Gastroparesis syndromes: Response to electrical stimulation.

BACKGROUND AND AIMS: Factors underlying gastroparesis are not well defined, nor is the mechanism of action of gastric electrical stimulation (GES). We hypothesized that GES acts via several mechanisms related to underlying disordered pathophysiology. METHODS: We studied 43 consecutive eligible patients with gastroparetic symptoms, previously evaluated by two methods in each of five core areas: inflammatory, autonomic, enteric, electrophysiologic, and hormonal; and also categorized by GI symptoms, metabolic status, illness quantification, and gastric physiology. We then studied 41 patients who underwent temporary GES for 5-7 days. Thirty-six of those patients were implanted and 30 were followed up at 6 months after permanent GES. RESULTS: In previous but separately reported work, patients had similar GI symptoms regardless of baseline gastric emptying or diabetic/idiopathic status and all patients demonstrated abnormalities in each of the five areas studied. After GES, patients showed early and late effects of electrical stimulation with changes noted in multiple areas, categorized by improvement status. CONCLUSION: Patients with symptoms of gastroparesis have multiple abnormalities, including systemic inflammation and disordered hormonal status. GES affects many of these abnormalities. We conclude electrical stimulation improves symptoms and physiology with (a) an early and sustained anti-emetic effect; (b) an early and durable gastric prokinetic effect in delayed emptying patients; (c) an early anti-arrhythmic effect that continues over time; (d) a late autonomic effect; (e) a late hormonal effect; (f) an early anti-inflammatory effect that persists; and (g) an early and sustained improvement in health-related quality of life. This study is registered with Clinicaltrials.gov under study # NCT03178370 (https://clinicaltrials.gov/ct2/show/NCT03178370).

A loss of social eating: the experience of individuals living with gastroparesis.

AIMS AND OBJECTIVES: To report the experience of patients living with gastroparesis. BACKGROUND: The complex illness of gastroparesis is a condition of delayed gastric emptying associated with a range of different symptoms, including nausea, vomiting and depression, resulting in altered eating patterns. Patients are often over-investigated, treatments are not always successful, and quality of life is often impaired. DESIGN: A descriptive phenomenology study was undertaken to examine the experience of living with gastroparesis. Nine gastroparesis patients gave in-depth interviews. The interviews were transcribed, and framework analysis methods applied. METHODS: A descriptive phenomenology study was undertaken. Nine gastroparesis patients gave in-depth interviews. The interviews were transcribed, and framework analysis methods applied. RESULTS: Four main themes emerged: the first described their experiences and opinions of medical professionals, the second their understanding of mental health and mental illness, the third how they managed social settings and the fourth their identity and security. Their behaviour around food and mealtimes was often associated with feelings of loss, isolation and rejection, which influenced their reported quality of life. These factors resulted in their personal struggle to understand how this chronic, stigmatising illness affects their identity and their need for security. CONCLUSIONS: The complex illness of gastroparesis affects every aspect of patients' lives. As treatments for gastroparesis continue to evolve, therapies to help these patients address the psychological impact and the feelings of loss they report must not be overlooked. RELEVANCE TO CLINICAL PRACTICE: A better understanding of these patients' sense of loss of normal eating behaviour and the associated psychological distress needs to inform gastroparesis service provision with a view to developing a more holistic service for this patient group.

Effect of DA-9701, a novel prokinetic agent, on stress-induced delayed gastric emptying and hormonal changes in rats.

BACKGROUND: DA-9701 is a novel prokinetic agent formulated with Pharbitis Semen and Corydalis Tuber. This study aimed to evaluate the effect of DA-9701 on stress-induced delay in gastric emptying and changes in plasma adrenocorticotropic hormone and ghrelin levels in rats. METHODS: Changes in gastric emptying in response to different durations of stress were evaluated. Gastric emptying was compared between the following groups: (i) nonstressed vehicle- or DA-9701-treated group, (ii) nonstressed vehicle- or mosapride-treated group, (iii) 2-h stressed vehicle- or DA-9701-treated group, and (iv) 2-h stressed vehicle- or mosapride-treated group. Water immersion restraint stress was used as the stressor. DA-9701 or mosapride at 3 mg kg(-1) was administered to the rats after subjecting them to 2-h stress, and then gastric emptying was measured using the phenol red method. KEY RESULTS: Gastric emptying was significantly delayed in the 2-h stressed group compared with the nonstressed group. Mosapride administration resulted in significant recovery from the stress-induced delay in gastric emptying. Gastric emptying in the rats that underwent 2-h stress followed by DA-9701 administration was not significantly different from that in the nonstressed group. The plasma adrenocorticotropic hormone and active ghrelin levels in the 2-h stressed group were significantly higher than those in the nonstressed group. These increases were significantly inhibited by DA-9701. CONCLUSIONS & INFERENCES: The administration of DA-9701 improved delayed gastric emptying and inhibited the hormonal changes induced by stress, suggesting that DA-9701 can be used as a gastroprokinetic agent for the treatment of delayed gastric emptying, particularly that associated with stress.

[Observation on therapeutic effect of routine acupoints plus mental activity-adjusting acupoints in the treatment of post-surgical gastroparesis syndrome].

OBJECTIVE: To evaluate the efficacy of routine plus mental-regulating acupoints on the head for post-operative gastroparesis syndrome. METHODS: Twenty patients were randomized into treatment group and control group, with 10 cases in each. For patients in the control group, transcutaneous nerve electrical stimulation (TENS) of Pishu (BL 20), Weishu (BL 21) and Sanjiaoshu (BL 22) was given for 20 min, followed by acupuncture of Neiguan (PC 6), Zhongwan (CV 12), Qihai (CV6), Tianshu (ST 25), etc., plus abdominal TDP irradiation and pellet-pressure of otopoints; Wei (MA-IC), Jiaogan (MA-AH 7), Neifenmi (MA-IC 3), Sanjiao (MA-IC 4), Pizhixia (MA-AT 1), etc. For patients of the treatment group, in addition to the treatment mentioned above, acupoints Baihui (GV 20), Yintang (EX-HN 3) and scalp-point Weiqu (Stomach Area) for adjusting the mental activity were punctured. The treatment was conducted once daily, 5 times a week and continuously for 4 weeks. Changes of the psychological status including Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA) scores, and gastric drainage volume/d were recorded. Results In comparison with pre-treatment, the HAMD and HAMA scores of both the treatment group and the control group after the treatment were decreased significantly (P < 0.01), and the therapeutic effects of the treatment group in reducing HAMD and HAMA scores were evidently superior to those of the control group (both P < 0.05). The gastric drainage volume/d in the two groups both decreased after the treatment. Of the two 10 cases in the treatment and control groups, 10 and 8 were cured, 0 and 2 were improved. No significant difference was found between the two groups in the therapeutic effect (P > 0.05), but the treatment sessions of the treatment and control groups were 7.3 +/- 1.3 and 10.4 +/- 2.1, respectively (P < 0.01). CONCLUSION: Mental activity-adjusting acupoints plus routine acupuncture (TENS, TDP irradiation and o-to-point-pellet pressure) can effectively improve post-surgical gastroparesis patients' psychological status and raise clinical therapeutic effect.

Update on gastroparesis.

Gastroparesis is a manifestation of diabetic autonomic neuropathy. Gastrointestinal autonomic neuropathy contributes to morbidity, mortality, reduced quality of life, and increased healthcare costs of a patient with diabetes mellitus. Complications from gastroparesis include ketoacidosis, infection, and bezoar formation. The gold standard for the diagnosis of gastroparesis is a gastric emptying study. Other tests and procedures may also be performed to eliminate other causes of the symptoms. In general, treatment involves dietary and lifestyle adjustment as well as pharmacological interventions. Gastric electrical stimulation has recently emerged as an effective strategy in the management of these patients. Research is evolving in this area to include the use of botulinum toxin to control symptoms of gastroparesis. Patients with gastroparesis can be frustrated with the symptoms they experience, the intensive treatment regimens they must follow, as well as the medical procedures they undergo during the course of their treatment. Quality of life is an important factor to consider when caring for and supporting these patients. This article will provide an overview of gastroparesis and the latest treatments available to improve gastric motility and prevent further complications.