High-Frequency Gastric Electrical Stimulation (GES) Is Effective in Treatment of Patients with Chronic Functional Nausea and Vomiting and a Normal Gastric Emptying

Abstract

Purpose: Previous reports have shown that long-term GES can improve symptoms and quality of life in up to 70% of patients with refractory gastroparesis. The aim of this study was to investigate the effectiveness of GES (Enterra™ Therapy) in patients with symptoms suggestive of gastroparesis but who had a normal gastric emptying and were given the diagnosis of functional nausea and vomiting not responding to standard approaches. Methods: We studied 16 such patients (3M, 13F, median age: 39 years, 5 diabetic and 11 idiopathic) who had a documented normal baseline 4-hr gastric emptying test (GET) (normal value at 4 hrs <10% gastric retention) and received GES therapy for at least 1 year. The GET, total symptom score (TSS) derived from 7 upper GI symptom sub-scores (0–4), quality of life (QOL) using SF-36 Health Status Survey including physical composite score (PCS) and mental composite score (MCS) and nutritional status were evaluated at baseline and at 1 year of GES administrated according to our previous publications (Am J Surgery 2001; 182:676). Results: Results are summarized in the table below. Overall there was no significant change in GET and approximately 67% patients continued to have a normal GET after 1 year. However, one third of patients did develop a slowing of GET. Symptom severity of nausea, vomiting and TSS were significantly improved (p < 0.05). 56% of patients had ≥50% reduction in TSS and the median reduction of TSS was 50%. Median PCS was significantly improved but not MCS. Weight remained stable. At implantation, 4 of the 16 patients required enteral feeding tubes for nutritional support and two continued after 1 year.TableConclusions: In patients with a normal GET and functional nausea and vomiting high-frequency GES is effective in improving upper GI symptoms, QOL and nutritional status. These data extend the indications for GES therapy in patients with chronic nausea and vomiting.