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Gastric Electrical Stimulation (gastric + electrical_stimulation)

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Medical Sciences	100%

Selected Abstracts

Review article: gastric electrical stimulation for gastroparesis , physiological foundations, technical aspects and clinical implications

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 7 2009
E. SOFFER
Summary Background, Application of electrical stimulation to the gut, primarily the stomach, has rapidly advanced in the last two decades, from mostly animal studies to the clinical arena. Most studies focused on the use of electrical stimulation for gastroparesis, the only approved indication for such intervention. Aim, To review the physiological basis of gastric electrical activity and the technical aspects and clinical outcome of gastric electrical stimulation (GES) for gastroparesis. Methods, PubMed search from 1966 to 2009, using gastroparesis and GES as search terms. Areas in focus were systematically reviewed. Results, The literature consists of open-label studies, mostly from single centres, published in the last decade. Improvement in symptoms, quality of life and nutritional status was reported by most studies. Physiologically, stimulation parameters approved in clinical practice do not regulate gastric slow wave activity and have inconsistent effect on gastric emptying. The mechanism of action of GES is not fully known, but data support modulation of gastric biomechanical activity and afferent neural mechanisms. Conclusions, Gastric electrical stimulation is a helpful intervention in recalcitrant gastroparesis. Controlled studies and better understanding of mechanisms of action of electrical stimulation are needed to evaluate further the clinical utility of this intervention and to exploit its therapeutic potential better. [source]

Systematic review: applications and future of gastric electrical stimulation

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 7 2006
J. ZHANG
Summary Background, Over the past 20 years, gastric electrical stimulation has received increasing attention among researchers and clinicians. Aim, To give a systematic review on the effects, mechanisms and applications of gastric electrical stimulation. Methods, Medline was used to identify the articles to be included in this review. Key words used for the search included gastric electrical stimulation, gastric pacing, electrical stimulation, stomach, gastrointestinal motility, central nervous system, gastroparesis, nausea and vomiting; obesity and weight loss. Combinational uses of these keywords were made to identify relevant articles. Most of the articles included in this review ranged from 1985 to 2006. Results, Based on the general search, the review was structured as follows: (i) peripheral and central effects and mechanisms of gastric electrical stimulation; (ii) clinical applications of gastric electrical stimulation for gastroparesis and obesity and (iii) future development of gastric electrical stimulation. Conclusions, Great progress has been made during the past decades. Gastric electrical stimulation has been shown to be effective in normalizing gastric dysrhythmia, accelerating gastric emptying and improving nausea and vomiting. Implantable device has been made available for treating gastroparesis as well as obesity. However, development of a new device and controlled clinical studies are required to further prove clinical efficacy of gastric electrical stimulation. [source]

An energy algorithm improves symptoms in some patients with gastroparesis and treated with gastric electrical stimulation

NEUROGASTROENTEROLOGY & MOTILITY, Issue 4 2006
N. Abidi
Abstract, Gastric electrical stimulation (GES) is effective to improve symptoms of nausea and vomiting in most patients, but very little is known about the effect of varying stimulation parameters. We analysed stimulation parameters in a pilot study of 22 patients (12 idiopathic, four diabetic and four postsurgical) with drug-refractory gastroparesis who did not respond optimally to initial settings. Patients underwent high-frequency/lowenergy GES using identical initial stimulation parameters: 5 mA of current, 330 ,s pulse width, 14 Hz for 0.1 s on and 5.0 s off. Due to lack on optimal response, 22 patients underwent alteration of an algorithm using stimulation parameters. At follow-up (mean of 4.3 years) a dose,response relationship for charge, power and energy were compared with baseline for the whole group and for each diagnostic subgroup by anovadata are reported as mean ± SE. Based on the mean of individual dose,response curves, differences in data are charge, current per pulse and energy per pulse were noted for the whole group at follow up vs baseline. The subgroup of patients with postsurgical gastroparesis required the most energy using the algorithm. In conclusion, an algorithmic approach to identify optimal stimulation parameters in GES for individual patients is associated with symptom improvement. Also, certain subgroups appear to have different energy parameters. Based on this preliminary data, the use of an algorithm for some patients with GES is feasible and may have potential for clinical application. A randomized-controlled trial of different stimulation parameters for GES seems warranted. [source]

Review article: gastric electrical stimulation for gastroparesis , physiological foundations, technical aspects and clinical implications

Systematic review: applications and future of gastric electrical stimulation

Association of the status of interstitial cells of Cajal and electrogastrogram parameters, gastric emptying and symptoms in patients with gastroparesis

NEUROGASTROENTEROLOGY & MOTILITY, Issue 1 2010
Z. Lin
Abstract, Our goal was to investigate associations between the status of interstitial cells of Cajal (ICC) and electrogastrogram (EGG) parameters, gastric emptying and symptoms in a large cohort of patients with gastroparesis. Forty-one patients with refractory gastroparesis who were referred for gastric electrical stimulation (GES) underwent full thickness gastric (antrum) biopsy during the surgery to place the GES device. The biopsy samples were stained with c-kit and scored for the presence of ICC based on criteria obtained from 10 controls. All patients underwent EGG recordings, a 4-h standardized scintigraphic gastric emptying study and symptom assessment prior to the surgery. Based on antral biopsy, 15 patients (36%) had almost no ICC (ICC, group) and 26 patients had adequate cell numbers (ICC+ group). EGG recordings in the ICC, group displayed significantly less normal slow waves than in the ICC+ group both in the fasting and fed states. Tachygastria in the ICC, group was significantly more than in the ICC+ group both in the fasting (32 ± 8%vs 11 ± 2%) and fed states (27 ± 9%vs 12 ± 2%). There was no statistical difference in gastric emptying, symptom severity of gastroparesis, aetiology, age and gender between the two groups. Severely depleted ICC occurs in up to 36% of gastroparetic patients and significantly correlates with an abnormal EGG. Severely depleted ICC does not correlate with the severity of gastroparesis as assessed by gastric emptying or symptom status but did result in a poorer symptomatic response to GES. These data suggest that the EGG may have a role for predicting ICC status during clinical evaluation of gastroparetic patients. [source]

Methods of gastric electrical stimulation and pacing: a review of their benefits and mechanisms of action in gastroparesis and obesity

NEUROGASTROENTEROLOGY & MOTILITY, Issue 3 2009
W. L. Hasler
Abstract, Development of gastric electrical stimulation techniques for treatment of gastric dysmotility syndromes and obesity has been a long-standing goal of investigators and clinicians. Depending on stimulus parameters and sites of stimulation, such methods have a range of theoretical benefits including entrainment of intrinsic gastric electrical activity, eliciting propagating contractions and reducing symptomatology in patients with gastroparesis and reducing appetite and food intake in individuals with morbid obesity. Additionally, gastric stimulation parameters have extragastrointestinal effects including alteration of systemic hormonal and autonomic neural activity and modulation of afferent nerve pathways projecting to the central nervous system that may represent important mechanisms of action. Numerous case series and smaller numbers of controlled trials suggest clinical benefits in these two conditions, however better controlled trials are mandated to confirm their efficacy. Current research is focusing on novel stimulation methods to better control symptoms in gastroparesis and promote weight reduction in morbid obesity. [source]

12 Effects of synchronized intestinal electrical stimulation on small intestinal motility in dogs

NEUROGASTROENTEROLOGY & MOTILITY, Issue 6 2006
J YIN
Our previous studies showed that synchronized gastric electrical stimulation enhanced antral contractions, accelerated gastric emptying in dogs. It has never been reported whether synchronized electrical stimulation could improve small intestinal motility. The aim of this study was to investigate the effects of synchronized intestinal electrical stimulation (SIES) on small bowel motility in both fasting and fed states in dogs. Methods:, Five healthy female dogs (18,24 kg) were equipped with a duodenal cannula for the measurement of small bowel motility using manometry. Two pairs of bipolar electrodes were implanted on the small intestinal serosa with an interval of 25 cm; the first one was 10 cm beyond the pylorus and used for stimulation. The experiment was consisted of four sessions in each dog with a randomized order. In the fasting state, 20 min after occurrence of phase III, SIES was initiated and maintained for 45 min, small bowel motility was recorded during the entire experiment, and no stimulation was performed in the control session. In other two sessions, dogs were fed with solid meal at the beginning of the experiment; glucagon (0.1 mg kg1) was injected 20 min after feeding, SIES was initiated at the same time for 20 min followed by 20 min recovery period. The stimulus was composed of train of pulses with on-time of 0.5 s, frequency of 20 Hz, pulse width of 2 ms and amplitude of 4 mA. Results:, 1). In the fasting state, SIES induced small intestinal contractions during phase I. The motility index was 5.2 ± 0.6 in the control session and significantly increased to 10.3 ± 0.7 with SIES (P = 0.003). 2). In the fed state, glucagon substantially and significantly inhibited small intestinal motility. The motility index was 11.3 ± 0.7 after feeding and reduced to 3.4 ± 0.5 with glucagon injection (P < 0.001). SIES significantly enhanced glucagon-induced small intestinal postprandial hypomotility. The motility index was 3.4 ± 0.5 in the control session and increased to 6.0 ± 0.3 with the presence of SIES (P = 0.03). Conclusions:, Intestinal electrical stimulation synchronized with intestinal slow waves induces intestinal contractions during phase I and enhanced small intestinal postprandial hypomotility induced by glucagon. SIES may have the therapeutic potential for treating small intestinal motility disorders. (Supported by a grant from American Diabetes Association). [source]

47 Effects of retrograde gastric electrical stimulation on gastric motility and plasma hormones in dogs

NEUROGASTROENTEROLOGY & MOTILITY, Issue 6 2006
G SONG
Aims:, The aim of this study was to investigate the effect of different parameters of RGES with trains of long pulses in turning gastric slow waves into tachygastria, and evaluate the effects of RGES with the efficient trains of pulses on gastric slow waves, gastric emptying of solids and plasma concentrations of satiety-related peptides and glucose. Methods:, Seven female dogs implanted with four pairs of gastric electrodes were studied in two experiments. The first experiment included a series of sessions with different pacing parameters in the fasting state, each lasting 10 min. The second experiment included two randomized sessions (control and RGES). Gastric emptying of solid was measured by scintigraphy for a period of 4 h. Blood samples were collected at 45 and 15 min before, 30, 60 and 120 min after the meal. Plasma leptin, insulin and glucagon were measured using radioimmunoassay method. Plasma glucose was assessed with a commercially available glucometer. RGES was applied via the distal pair of electrodes (2 cm above the pylorus) with trains of pulses. RGES was initiated 30 min before the first blood sample and maintained for a period of 2.5 h. Gastric slow waves and symptomatic response were also recorded in each session. Results:, (1) RGES with pulse trains (12 trains/min) was able to turn regular gastric slow waves into tachygastria. (2) RGES with the efficient parameters (frequency: 40 Hz; pulse width: 2 ms; amplitude: 5 mA; train on-time, 2 s; off-time, 3 s) was capable of delaying gastric emptying of solids (P < 0.05). (3) Compared with the control session without RGES, the total AUC's of plasma insulin with RGES was significantly decreased in the fasting and postprandial periods (p < 0.05). However, the total area under curves (AUC's) of plasma leptin, glucagon, and glucose were not significantly affected by RGES (p > 0.05). (4) This method of GES induced no noticeable symptoms. Conclusion:, RGES with at a tachygastrial frequency decreases gastric emptying of solids and plasma insulin, but has no effects on plasma leptin, glucagons, and glucose. [source]

Efficacy and efficiency of gastric electrical stimulation with short pulses in the treatment of vasopressin-induced emetic responses in dogs

NEUROGASTROENTEROLOGY & MOTILITY, Issue 5 2006
G. Song
Abstract, The aim of this study was to determine the most effective and efficient anti-emetic parameters of short-pulse gastric electrical stimulation (GES) in dogs. Seven female beagle dogs implanted with four pairs of gastric electrodes were studied in eight randomized sessions (saline, vasopressin, and six GES sessions with different parameters). Each session consisted of four 20-min recordings of gastric slow waves and symptoms. In sessions 1 and 2, saline and vasopressin, respectively, were infused during the second 20-min period. The protocol of the other six sessions was the same as session 2 except that GES was continuously applied. It was found that: (1) vasopressin induced gastric dysrhythmia and emetic response (P < 0.01, anova); (2) short-pulse GES with a frequency of 14 or 40 Hz and pulse width of 0.1 or 0.3 ms, but not 0.6 ms was able to reduce symptoms induced by vasopressin; (3) short-pulse GES with a pulse width of 0.3 ms was the most effective in preventing vasopressin-induced symptoms; (4) none of the tested GES methods improved vasopressin-induced gastric dysrhythmia. We conclude that vasopressin induces gastric dysrhythmia and symptoms. Short-pulse GES with a pulse width of 0.3 ms and frequency of 14 Hz is most effective and efficient in preventing vasopressin-induced emetic responses in dogs. [source]

An energy algorithm improves symptoms in some patients with gastroparesis and treated with gastric electrical stimulation

Postinfectious gastroparesis related to autonomic failure: a case report

NEUROGASTROENTEROLOGY & MOTILITY, Issue 2 2006
A. Lobrano
Abstract, Background and aim:, Severe dysautonomia may be secondary to viral infections, resulting in impaired autoimmune, cardiovascular, urinary and digestive dysfunction. Herein, we present a case of a 31-year-old white female patient who had severe gastroparesis related to autonomic failure following an episode of acute gastroenteritis. This seems to be the first report providing thorough assessment of the enteric and autonomic nervous system by analysis of full-thickness small intestinal biopsies, cardiovagal testing and autopsy. Hospital course:, This patient affected by a severe gastroparesis was treated with antiemetics, prokinetics, analgesics and gastric electrical stimulation to control symptoms. Nutritional support was made using jejunal feeding tube and, in the final stage of disease, with total parenteral nutrition. Autonomic studies revealed minimal heart rate variability and a disordered Valsalva manoeuvre although the enteric nervous system and the smooth muscle layer showed a normal appearance. Hospital courses were complicated by episodes of bacteraemia and fungemia. Serum antiphospholipid antibodies were noted but despite anticoagulation, she developed a pulmonary embolism and shortly thereafter the patient died. Autopsy revealed acute haemorrhagic Candida pneumonia with left main pulmonary artery thrombus. Sympathetic chain analysis revealed decreased myelinated axons with vacuolar degeneration and patchy inflammation consistent with Guillain-Barre syndrome. The evaluation of the enteric nervous system in the stomach and small bowel revealed no evidence of enteric neuropathy or myopathy. Conclusion:, A Guillain-Barre-like disease with gastroparesis following acute gastroenteritis is supported by physiological and autonomic studies with histological findings. [source]