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Cheng LK, Li L, Bonaz B, Chen JDZ. Editorial: Translational Side of Emerging Invasive and Non-invasive Stimulation Therapies. Front Neurosci 2022; 16:872551. [PMID: 35401080 PMCID: PMC8984023 DOI: 10.3389/fnins.2022.872551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 02/21/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Leo K. Cheng
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Luming Li
- National Engineering Laboratory for Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, China
| | - Bruno Bonaz
- Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Jiande D. Z. Chen
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, United States
- *Correspondence: Jiande D. Z. Chen
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Debelle A, Hesta M, de Rooster H, Bianchini E, Vanhoestenberghe A, Stock E, Vanderperren K, Polis I, Smets H, Cury J, Acuña V, Delchambre A, Innocenti B, Devière J, Nonclercq A. Impact of adaptive gastric electrical stimulation on weight, food intake, and food intake rate in dogs. Artif Organs 2021; 46:1055-1067. [PMID: 34932224 DOI: 10.1111/aor.14156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/04/2021] [Accepted: 12/07/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Gastric electrical stimulation (GES) has been studied for decades as a promising treatment for obesity. Stimulation pulses with fixed amplitude and pulse width are usually applied, but these have limitations with regard to overcoming habituation to GES and inter-subject variation. This study aims to analyze the efficacy of an adaptive GES protocol for reducing food intake and maintaining lean weight in dogs. METHODS Six beagle dogs were implanted with a remotely programmable gastric stimulator. An adaptive protocol was designed to increase the stimulation energy proportionally to the excess of food consumption, with respect to the dogs' maintenance energy requirements. After surgery and habituation to experimental conditions, the dogs went through both a control and a stimulation period of 4 weeks each, in a randomized order. The stimulation parameters were adapted daily. Body weight, food intake, food intake rate, and postprandial cutaneous electrogastrograms (EGG) were recorded to assess the effect of adaptive GES. RESULTS Adaptive GES decreased food intake and food intake rate (p < 0.05) resulting in weight maintenance. In the absence of GES, the dogs gained weight (p < 0.05). Postprandial EGG dominant frequency was accelerated by GES (p < 0.05). The strategy of adapting the stimulation energy was effective in causing significant mid-term changes. CONCLUSION Adaptive GES is effective for reducing food intake and maintaining lean weight. The proposed adaptive strategy may offer benefits to counter habituation and adapt to inter-subject variation in clinical use of GES for obesity.
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Affiliation(s)
- Adrien Debelle
- Bio, Electro and Mechanical Systems Department, Ecole polytechnique de Bruxelles, Université libre de Bruxelles, Brussels, Belgium
| | - Myriam Hesta
- Department of Veterinary Medical Imaging and Small Animal Orthopedics, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Hilde de Rooster
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Erika Bianchini
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Anne Vanhoestenberghe
- Aspire Centre for Rehabilitation Engineering and Assistive Technology, Department of Materials and Tissue, University College London, Stanmore, UK
| | - Emmelie Stock
- Department of Veterinary Medical Imaging and Small Animal Orthopedics, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Katrien Vanderperren
- Department of Veterinary Medical Imaging and Small Animal Orthopedics, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Ingeborgh Polis
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Hugo Smets
- Bio, Electro and Mechanical Systems Department, Ecole polytechnique de Bruxelles, Université libre de Bruxelles, Brussels, Belgium
| | - Joaquin Cury
- Bio, Electro and Mechanical Systems Department, Ecole polytechnique de Bruxelles, Université libre de Bruxelles, Brussels, Belgium
| | - Vicente Acuña
- Bio, Electro and Mechanical Systems Department, Ecole polytechnique de Bruxelles, Université libre de Bruxelles, Brussels, Belgium
| | - Alain Delchambre
- Bio, Electro and Mechanical Systems Department, Ecole polytechnique de Bruxelles, Université libre de Bruxelles, Brussels, Belgium
| | - Bernardo Innocenti
- Bio, Electro and Mechanical Systems Department, Ecole polytechnique de Bruxelles, Université libre de Bruxelles, Brussels, Belgium
| | - Jacques Devière
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Antoine Nonclercq
- Bio, Electro and Mechanical Systems Department, Ecole polytechnique de Bruxelles, Université libre de Bruxelles, Brussels, Belgium
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3
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Managing motility disorders of the gastrointestinal segment and obesity through electrical stimulation. HEALTH AND TECHNOLOGY 2021. [DOI: 10.1007/s12553-021-00590-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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4
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Paulus GF, van Avesaat M, van Rijn S, Alleleyn AME, Swain JM, Abell TL, Williams DB, Bouvy ND, Masclee AAM. Multicenter, Phase 1, Open Prospective Trial of Gastric Electrical Stimulation for the Treatment of Obesity: First-in-Human Results with a Novel Implantable System. Obes Surg 2021; 30:1952-1960. [PMID: 32133590 PMCID: PMC7228902 DOI: 10.1007/s11695-020-04422-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background and Aims To assess safety of the Exilis™ gastric electrical stimulation (GES) system and to investigate whether the settings can be adjusted for comfortable chronic use in subjects with morbid obesity. Gastric emptying and motility and meal intake were evaluated. Method In a multicenter, phase 1, open prospective cohort study, 20 morbidly obese subjects (17 female, mean BMI of 40.8 ± 0.7 kg/m2) were implanted with the Exilis™ system. Amplitude of the Exilis™ system was individually set during titration visits. Subjects underwent two blinded baseline test days (GES ON vs. OFF), after which long-term, monthly follow-up continued for up to 52 weeks. Results The procedure was safe, and electrical stimulation was well tolerated and comfortable in all subjects. No significant differences in gastric emptying halftime (203 ± 16 vs. 212 ± 14 min, p > 0.05), food intake (713 ± 68 vs. 799 ± 69 kcal, p > 0.05), insulin AUC (2448 ± 347 vs. 2186 ± 204, p > 0.05), and glucose AUC (41 ± 2 vs.41 ± 2, p > 0.05) were found between GES ON and OFF. At week 4, 13, and 26, a significant (p < 0.01) reduction in weight loss was observed but not at week 52. At this time point, the mean excess weight loss (EWL) was 14.2 ± 4.5%. Conclusion Gastric electrical stimulation with the Exilis™ system can be considered as safe. No significant effect on food intake, gastric emptying, or gastric motility was observed. The reduction in weight loss with Exilis™ GES was significant but short lasting. Further electrophysiological research is needed to gain more insight in optimal stimulation parameters and lead localization.
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Affiliation(s)
- G F Paulus
- Department of General Surgery, NUTRIM, Maastricht University Medical Center, Maastricht, The Netherlands.
- Department of General Surgery, Spaarne Gasthuis, Haarlem / Hoofddorp, Netherlands.
| | - M van Avesaat
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, NUTRIM, Maastricht University Medical Center, Maastricht, The Netherlands
| | - S van Rijn
- Department of General Surgery, NUTRIM, Maastricht University Medical Center, Maastricht, The Netherlands
| | - A M E Alleleyn
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, NUTRIM, Maastricht University Medical Center, Maastricht, The Netherlands
| | - J M Swain
- HonorHealth Bariatric Center, Scottsdale, AZ, USA
| | - T L Abell
- Division of Gastroenterology, Hepatology, and Nutrition, University of Louisville, Louisville, KY, USA
| | - D B Williams
- Vanderbilt Center for Surgical Weight Loss, Vanderbilt University Medical Center, Nashville, TN, USA
| | - N D Bouvy
- Department of General Surgery, NUTRIM, Maastricht University Medical Center, Maastricht, The Netherlands
| | - A A M Masclee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, NUTRIM, Maastricht University Medical Center, Maastricht, The Netherlands
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6
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Carrano FM, Peev MP, Saunders JK, Melis M, Tognoni V, Di Lorenzo N. The Role of Minimally Invasive and Endoscopic Technologies in Morbid Obesity Treatment: Review and Critical Appraisal of the Current Clinical Practice. Obes Surg 2019; 30:736-752. [DOI: 10.1007/s11695-019-04302-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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7
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Jang Y, Kim SM, Kim KJ, Sim HJ, Kim BJ, Park JW, Baughman RH, Ruhparwar A, Kim SJ. Self-Powered Coiled Carbon-Nanotube Yarn Sensor for Gastric Electronics. ACS Sens 2019; 4:2893-2899. [PMID: 31525897 DOI: 10.1021/acssensors.9b01180] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The strong peristaltic contraction of the stomach facilitates mixing and emptying of ingested food, which occurs rhythmically at approximately 3 cycles/min (cpm) in humans. Generally, most patients with gastroparesis show gastric electrical dysrhythmia that is disrupted electrical signals controlling gastric contractions. For treatment of gastric electrical dysrhythmia, in vivo electrical impulses to the stomach via an implanted gastric stimulator have been known to restore these gastric deformations. Nevertheless, improved sensors to monitor gastric contractions are still needed in current gastric stimulators. Recently, we have developed a new technology converting mechanical motion to electrical energy by using stretch-induced capacitance changes of a coiled carbon-nanotube (CNT) yarn. For its potential use as a gastric deformation sensor, the performance of a coiled CNT yarn was evaluated in several biological fluids. For a sinusoidal stretch to 30%, the peak-to-peak open-circuit voltage (OCV) was consistently generated at frequencies below 0.1 Hz. This sinusoidal variation in OCV augmented as the strain increased from 10 to 30%. In an in vitro artificial gastric system, the OCV was approximately linearly proportional to the balloon volume, which can monitor periodic deformations of the balloon at 2, 3, and 4 cpm as shown for human gastric deformations. Moreover, stretchy coiled yarns generate the peak electrical voltage and power when deformed. The present study shows that a self-powered CNT yarn sensor can not only monitor the changes in frequency and amplitude of volumetric change but also generate electrical power by periodic deformations of the balloon. Therefore, it seems possible to automatically deliver accurate electrical impulses according to real-time evaluation of a patient's gastric deformation based on information on the frequency, amplitude, and rate of the OCV from CNT yarn.
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Affiliation(s)
| | | | | | | | | | | | - Ray H. Baughman
- Alan G. MacDiarmid NanoTech Institute, University of Texas at Dallas, Richardson, Texas 75083, United States
| | - Arjang Ruhparwar
- Department of Cardiac Surgery, Heart Center, University Hospital Heidelberg, Heidelberg 69120, Germany
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Maisiyiti A, Chen JDZ. Systematic review on gastric electrical stimulation in obesity treatment. Expert Rev Med Devices 2019; 16:855-861. [PMID: 31570014 PMCID: PMC6946629 DOI: 10.1080/17434440.2019.1673728] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 09/24/2019] [Indexed: 12/16/2022]
Abstract
Introduction: Obesity is a very common public health problem worldwide. However, there is a lack of effective therapies. Only a small portion of patients with morbid obesity are accepting bariatric surgery as the last option due to the risks associated with invasive therapy. Areas covered: In this paper, we review an emerging weight loss treatment: gastric electrical stimulation (GES). The feasibility of GES as a potential therapy for obesity is introduced. Methodologies and parameters of GES are presented. Several GES methods for treating obesity and their effects on food intake and body weight are presented. Possible mechanisms involved in the anti-obesity effect of GES are discussed. Finally, our comments on the potential of GES for obesity and expectations for future development of the GES therapy are provided. The PubMed central database was searched from inception to May 2019. The literature search used the following terms: 'Gastric electrical stimulation' combined with 'obesity' and 'Implantable gastric stimulation' and 'pharmaceutical therapy' and 'bariatric surgery'. Expert opinion: There is a potential to use GES for treating obesity. However, more efforts are needed to develop appropriate stimulation devices and to design an adequate therapy for treating obesity in humans.
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Affiliation(s)
- Alimujiang Maisiyiti
- Department of Minimally Invasive Surgery, Hernias and Abdominal Wall Surgery, People’s Hospital of Xinjiang Uyghur Autonomous Region, Urumqi, 830001, China
| | - Jiande DZ Chen
- Division of Gastroenterology and Hepatology, University of Johns Hopkins School of Medicine, Baltimore, MD, USA
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Prologo JD, Lin E, Horesh Bergquist S, Knight J, Matta H, Brummer M, Singh A, Patel Y, Corn D. Percutaneous CT-Guided Cryovagotomy in Patients with Class I or Class II Obesity: A Pilot Trial. Obesity (Silver Spring) 2019; 27:1255-1265. [PMID: 31339003 DOI: 10.1002/oby.22523] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 04/13/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVE This study evaluated the safety of percutaneous CT-guided cryoablation of the vagus nerve (percutaneous cryovagotomy) in participants with class I or class II obesity. METHODS The study was an open-label, single-group, prospective pilot investigation designed around safety-related stopping criteria. Twenty participants with 30 > BMI > 37 underwent percutaneous cryovagotomy with follow-up visits at day 7, 45, 90, and 180. Data related to adverse events, technical success, weight loss, quality of life, dietary intake, global impressions of hunger change, activity, and body composition were analyzed. RESULTS The procedural technical success rate was 100%. There were no adverse events in 19 participants who completed the trial. Ninety-five percent of patients reported decreased appetite following the procedure, and reductions in mean absolute weight and BMI were observed at all time points. The mean quality of life and activity scores improved from baseline to 6 months post procedure, and mean caloric intake and overall body fat decreased over the same period. CONCLUSIONS Percutaneous CT-guided cryovagotomy is feasible and was tolerated without complications or adverse events in this cohort. Quantitative preliminary data from this pilot investigation inform the design of a larger prospective randomized clinical trial.
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Affiliation(s)
- J David Prologo
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Edward Lin
- Division of General and Gastrointestinal Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Jackie Knight
- Department of Radiology and Imaging Sciences, Emory Healthcare, Atlanta, Georgia, USA
| | - Hazem Matta
- Radiology Regional Center, Fort Myers, Florida, USA
| | - Marjin Brummer
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Arvinpal Singh
- Division of Bariatric Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Yogi Patel
- Department of Bioengineering and Neuroengineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - David Corn
- Department of Periodontics and Endodontics, The State University of New York, Buffalo, New York, USA
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Berthoud HR, Neuhuber WL. Vagal mechanisms as neuromodulatory targets for the treatment of metabolic disease. Ann N Y Acad Sci 2019; 1454:42-55. [PMID: 31268181 PMCID: PMC6810744 DOI: 10.1111/nyas.14182] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 05/23/2019] [Accepted: 06/05/2019] [Indexed: 12/30/2022]
Abstract
With few effective treatments available, the global rise of metabolic diseases, including obesity, type 2 diabetes mellitus, and cardiovascular disease, seems unstoppable. Likely caused by an obesogenic environment interacting with genetic susceptibility, the pathophysiology of obesity and metabolic diseases is highly complex and involves crosstalk between many organs and systems, including the brain. The vagus nerve is in a key position to bidirectionally link several peripheral metabolic organs with the brain and is increasingly targeted for neuromodulation therapy to treat metabolic disease. Here, we review the basics of vagal functional anatomy and its implications for vagal neuromodulation therapies. We find that most existing vagal neuromodulation techniques either ignore or misinterpret the rich functional specificity of both vagal efferents and afferents as demonstrated by a large body of literature. This lack of specificity of manipulating vagal fibers is likely the reason for the relatively poor beneficial long‐term effects of such therapies. For these therapies to become more effective, rigorous validation of all physiological endpoints and optimization of stimulation parameters as well as electrode placements will be necessary. However, given the large number of function‐specific fibers in any vagal branch, genetically guided neuromodulation techniques are more likely to succeed.
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Affiliation(s)
- Hans-Rudolf Berthoud
- Neurobiology of Nutrition and Metabolism Department, Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, Louisiana
| | - Winfried L Neuhuber
- Institut fur Anatomie und Zellbiologie, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
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Payne SC, Furness JB, Stebbing MJ. Bioelectric neuromodulation for gastrointestinal disorders: effectiveness and mechanisms. Nat Rev Gastroenterol Hepatol 2019; 16:89-105. [PMID: 30390018 DOI: 10.1038/s41575-018-0078-6] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The gastrointestinal tract has extensive, surgically accessible nerve connections with the central nervous system. This provides the opportunity to exploit rapidly advancing methods of nerve stimulation to treat gastrointestinal disorders. Bioelectric neuromodulation technology has considerably advanced in the past decade, but sacral nerve stimulation for faecal incontinence currently remains the only neuromodulation protocol in general use for a gastrointestinal disorder. Treatment of other conditions, such as IBD, obesity, nausea and gastroparesis, has had variable success. That nerves modulate inflammation in the intestine is well established, but the anti-inflammatory effects of vagal nerve stimulation have only recently been discovered, and positive effects of this approach were seen in only some patients with Crohn's disease in a single trial. Pulses of high-frequency current applied to the vagus nerve have been used to block signalling from the stomach to the brain to reduce appetite with variable outcomes. Bioelectric neuromodulation has also been investigated for postoperative ileus, gastroparesis symptoms and constipation in animal models and some clinical trials. The clinical success of this bioelectric neuromodulation therapy might be enhanced through better knowledge of the targeted nerve pathways and their physiological and pathophysiological roles, optimizing stimulation protocols and determining which patients benefit most from this therapy.
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Affiliation(s)
- Sophie C Payne
- Bionics Institute, East Melbourne, Victoria, Australia. .,Medical Bionics Department, University of Melbourne, Parkville, Victoria, Australia.
| | - John B Furness
- Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia.,Department of Anatomy and Neuroscience, University of Melbourne, Parkville, Victoria, Australia
| | - Martin J Stebbing
- Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia.,Department of Anatomy and Neuroscience, University of Melbourne, Parkville, Victoria, Australia
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Abstract
OPINION STATEMENT Diabetes mellitus (DM) and its associated complications are becoming increasingly prevalent. Gastrointestinal symptoms associated with diabetes is known as diabetic enteropathy (DE) and may manifest as either diarrhea, fecal incontinence, constipation, dyspepsia, nausea, and vomiting or a combination of symptoms. The long-held belief that vagal autonomic neuropathy is the primary cause of DE has recently been challenged by newer theories of disease development. Specifically, hyperglycemia and the resulting oxidative stress on neural networks, including the nitrergic neurons and interstitial cells of Cajal (ICC), are now believed to play a central role in the development of DE. DE occurs in the majority of patients with diabetes; however, tools for early diagnosis and targeted therapy to counter the detrimental and potentially irreversible effects on the small bowel are lacking. Delay in diagnosis is further compounded by the fact that DE symptoms overlap with those of gastroparesis or can be confused with side effects from diabetes medications. Still, early recognition of the presence of DE is essential to mitigating symptoms and preventing further progression of complications including dysmotility and malabsorption. Current diagnostic modalities include manometry, wireless motility capsule (SmartPill™), and scintigraphy; however, these are not regularly utilized in clinical practice due to limited availability. Several medications are available for symptom relief in DE patients including rifaximin for small intestinal bacterial overgrowth (SIBO) and somatostatin analogues for diarrhea. While rodent models on stem cell therapy and alteration of the microbiome are promising, there is still a great need for further research on the pathologic underpinnings and development of novel treatment modalities for DE.
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Affiliation(s)
- Jonathan Gotfried
- Temple University Digestive Disease Center, Temple University Hospital, Philadelphia, PA, USA
| | - Stephen Priest
- Temple University Lewis Katz School of Medicine at Temple University & Temple University Health System, Philadelphia, PA, USA
| | - Ron Schey
- Temple University Digestive Disease Center, Temple University Hospital, Philadelphia, PA, USA. .,Temple University Lewis Katz School of Medicine at Temple University & Temple University Health System, Philadelphia, PA, USA.
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Abstract
Obesity is a major public health concern that leads to numerous metabolic, mechanical and psychological complications. Although lifestyle interventions are the cornerstone of obesity management, subsequent physiological neurohormonal adaptations limit weight loss, strongly favour weight regain and counteract sustained weight loss. A range of effective therapies are therefore needed to manage this chronic relapsing disease. Bariatric surgery delivers substantial, durable weight loss but limited access to care, perceived high risks and costs restrict uptake. Medical devices are uniquely positioned to bridge the gap between more conservative lifestyle intervention and weight-loss pharmacotherapy and more disruptive bariatric surgery. In this Review, we examine the range of gastrointestinal medical devices that are available in clinical practice to treat obesity, as well as those that are in advanced stages of development. We focus on the mechanisms of action as well as the efficacy and safety profiles of these devices. Many of these devices are placed endoscopically, which provides gastroenterologists with exciting opportunities for treatment.
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Koch CA, Bornstein SR, Birkenfeld AL. Introduction to Hanefeld Symposium: 40+ years of metabolic syndrome. Rev Endocr Metab Disord 2016; 17:1-4. [PMID: 27165257 DOI: 10.1007/s11154-016-9356-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
| | - Stefan R Bornstein
- Medizinische Klinik III, Universitätsklinikum Carl Gustav Carus TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany
- Section of Diabetes and Nutritional Sciences, Rayne Institute, Denmark Hill Campus, King's College London, London, UK
| | - Andreas L Birkenfeld
- Medizinische Klinik III, Universitätsklinikum Carl Gustav Carus TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
- Section of Diabetes and Nutritional Sciences, Rayne Institute, Denmark Hill Campus, King's College London, London, UK.
- Competence Center Metabolic Vascular Medicine Prof. Hanefeld, GWT-TUD, Dresden, Germany.
- German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany.
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