Digestive Diseases and Sciences

, Volume 50, Issue 7, pp 1328–1334

Chronic Gastric Electrical Stimulation for Gastroparesis Reduces the Use of Prokinetic and/or Antiemetic Medications and the Need for Hospitalizations

  • Zhiyue Lin
  • Chris McELHINNEY
  • Irene Sarosiek
  • Jameson Forster
  • Richard McCALLUM
Article

Abstract

To investigate the effect of chronic gastric electrical stimulation (GES) on the daily use of prokinetics and antiemetics, hospitalizations, total symptom score (TSS), SF-36 status for health-related quality of life (HQOL), and gastric emptying of a solid meal, we evaluated 37 gastroparetic patients preoperatively and 1 year after undergoing GES implant. Prokinetic and antiemetic use was significantly reduced. Of 27 patients on at least one prokinetic at baseline, 8 were off at 1 year. Twenty-six patients requiring antiemetics before surgery decreased to 17. Mean TSS was significantly reduced and the reduction for patients off medications was significantly better than for patients still on medications. Overall SF-36 scores for HQOL were significantly improved, and patients off antiemetics had a significantly higher HQOL score than for patients on antiemetics at 1 year. Hospitalizations decreased from 50 ± 10 days for the year prior to GES therapy to 14± 3 days (P < 0.05). However, gastric emptying was not significantly improved. Conclusions are as follows. (1) Chronic GES significantly reduced the use of prokinetic/antiemetic medications and the need for hospitalization in gastropraretic patients, whose clinical and quality of life outcomes also significantly improved (2) These data provide evidence of the positive economic impact of this new therapy on long-term clinical outcomes in gastroparetic patients not responding to standard medical therapy.

Key Words

gastric electrical stimulation gastroparesis prokinetic medications antiemetic medications nausea and vomiting health-related quality of life 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Hornbuckle K, Barnett JL: The diagnosis and work up of the patients with gastroparesis. J Clin Gastroenterol 30:117–124, 2000PubMedGoogle Scholar
  2. 2.
    Soykan I, Sivri B, Sarosiek I, Kieman B, McCallum RW: Demography, clinical characteristic, psychological and abuse profiles, treatment, and long-term follow-up of patients with gastroparesis. Dig Dis Sci 43:2398–2404, 1998PubMedGoogle Scholar
  3. 3.
    Kendall BJ, McCallum RW: Gastroparesis and the current use of prokinetic drugs. Gastroenterologist 1:107–114, 1993PubMedGoogle Scholar
  4. 4.
    Koch KL: Diabetic gastropathy: gastric neuromuscular dysfunction in diabetes mellitus, a review of symptoms, pathophysiology, and treatment. Dig Dis Sci 44:1061–1075, 1994Google Scholar
  5. 5.
    Hasler WL: Gastric neurostimulation for gastroparesis: Time to pick up the pace. Gastroenterology 125:979–981, 2003PubMedGoogle Scholar
  6. 6.
    Bortolotti M: The “electrical way” to cure gastroparesis. Am J Gastroenterol 97:1874–1883, 2002PubMedGoogle Scholar
  7. 7.
    Lin ZY, Forster J, Sarosiek I, McCallum RW: Review article: Treatment of gastroparesis with electrical stimulation. Dig Dis Sci 48(5):837–848, 2003PubMedGoogle Scholar
  8. 8.
    Familoni BO, Abell TL, Nemoto D, Voeller G, Salem A, Gabor O: Electrical stimulation at a frequency higher than basal rate in human stomach. Dig Dis Sci 42:885–891, 1997PubMedGoogle Scholar
  9. 9.
    Forster J, Sarosiek I, Delcore R, Lin ZY, Raju GS, McCallum RW: Gastric pacing is a new surgical treatment for gastroparesis. Am J Surg 182:676–681, 2001PubMedGoogle Scholar
  10. 10.
    Abell T, McCallum RW, Hocking M, Koch K, Abrahamssion H, LeBlang I, Lindberg G, Konturek J, Nowak T, Quigley EMM, Tougas G, Starkebaum W: Gastric electrical stimulation for medically refractory gastroparesis. Gastroenterology 125:421–428, 2003PubMedGoogle Scholar
  11. 11.
    Abell TL, Cutsem EV, Abrahamsson H, Huizinga JD, Kontruek JW, Galmiche JP, Voeller G, Filez L, Everts B, Waterfall WE, Domschke W, des Varanbes SB, Familoni BO, Bourgeois IM, Janssens J, Tougas G: Gastric electrical stimulation in intractable symptomatic gastroparesis. Digestion 66:204–212, 2002PubMedGoogle Scholar
  12. 12.
    Lin ZY, Forster J, Sarosiek I and McCallum RW: Treatment of diabetic gastroparesis by highDfrequency gastric electrical stimulation. Diabetes Care 27:1071–1076, 2004PubMedGoogle Scholar
  13. 13.
    McElhinney C, Sarosiek I, Lin Z, McCallum RW: Comparison of hospitalizations, medications, and quality of life in patients receiving gastric electrical stimulation (GES) therapy for severe gastroparesis. Gastroenterology 122:A–82, 2002 (abstract)Google Scholar
  14. 14.
    Soykan I, Sarodiek I, McCallum RW: The effect of chronic oral domperidone therapy on GI symptoms, gastric emptying and quality of life in patients with gastroparesis. Am J Gastrointerol 92:976–980, 1997Google Scholar
  15. 15.
    Richards RD, Davenport K, McCallum RW: The treatment of idiopathic and diabetic gastroparesis with acute intravenous and chronic oral erythromycin. Am J Gastroenterol 88:203–207, 1993PubMedGoogle Scholar
  16. 16.
    Abell TL, Hocking M, McCallum R, Koch K, Nowak T, Diabaise JK: LongDterm hospitalization outcomes and economic impact of gastric electrical stimulation (GES) in patients with drug refractory gastroparesis. Gastroenterology 120(5):A–408, 2001 (abstract)Google Scholar
  17. 17.
    Forster J, Sarosiek I, Lin ZY, Durham S, Denton S, Roeser K, McCallum RW: Further experience with gastric stimulation to treat drug refractory gastroparesis. Am J Surg 186(6):690–695, 2003PubMedGoogle Scholar
  18. 18.
    Tougas G, Eaker EY, Abell TL, Abrahamsson H, Boivin M, Chen J, Hocking MP, Quigley EMM, Koch K, Tokayer AZ, Stanghellini V, Chen Y, Huizinga JD, Ryden J, Bourgeois I, McCallum RW: Assessment of gastric emptying using a low fat meal: Establishment of international control values. Am J Gastroenterol 95(6):1456–1462, 2000PubMedGoogle Scholar
  19. 19.
    Ware JE Jr: SF–36 Health Survey, manual and interpretation guide. Boston, MA, Health Institute, New England Medical Center, 1993Google Scholar
  20. 20.
    Ware JE, Kosinski M, Keller SD: SFD36 Physical and Mental Health Summary Scales: A userõs manual. Boston, MA, Health Assessment Lab, 1994Google Scholar
  21. 21.
    Koch KL, Stern RM, Stewart WR, Vasey MW: Gastric emptying and gastric myoelectrical activity in patients with diabetic gastroparesis: effect of longDterm domperidone treatment. Am J Gastroenterol 84:1069–1075, 1989PubMedGoogle Scholar
  22. 22.
    Cuts TF, Abell TL, Karas JG, Kuns J: Symptom improvement from prokinetic therapy corresponds to improved quality of life in patients with severe dyspepsia. Dig Dis Sci 41:1369–1378, 1996PubMedGoogle Scholar
  23. 23.
    Tack J, Coulie B, Van Cutsem E, Ryden J, Janssens KU: The influence of gastric electrical stimulation on proximal gastric motor and sensory function in severe idiopathic gastroparesis. Gastroenterology 116:G4733, 1999Google Scholar
  24. 24.
    Tougas G, Huizinga JD: Gastric pacing as a treatment for intractable gastroparesis: Shocking news? Gastroenterology 114:598–601, 1998PubMedGoogle Scholar

Copyright information

© Springer Science + Business Media, Inc. 2005

Authors and Affiliations

  • Zhiyue Lin
    • 1
  • Chris McELHINNEY
    • 1
  • Irene Sarosiek
    • 1
  • Jameson Forster
    • 2
  • Richard McCALLUM
    • 1
    • 3
  1. 1.Department of MedicineUniversity of Kansas Medical CenterKansas CityUSA
  2. 2.Department of SurgeryUniversity of Kansas Medical CenterKansas CityUSA
  3. 3.Department of Medicine, Mail Stop 1058University of Kansas Medical CenterKansas CityUSA

Personalised recommendations