Abstract
Introduction: Gastric electrical stimulation (GES) is a surgically implanted treatment option for drug refractory gastroparesis syndromes. Evidence supporting use of GES and the pathophysiology of gastroparesis syndromes is not widely known. We conducted a descriptive review to elucidate the pathophysiology of gastroparesis syndromes, with particular focus on gastrointestinal neuromodulation and the known mechanisms of action of GES. Methods: A descriptive review of PubMed, Web of Science and Cochrane Library was conducted using the keywords gastric electrical stimulation, gastroparesis, nausea, vomiting, neuromodulation, gastroparesis syndromes, central nervous system, gastric pacing and electrical stimulation. Results: 1040 potentially relevant articles were identified, of which 34 were included. These studies explored various central and peripheral effects of GES, as well as its effect on quality of life, hospital stay, mortality and health-related costs. Conclusion: Although evidence supporting gastrointestinal (GI) electrical stimulation and GI neuromodulation use is not widely known, GES does seem to offer significant improvement in symptom control, quality of life and other effects to many patients. GES exerts its effects through multiple central and peripheral mechanisms and has potential to modify the natural history of disease. Future work on gastroparetic syndromes and their treatment might be better focused in terms of pathophysiologic mechanisms. Improving outcomes with specific neuromodulation therapies, like GES, may offer improvements in health for many patients with refractory upper gastrointestinal symptoms.
Highlights
Gastric electrical stimulation (GES) is a surgically implanted treatment option for drug refractory gastroparesis syndromes
This article reviews some of the new findings on the pathophysiology of gastroparesis syndromes and mechanisms of action of GES, while focusing on one particular therapy—GI neuromodulation via low and medium energy gastric electrical stimulation (GES)
The addition of gastroparesis-like syndrome (GLS) to Gp, which together can be termed as gastroparesis syndromes, helps include patients who exhibit the symptoms of gastroparesis but have a normal or even rapid emptying study
Summary
Gastroparesis is traditionally defined as a syndrome of objectively delayed gastric emptying in the absence of mechanical obstruction and cardinal symptoms. High-frequency, low-energy gastric electrical stimulation (GES) has been reported to reduce symptoms of drug-refractory gastroparesis [2]. The United States Food and Drug Administration (FDA) approved the use of GES to treat drug-refractory idiopathic and diabetic gastroparesis in the year 2000. This FDA approval, for the current Enterra system (Medtronic, Inc.), allows for use of higher than nominal energies of stimulation. This article reviews some of the new findings on the pathophysiology of gastroparesis syndromes and mechanisms of action of GES, while focusing on one particular therapy—GI neuromodulation via low and medium energy gastric electrical stimulation (GES)
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