Abstract
Gastric pacing and stimulation strategies were first proposed in the 1960s to treat motility disorders. However, there has been relatively limited clinical translation of these techniques. Experimental investigations have been critical in advancing our understanding of the control mechanisms that innervate gut function. In this review, we will discuss the use of pacing to modulate the rhythmic slow wave conduction patterns generated by interstitial cells of Cajal in the gastric musculature. In addition, the use of gastric high-frequency stimulation methods that target nerves in the stomach to either inhibit or enhance stomach function will be discussed. Pacing and stimulation protocols to modulate gastric activity, effective parameters and limitations in the existing studies are summarized. Mathematical models are useful to understand complex and dynamic systems. A review of existing mathematical models and techniques that aim to help refine pacing and stimulation protocols are provided. Finally, some future directions and challenges that should be investigated are discussed.
Highlights
Bioelectricity is a key regulator of bodily function
Since initially being proposed in the 1960s, significant advances have been made towards the use of electrical therapies for modulating gastric function
Widespread clinical usage remains limited when compared to the large number of therapies approved to treat cardiac electrophysiology disorders
Summary
Bioelectricity is a key regulator of bodily function. The coordinated contraction and relaxation of the muscles necessary for controlling movement are initiated by electrical signals propagating through the nerves and muscles. HR mapping studies in gastroparetic and chronic unexplained nausea and vomiting patients undergoing Enterra stimulator implantation (Medtronic Inc., Minneapolis, MN, United States) reported a range of abnormal slow wave propagation patterns including, ectopic pacemakers and conduction blocks (O’Grady et al, 2012a; Angeli et al, 2015). For detailed meta-analysis of past high-frequency stimulation trials for treating gastroparesis refer to Table 1 in O’Grady et al (2009) and Table 1 in Chu et al (2012) As part of these analyses only two randomized, control trials were reported and both were classified as “medium quality” A high degree of variation in the stimulation parameters is noted in these studies and it is hypothesized that
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