Gastric electrical stimulation (GES) reduces nausea and vomiting and improves quality of life in diabetic patients with gastroparesis, according to Richard W. McCallum et al. in the November issue of Clinical Gastroenterology and Hepatology.
McCallum et al. studied 55 diabetic patients with gastroparesis (delayed gastric emptying, which leads to vomiting, nausea, bloating, fullness, and epigastric pain) who did not respond to medical therapy. All were given implants of the Enterra® gastric stimulation system. Six weeks later, the frequency of vomiting was reduced by 57%. These patients also had increased gastric emptying and spent fewer days in the hospital. Among 35 patients who completed 12 months of the study, vomiting frequency decreased by 67%, compared with the start of the trial.
Gastroparesis is common among diabetics; it causes dehydration, weight loss, kidney malfunction, and fluctuations in glucose that make it a challenge to manage diabetes. Although there are medical treatments for gastroparesis, they often cause side effects or are not effective in many patients.
Normal gastric emptying requires gastric electrical rhythms (also known as slow waves) to coordinate peristaltic contractions; this wave activity is reduced in diabetics. GES delivers low-amplitude, brief bursts of electric current via electrodes to gastric smooth muscle to restore these contractions.
Some questions remain about the study. After the first 6 weeks, during which all patients received GES, there was a 3-month period during which some patients had the device turned off, then back on. No differences in vomiting were observed between groups with the device turned on or off during this period.
In an accompanying editorial, Kenneth L. Koch points out that the period in which the GES was turned on at the beginning of the study might have had positive effects that remained when patients later had their devices turned off. Koch concludes that gastroenterologists should initiate GES for diabetic patients with symptoms of gastroparesis that do not respond to diet or drugs.
More Information on Gastroparesis:
- The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Web Site on Gastroparesis
Read the article online:
McCallum RW, Snape W, Brody F, et al. Gastric electrical stimulation with Enterra therapy improves symptoms from diabetic gastroparesis in a prospective study. Clin Gastroenterol and Hepatol 2010;8:947-954.e1.
Read the accompanying editorial:
Koch KL. Gastric electrical stimulation and the “eye of the beholder”. Clin Gastroenterol and Hepatol 2010;8:908-909.