A slow caloric satiety drinking test in patients with temporary and permanent gastric electrical stimulation

Elfvin, Anders; Ringström, Gisela; Lönroth, Hans; Abrahamsson, Hasse; Simrén, Magnus

doi:10.1097/meg.0b013e3283365642

Cited by 5 publications

(3 citation statements)

References 29 publications

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“…In relation to the clinical literature, the analysis is tempered by the existence of few controlled studies, which show slight or no effects of GES on emesis (or nausea) when comparing ‘on’ vs ‘off’ stimulation conditions . The variability in the effects of GES on nausea and vomiting in these studies, combined with the absence of proper controls (e.g., sham or no‐stimulation), make it difficult to directly compare the patient‐reported symptom improvement with the objectively measured physiological responses quantified in our study.…”

Section: Discussionmentioning

confidence: 90%

“…47 In relation to the clinical literature, the analysis is tempered by the existence of few controlled studies, which show slight or no effects of GES on emesis (or nausea) when comparing 'on' vs 'off' stimulation conditions. 4,[48][49][50][51] The variability in the effects of GES on nausea and vomiting in these studies, combined with the absence of proper controls (e.g., sham or nostimulation), make it difficult to directly compare the patient-reported symptom improvement with the objectively measured physiological responses quantified in our study. However, we are confident the results from the current study are reliable and valid with specific regard to gastric distension-induced emesis, but cannot address the effect of GES on emesis induced in this model by other mechanisms including gastro-paresis.…”

Section: Discussionmentioning

confidence: 99%

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Impact of electrical stimulation of the stomach on gastric distension‐induced emesis in the musk shrew

Horn

Zirpel

Sciullo

et al. 2016

Neurogastroenterology Motil

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Background Gastric electrical stimulation (GES) is implicated as a potential therapy for difficult-to-treat nausea and vomiting; however, there is a lack of insight into the mechanisms responsible for these effects. The current study tested the relationship between acute GES and emesis in musk shrews, an established emetic model system. Methods Urethane-anesthetized shrews were used to record emetic responses (monitoring intra-tracheal pressure and esophageal contractions), respiration rate, heart rate variability, blood pressure, and gastrointestinal electromyograms. We investigated the effects of acute GES pulse duration (0.3, 1, 5, and 10 ms), current amplitude (0.5, 1, and 2 mA), pulse frequency (8, 15, 30, and 60 Hz), and electrode placement (antrum, body, and fundus) on emesis induced by gastric stretch, using a balloon. Key results There were four outcomes: (1) GES did not modify the effects of gastric stretch-induced emesis; (2) GES produced emesis, depending on the stimulation parameters, but was less effective than gastric stretch; (3) other physiological changes were closely associated with emesis and could be related to a sub-threshold activation of the emetic system, including suppression of breathing and rise in blood pressure; and (4) a control experiment showed that 8-OH-DPAT, a reported 5-HT1A receptor agonist that acts centrally as an antiemetic, blocked gastric stretch-induced emesis. Conclusions & Inferences These results do not support an antiemetic effect of acute GES on gastric distension-induced emesis within the range of conditions tested, but further evaluation should focus on a broader range of emetic stimuli and GES stimulation parameters.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Impact of electrical stimulation of the stomach on gastric distension‐induced emesis in the musk shrew

Horn

Zirpel

Sciullo

et al. 2016

Neurogastroenterology Motil

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“…A 2003 study incorporated a 1‐month observation period after GES implantation with subjects randomized to having the pacemaker turned on or off and reported a preference for having the pacemaker turned on . However, more recent controlled trials using temporary GES therapy did not show a statistically significant improvement in symptoms when implanted electrodes delivered stimulation vs when they did not . This suggests that placebo effect, or perhaps the placement of electrodes in the gastric musculature, may play a significant role in the symptomatic improvement observed with GES therapy.…”

Section: Discussionmentioning

confidence: 99%

Improvement of quality of life and symptoms after gastric electrical stimulation in children with functional dyspepsia

Teich

Lorenzo

et al. 2013

Neurogastroenterology Motil

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Gastric Electrical Stimulation for Gastroparesis and Chronic Unexplained Nausea and Vomiting

Nowak

Waseem

et al. 2016

Curr Treat Options Gastro

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Gastroparesis is a heterogeneous clinical syndrome. Some patients have debilitating vomiting, weight loss, and dehydration, while others have effortless regurgitation of undigested foods or postprandial distress suggestive of functional dyspepsia. Gastric electrical stimulation (GES) has been proposed as an effective treatment option for patients with gastroparesis refractory to medical therapy. Evidence suggests that the clinically available device, a low-energy high-frequency GES, activates the vagal afferent pathways to influence the central control mechanisms for nausea and vomiting. Myoelectrical effects of the stomach are also involved. The results of randomized controlled trials (RCTs) for adults with diabetic and idiopathic gastroparesis are conflicting. There are no RCTs in adults with chronic unexplained nausea and vomiting (CUNV) with normal gastric emptying or in children with gastroparesis. However, there is increasing evidence from large unblinded studies showing the long-term efficacy in selected adults with gastroparesis. Selection criteria should be based on three categories: (a) underlying etiology, (b) clinical presentation and predominant symptoms, and (c) potential risk for complication. Significant abdominal pain, daily opiate use, and idiopathic gastroparesis are identified as negative predictors of success. Temporary GES has been utilized to identify patients who may benefit from surgical GES, but this strategy has yet to be proven in controlled studies. Objectives for this review are to highlight the mechanisms of action for GES, to look at the evidence for clinical efficacy, and to select patients who are likely to benefit.

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A slow caloric satiety drinking test in patients with temporary and permanent gastric electrical stimulation

Abstract: GES had no effect on proximal gastric function as evaluated by the slow caloric satiety drinking test. This seems to be the case for patients with approved as well as nonapproved indications for GES, and irrespective of the symptomatic response.

Cited by 5 publications

References 29 publications

Impact of electrical stimulation of the stomach on gastric distension‐induced emesis in the musk shrew

Impact of electrical stimulation of the stomach on gastric distension‐induced emesis in the musk shrew

Improvement of quality of life and symptoms after gastric electrical stimulation in children with functional dyspepsia

Gastric Electrical Stimulation for Gastroparesis and Chronic Unexplained Nausea and Vomiting

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