Therapeutic Potential of Gastric Electrical Stimulation for Obesity

Chapter
Part of the Lecture Notes in Computational Vision and Biomechanics book series (LNCVB, volume 10)

Abstract

Obesity is one of the major public health problems in the world. While various methods have been investigated or introduced, bariatric surgical procedures are currently the only effective long-term therapies for treating obesity. Due to mortality and morbidity, the bariatric surgery is limited to a subset of patients with morbid obesity. In this chapter we present an overview of an emerging anti-obesity therapy: gastric electrical stimulation (GES). First, the scientific basis for GES as a potential therapy for obesity is introduced. Secondly, GES methodologies and configurations are presented. Methods of GES that have been used for treating obesity are then introduced, and their effects on food intake and body weight are presented, followed with the discussion on possible mechanical, neural and hormonal mechanisms involved in the anti-obesity effect of GES. Finally, our viewpoint on the potential of GES for obesity and future development of the GES therapy are provided.

Keywords

Gastric Emptying Pulse Train Gastric Motility Reduce Food Intake Intragastric Balloon 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Aelen P, Neshev E, Cholette M, Crisanti K, Mitchell P, Debru E, Church N, Mintchev MP (2008) Manipulation of food intake and weight dynamics using retrograde neural gastric electrical stimulation in a chronic canine model. Neurogastroenterol Motil 20:358–368PubMedCrossRefGoogle Scholar
  2. 2.
    Allison DB, Fontaine KR, Manson JE, Stevens J, VanItallie TB (1999) Annual deaths attributable to obesity in the United States. JAMA 282:1530–1538PubMedCrossRefGoogle Scholar
  3. 3.
    Aviello G, Matias I, Capasso R, Petrosino S, Borrelli F, Orlando P, Romano B, Capasso F, Di Marzo V, Izzo AA (2008) Inhibitory effect of the anorexic compound oleoylethanolamide on gastric emptying in control and overweight mice. J Mol Med 86:413–422PubMedCrossRefGoogle Scholar
  4. 4.
    Bohdjalian A, Prager G, Aviv R, Policker S, Schindler K, Kretschmer S, Riener R, Zacherl J, Ludvik B (2006) One-year experience with Tantalus: a new surgical approach to treat morbid obesity. Obes Surg 16:627–634PubMedCrossRefGoogle Scholar
  5. 5.
    Bohdjalian A, Prager G, Rosak C, Weiner R, Jung R, Schramm M, Aviv R, Schindler K, Haddad W, Rosenthal N, Ludvik B (2009) Improvement in glycemic control in morbidly obese type 2 diabetic subjects by gastric stimulation. Obes Surg 19(9):1221–1227PubMedCrossRefGoogle Scholar
  6. 6.
    Bray GA, Greenway FL (1999) Current and potential drugs for treatment of obesity. Endocr Rev 20(6):805–875PubMedCrossRefGoogle Scholar
  7. 7.
    Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, Schoelles K (2004) Bariatric surgery: a systematic review and meta-analysis. JAMA 292:1724–1737PubMedCrossRefGoogle Scholar
  8. 8.
    Camilleri M, Grudell AB (2007) Appetite and obesity: a gastroenterologist’s perspective. Neurogastroenterol Motil 19:333–341PubMedCrossRefGoogle Scholar
  9. 9.
    Chen JDZ, Qian LW, Ouyang H, Yin JY (2003) Gastric electrical stimulation with short pulses improves vomiting but not gastric dysrhythmia in dogs. Gastroenterology 124:401–409PubMedCrossRefGoogle Scholar
  10. 10.
    Cigaina V (2004) Long-term follow-up of gastric stimulation for obesity: the Mestre 8-year experience. Obes Surg 14(Suppl 1):S14–S22PubMedCrossRefGoogle Scholar
  11. 11.
    D’Argent J (2002) Gastric electrical stimulation as therapy of morbid obesity: preliminary results from the French study. Obes Surg 12(Suppl 1):21S–25SPubMedCrossRefGoogle Scholar
  12. 12.
    Deitel M (2003) Overweight and obesity worldwide now estimated to involve 1.7 billion people. Obes Surg 13:329–330PubMedCrossRefGoogle Scholar
  13. 13.
    De Luca M, Segato G, Busetto L, Favretti F, Aigner F, Weiss H, de Gheldere C, Gaggiotti G, Himpens J, Limao J, Scheyer M, Toppino M, Zurmeyer EL, Bottani G, Penthaler H (2004) Progress in implantable gastric stimulation: summary of results of the European multi-center study. Obes Surg 14(Suppl 1):S33–S39PubMedCrossRefGoogle Scholar
  14. 14.
    Dickey RA, Bartuska CDG, Bray GW, Callaway CW, Davidson ET, Feld S, Ferraro RT, et al. (1998) AACE/ACE Position statement on the prevention, diagnosis, and treatment of obesity (1998 revision) Endocr Pract 4(5):297–350Google Scholar
  15. 15.
    Di Marzo V, Capasso R, Matias I, Aviello G, Petrosino S, Borrelli F, Romano B, Orlando P, Capasso F, Izzo AA (2008) The role of endocannabinoids in the regulation of gastric emptying: alterations in mice fed a high-fat diet. Br J Pharmacol 153:1272–1280PubMedCrossRefGoogle Scholar
  16. 16.
    Eagon JC, Kelly KA (1993) Effects of gastric pacing on canine gastric motility and emptying. Am J Physiol 265:G767–G774PubMedGoogle Scholar
  17. 17.
    Finkelstein EA, Trogdon JG, Cohen JW, Dietz W (2009) Annual medical spending attributable to obesity: payer-and service-specific estimates. Health Aff (Millwood) 28:w822–w831CrossRefGoogle Scholar
  18. 18.
    Gortmaker SL, Must A, Perrin JM, Sobol AM, Dietz WH (1993) Social and economic consequences of overweight in adolescence and young adulthood. N Engl J Med 329:1008–1012PubMedCrossRefGoogle Scholar
  19. 19.
    Hocking MP, Vogel SB, Sninsky CA (1992) Human gastric myoelectrical activity and gastric emptying following gastric surgery and with pacing. Gastroenterology 103:1811–1816PubMedGoogle Scholar
  20. 20.
    Imaz I, Martinez-Cervell C, Garcia-Alvarez EE, Sendra-Gutierrez JM, Gonzalez-Enriquez J (2008) Safety and effectiveness of the intragastric balloon for obesity. A meta-analysis. Obes Surg 18:841–846PubMedCrossRefGoogle Scholar
  21. 21.
    Krentz AJ, Patel MB, Bailey CJ (2008) New drugs for type 2 diabetes mellitus: what is their place in therapy? Drugs 68:2131–2162PubMedCrossRefGoogle Scholar
  22. 22.
    Li S, Chen JD (2010) Cellular effects of gastric electrical stimulation on antral smooth muscle cells in rats. Am J Physiol Regul Integr Comp Physiol 298(6):R1580–R1587PubMedCrossRefGoogle Scholar
  23. 23.
    Lin ZY, Chen JDZ (2002) Advances in gastrointestinal electrical stimulation. Crit Rev Biomed Eng 30:419–458PubMedCrossRefGoogle Scholar
  24. 24.
    Lin Z, Forster J, Sarosiek I, McCallum RW (2003) Treatment of gastroparesis with electrical stimulation. Dig Dis Sci 48(5):837–848PubMedCrossRefGoogle Scholar
  25. 25.
    Liu J, Hou X, Song G, Cha H, Yang B, Chen JD (2006) Gastric electrical stimulation using endoscopically placed mucosal electrodes reduces food intake in humans. Am J Gastroenterol 101:798–803PubMedCrossRefGoogle Scholar
  26. 26.
    Malinowski SS (2006) Nutritional and metabolic complications of bariatric surgery. Am J Med Sci 331:219–225PubMedCrossRefGoogle Scholar
  27. 27.
    Mathus-Vliegen EM (2008) Intragastric balloon treatment for obesity: what does it really offer? Dig Dis 26:40–44PubMedCrossRefGoogle Scholar
  28. 28.
    Mayer MA, Höcht C, Puyó A, Taira CA (2009) Recent advances in obesity pharmacotherapy. Curr Clin Pharmacol 4:53–61PubMedCrossRefGoogle Scholar
  29. 29.
    McCallum RW, Chen JD, Lin Z, Schirmer BD, Williams RD, Ross RA (1998) Gastric pacing improves emptying and symptoms in patients with gastroparesis. Gastroenterology 114(3):456–461PubMedCrossRefGoogle Scholar
  30. 30.
    McCallum RW, Sarosiel, Lin Z, Moncure M, USA Study Group (2002) Preliminary results of gastric electrical stimulation on weight loss and gastric emptying in morbidly obese patients—randomized double blinded trial. Neurogastroenterol Motil 14:422CrossRefGoogle Scholar
  31. 31.
    Neshev E, Onen D, Jalilian E, Mintchev MP (2006) Pre-pyloric neural electrical stimulation produces cholinergically-mediated reverse peristalsis in the acute canine model of microprocessor-invoked gastric motility for the treatment of obesity. Obes Surg 16:510–520PubMedCrossRefGoogle Scholar
  32. 32.
    Ouyang H, Yin JY, Chen JDZ (2003) Inhibitory effects of chronic gastric electrical stimulation on food intake and weight and their possible mechanisms. Dig Dis Sci 48:698–705PubMedCrossRefGoogle Scholar
  33. 33.
    Ouyang H, Xing J, Chen JD (2005) Tachygastria induced by gastric electrical stimulation is mediated via alpha- and beta-adrenergic pathway and inhibits antral motility in dogs. Neurogastroenterol Motil 17(6):846–853PubMedCrossRefGoogle Scholar
  34. 34.
    Ouyang H, Yin J, Chen JD (2006) Gastric or intestinal electrical stimulation-induced increase in gastric volume is correlated with reduced food intake. Scand J Gastroenterol 41:1261–1266PubMedCrossRefGoogle Scholar
  35. 35.
    Peles S, Petersen J, Aviv R, Policker S, Abu-Hatoum O, Ben-Haim SA, Gutterman DD, Sengupta JN (2003) Enhancement of antral contractions and vagal afferent signaling with synchronized electrical stimulation. Am J Physiol Gastrointest Liver Physiol 285:G577–G585PubMedGoogle Scholar
  36. 36.
    Qin C, Sun Y, Chen JDZ, Foreman R (2005) Gastric electrical stimulation modulates neuronal activity in nucleus tractus solitarii in rats. Auton Neurosci Basic Clin 119:1–8CrossRefGoogle Scholar
  37. 37.
    Sanmiguel CP, Haddad W, Aviv R, Cunneen SA, Phillips EH, Kapella W, Soffer EE (2007) The TANTALUS system for obesity: effect on gastric emptying of solids and ghrelin plasma levels. Obes Surg 17:1503–1509PubMedCrossRefGoogle Scholar
  38. 38.
    Scheen AJ, Lefebvre PJ (2000) Antiobesity pharmacotherapy in the management of type 2 diabetes. Diabetes Metab Res Rev 16:114–124PubMedCrossRefGoogle Scholar
  39. 39.
    Shikora SA, Bergenstal R, Bessler M, Brody F, Foster G, Frank A, Gold M, Klein S, Kushner R, Sarwer DB (2009) Implantable gastric stimulation for the treatment of clinically severe obesity: results of the SHAPE trial. Surg Obes Relat Dis 5:31PubMedCrossRefGoogle Scholar
  40. 40.
    Soffer E, Abell T, Lin Z, Lorincz A, McCallum R, Parkman H, Policker S, Ordog T (2009) Review article: gastric electrical stimulation for gastroparesis–physiological foundations, technical aspects and clinical implications. Aliment Pharmacol Ther 30(7):681–694PubMedCrossRefGoogle Scholar
  41. 41.
    Song GQ, Hou X, Sun Y, Yang B, Qian W, Chen JD (2007) Effects of retrograde gastric electrical stimulation with pulse trains on gastric emptying of solids and plasma hormones in dogs. Am J Surg 194(1):122–127PubMedCrossRefGoogle Scholar
  42. 42.
    Sun X, Tang M, Zhang J, Chen JD (2006) Excitatory effects of gastric electrical stimulation on gastric distension responsive neurons in ventromedial hypothalamus (VMH) in rats. Neurosci Res 55:451–457PubMedCrossRefGoogle Scholar
  43. 43.
    Tang M, Zhang J, Chen JDZ (2006) Central mechanisms of gastric electrical stimulation involving neurons in paraventricular nucleus of hypothalamus in rats. Obes Surg 16:344–352Google Scholar
  44. 44.
    Tang M, Zhang J, Xu L, Chen JD (2006) Implantable gastric stimulation alters expression of oxytocin- and orexin-containing neurons in the hypothalamus of rats. Obes Surg 16(6):762–769PubMedCrossRefGoogle Scholar
  45. 45.
    Vazquez Roque MI, Camilleri M, Clark MM, Tepoel DA, Jensen MD, Graszer KM, Kalsy SA, Burton DD, Baxter KL, Zinsmeister AR (2007) Alteration of gastric functions and candidate genes associated with weight reduction in response to sibutramine. Clin Gastroenterol Hepatol 5:829–837Google Scholar
  46. 46.
    Xing J, Chen JD (2004) Alterations of gastrointestinal motility in obesity. Obes Res 12:1723–1732PubMedCrossRefGoogle Scholar
  47. 47.
    Xing JH, Chen JD (2006) Effects and mechanisms of long-pulse gastric electrical stimulation on canine gastric tone and accommodation. Neurogastroenterol Motil 18:136–143PubMedCrossRefGoogle Scholar
  48. 48.
    Xu L, Tang M, Chen JDZ (2005) Effect of gastric electrical stimulation on gastric distention responsive neurons and expression of nNOS in rodent hippocampus. Gastroenterology 128:A624CrossRefGoogle Scholar
  49. 49.
    Xu X, Zhu H, Chen JD (2005) Pyloric electrical stimulation reduces food intake by inhibiting gastric motility in dogs. Gastroenterology 128(1):43–50PubMedCrossRefGoogle Scholar
  50. 50.
    Xu J, Chen JDZ (2008) Effects of sibutramine on gastric emptying, intestinal motility and rectal tone in dogs. Dig Dis Sci 53:155–162PubMedCrossRefGoogle Scholar
  51. 51.
    Yao S, Ke M, Wang Z, Xu D, Zhang Y, Chen JD (2005) Retrograde gastric pacing reduces food intake and delays gastric emptying in humans: a potential therapy for obesity? Dig Dis Sci 50:1569–1575PubMedCrossRefGoogle Scholar
  52. 52.
    Yin J, Chen JD (2005) Retrograde gastric electrical stimulation reduces food intake and weight in obese rats. Obes Res 13:1580–1587PubMedCrossRefGoogle Scholar
  53. 53.
    Yin J, Chen J (2006) Inhibitory effects of gastric electrical stimulation on ghrelin-induced excitatory effects on gastric motility and food intake in dogs. Scand J Gastroenterol 41(8):903–909PubMedCrossRefGoogle Scholar
  54. 54.
    Zhang J, Chen JD (2006) Systematic review: applications and future of gastric electrical stimulation. Aliment Pharmacol Ther 24(7):991–1002Google Scholar
  55. 55.
    Zhang J, Tang M, Chen JD (2009) Gastric electrical stimulation for obesity: the need for a new device using wider pulses. Obesity 17(3):474–480PubMedCrossRefGoogle Scholar
  56. 56.
    Zhang J, Maude-Griffin R, Zhu H, Sun Y, Starkebaum W, Firestone E, Chen JD (2011) Gastric electrical stimulation parameter dependently alters ventral medial hypothalamic activity and feeding in obese rats. Am J Physiol Gastrointest Liver Physiol 301:G912–G918PubMedCrossRefGoogle Scholar
  57. 57.
    Zhu H, Sallam H, Chen DD, Chen JD (2007) Therapeutic potential of synchronized gastric electrical stimulation for gastroparesis: enhanced gastric motility in dogs. Am J Physiol Regul Integr Comp Physiol 293(5):R1875–R1881PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  1. 1.Division of GastroenterologyGI Research, Route 0655, University of Texas Medical BranchGalvestonUSA

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