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In future clinicians
could use GES to minimize vomiting in diabetic and non-diabetic patients with
refractory chronic vomiting that cannot be relieved with other therapies.
In diabetic and non-diabetic individuals having refractory vomiting with or without delayed gastric emptying, a four months gastric electrical stimulation (GES) performed with standard stimulation parameters was found to be effective in minimizing the frequency of refractory vomiting and nausea. However, it did not accelerate the gastric emptying rate or improve the quality of life.
A large, randomized, double-blind, prospective, multicenter, cross-over trial was carried out to explore the GES efficacy in patients suffering from refractory vomiting, whether or not linked with gastroparesis.
The study participants were evaluated from 2009 to 2013. The symptoms were evaluated in 172 subjects with more than 12 months of chronic refractory vomiting (idiopathic, and linked with a type 1 or 2 diabetic condition, or post-surgical) for four months.
After implantation of a GES device, it was left unactivated until participants were allocated to groups that were given four months of stimulation parameters or no stimulation (controls). This was followed by crossing over of 149 participants to the other cohort for four months.At the end of each four months, an assessment of the participants was carried out. The quality of life and vomiting score ranging from 0-4 (daily vomiting-no vomiting) examined by the Gastrointestinal QoL index (GIQLI) scoring system were the primary outcomes ascertained. Nutritional status, alterations in other digestive symptoms, diabetes control, and gastric emptying were the secondary outcomes ascertained.
Compared to the control group, the vomiting scores were found to be elevated in the group with the device on in non-diabetic and diabetic participants during both stages of the cross-over study, as illustrated in the following tables:
In patients suffering from normal or delayed gastric emptying, the vomiting scores were remarkably raised when the device was on. Compared to the off period, the gastric emptying was not expedited during the on period, as shown in the following figure:
Improved quality of life was not linked with the GES turned
on. Thus, GES can effectively diminish the
frequency of nausea and refractory vomiting. Future studies should focus on
assessing predictive factors of potent response and the technique’s
cost-effectiveness.
Gastroenterology
Gastric Electrical Stimulation Reduces Refractory Vomiting in a Randomized Cross-Over Trial
Philippe Ducrotte et al.
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