS We performed a systematic literature review to identify the prevalence of dyspeptic symptoms in GERD patients. We identified 2057 studies, and 37 studies (2%) met the entry criteria, including 17 articles describing the prevalence of dyspeptic symptoms in GERD subjects, 7 studies describing mechanistic evaluation of dyspeptic symptoms in GERD, 7 studies describing questionnaires used to measure dyspeptic symptoms, and 6 studies assessing the role of proton pump inhibitor therapy for dyspeptic symptoms associated with GERD. We used an evidence-based approach to assess the literature. RESULTS The median (± standard deviation) prevalence of GERD in 30,384 subjects from 8 studies conducted in Western countries was 30% ± 8% (range, 20%-40%). Dyspeptic symptoms were present in 38% ± 14% (range, 21%-63%) and were more frequent in patients with frequent GERD symptoms, compared with patients with intermittent or no GERD symptoms [Evidence B]. Patients with nonerosive disease had a higher prevalence of dyspeptic symptoms [Evidence B] in addition to a lower response to proton pump inhibitor therapy [Evidence A], compared with patients with erosive esophagitis. Epigastic pain, belching, bloating, and early satiety demonstrated improvement on PPI therapy [Evidence A], compared with symptoms of nausea and vomiting that did not improve [Evidence A]. Patients with dyspepsia were at risk for a subsequent new diagnosis of GERD [Evidence B]. Dyspeptic symptoms contributed significantly to the decrement in health-related quality of life associated with GERD. CONCLUSIONS Dyspeptic symptoms are common in GERD patients and impact health-related quality of life.
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Affiliation(s)
- Lauren B Gerson
- Stanford University School of Medicine, Stanford, California, USA.
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95
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96
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Hibbard ML, Dunst CM, Swanström LL. Laparoscopic and endoscopic pyloroplasty for gastroparesis results in sustained symptom improvement. J Gastrointest Surg 2011; 15:1513-9. [PMID: 21720926 DOI: 10.1007/s11605-011-1607-6] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Accepted: 06/20/2011] [Indexed: 02/06/2023]
Abstract
BACKGROUND Gastroparesis is a chronic digestive disorder with symptoms of nausea, vomiting, bloating, and abdominal pain resulting in a poor quality of life. Surgeons are increasingly asked to treat patients with gastroparesis as medical options have become limited due to safety concerns of many prokinetics. Surgical options include gastric stimulator implantation, sub-total gastrectomy, and pyloroplasty. We report our experience with minimally invasive pyloroplasty as sole surgical treatment for adult gastroparesis. MATERIALS AND METHODS A retrospective review of prospectively collected data of 28 patients who underwent minimally invasive pyloroplasty alone as treatment for gastroparesis from Jan 2007 to Sept 2010. Pre- and postoperative symptom severity score (SSS), gastric emptying scintigraphy (GES), and medication use were reviewed. RESULTS A laparoscopic Heineke-Mikulicz pyloroplasty was performed in 26 patients. A laparoscopic assisted, flexible trans-oral endoscopic circular stapled pyloroplasty was used in two patients. Prokinetic use was significantly reduced from 89% to 14% (p = <0.0001). The mean GES T1/2 decreased from 320 to 112 min (p = 0.001) and normalized in 71%. Significant improvements in the SSS were seen at 1 month for nausea (p = <0.0001), vomiting (p = <0.0001), bloating (p = 0.0023), abdominal pain (p = <0.0001), and gastroesophageal reflux disease (GERD) symptoms (p = 0.0143). Significant improvement persisted at 3 months for nausea (p = <0.0001), vomiting (p = <0.0001), bloating (p = 0.0004), abdominal pain (p = 0.0001) and GERD symptoms (p = 0.013). The average length of stay was 3.71 days. Overall, 83% of patients' indicated that they saw improvement at 1 month follow-up. CONCLUSION Minimally invasive pyloroplasty provides excellent outcomes for patients with gastroparesis and should be considered as a primary treatment along with diet and medications as it is effective and does not eliminate the option for additional surgical options in the future for refractory disease. With technological advancements, a totally endoscopic pyloroplasty may be a less invasive option.
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Affiliation(s)
- Michael L Hibbard
- Division of Gastrointestinal and Minimally Invasive Surgery, The Oregon Clinic, Portland, OR 97210, USA
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97
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Abstract
Gastroparesis is a prevalent condition that produces symptoms of delayed gastric emptying in the absence of physical blockage. The most common etiologies of gastroparesis are idiopathic, diabetic, and postsurgical disease, although some cases stem from autoimmune, paraneoplastic, neurologic or other conditions. Histologic examination of gastric tissues from patients with severe gastroparesis reveals heterogeneous and inconsistent defects in the morphology of enteric neurons, smooth muscle and interstitial cells of Cajal, and increased levels of inflammatory cells. Diagnosis is most commonly made by gastric emptying scintigraphy; however, wireless motility capsules and nonradioactive isotope breath tests have also been validated. A range of treatments have been used for gastroparesis including dietary modifications and nutritional supplements, gastric motor stimulatory or antiemetic medications, endoscopic or surgical procedures, and psychological interventions. Most treatments have not been subjected to controlled testing in patients with gastroparesis. The natural history of this condition is poorly understood. Active ongoing research is providing important insights into the pathogenesis, diagnosis, treatment and outcomes of this disease.
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Affiliation(s)
- William L Hasler
- Division of Gastroenterology, University of Michigan Hospital, 3912 Taubman Center, Ann Arbor, MI 5362, USA.
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98
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Stanghellini V. Unfulfilled wishes by gastric electrical stimulation. Clin Gastroenterol Hepatol 2011; 9:447-8; author reply 448-9. [PMID: 21238610 DOI: 10.1016/j.cgh.2011.01.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2010] [Accepted: 01/03/2011] [Indexed: 02/07/2023]
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99
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Song J, Zhong DX, Qian W, Hou XH, Chen JDZ. Short pulse gastric electrical stimulation for cisplatin-induced emesis in dogs. Neurogastroenterol Motil 2011; 23:468-74, e178. [PMID: 21362107 DOI: 10.1111/j.1365-2982.2011.01684.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND In a previous study, we investigated the ameliorating effect of gastric electrical stimulation (GES) with a single set of parameters on emesis and behaviors suggestive of nausea induced by cisplatin in dogs. The aim of this study was to investigate the effects of GES with different parameters on cisplatin-induced emesis in dogs. METHODS Seven dogs implanted with gastric serosal electrodes were studied in six randomized sessions: one control session with cisplatin (2 mg kg(-1)) and five sessions with cisplatin plus GES of different parameters: GES-A: 14 Hz, 5 mA, 0.3 ms, 0.1 s on and 5 s off; GES-B: increased frequency and on-time; GES-C: increased frequency; GES-D: increased frequency and pulse width; and GES-E: increased frequency and amplitude. Gastric slow waves and emetic responses were recorded in each session. KEY RESULTS (i) Cisplatin induced emetic responses and gastric dysrhythmia. The peak time of the emetic response was during the fourth hour after cisplatin. (ii) GES with appropriate parameters reduced cisplatin-induced emesis. The number of vomiting times during the 6 h after cisplatin was 7.0 ± 1.4 in the control, 4.7 ± 1.2 with GES-A (P = 0.179), 4.2 ± 1.2 with GES-B (P = 0.109), 7.0 ± 0.8 with GES-C (P = 0.928), 2.1 ± 0.3 with GES-D (P = 0.005) and 4.7 ± 1.5 with GES-E (P = 0.129). However, none of the GES parameters could improve gastric dysrhythmia. CONCLUSIONS & INFERENCES Gastric electrical stimulation with appropriate parameters reduces cisplatin-induced emetic responses and behaviors suggestive of nausea in dogs. Among the tested parameters, GES with increased pulse width seems to produce better relief of cisplatin-induced emesis.
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Affiliation(s)
- J Song
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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100
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Kopelman Y, Triadafilopoulos G. Endoscopy in the diagnosis and management of motility disorders. Dig Dis Sci 2011; 56:635-54. [PMID: 21286936 DOI: 10.1007/s10620-011-1584-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Accepted: 01/14/2011] [Indexed: 12/14/2022]
Abstract
BACKGROUND Gastrointestinal illness may result from either an underlying structural abnormality (e.g. neoplastic obstruction), or a functional disorder (e.g. motor diarrhea), or both (e.g. achalasia with squamous esophageal cancer). AIMS The purpose of this study was to highlight the potential value and role of endoscopy in the recognition and management of patients with functional and motility disorders. METHODS We performed a literature review in PubMed. RESULTS Diagnostic and therapeutic endoscopy may be under-used by motility-oriented gastroenterologists; in contrast, motility and other functional studies may be under-used by endoscopists. Yet, many areas of cross-exchange exist. CONCLUSIONS This review aims to guide the appropriate indications for the use of endoscopy in diagnosing and treating functional GI and motility disorders and serve as a bridge and a forum of exchange between endoscopists and motility specialists.
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Affiliation(s)
- Yael Kopelman
- Stanford University School of Medicine, Stanford, CA, USA
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