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Gastric Pacemaker Placement

We are one of only 2 centers in the state of Washington that place these innovative devices. These pacemakers allow normalization of stomach function for patients suffering from severe gastroparesis.  The pacemaker is implanted under the skin, and two electrode leads run from the pacemaker to the patient's stomach. We are often able to place these innovative devices using the laparoscope, as an outpatient, day-surgery procedure.  Successful placement of a gastric stimulator does not cure gastroparesis, but it can greatly improve the quality of life.  Gastroparesis treatment always includes a combination of diet, medications and pacemaker.

 

 

What is Gastroparesis ?

Gastroparesis is a stomach disorder in which food is digested more slowly than normal. In a healthy digestive system, strong muscular contractions move food from the stomach through the digestive tract. With gastroparesis, however, the stomach muscles work poorly (or not at all), thus preventing the stomach from emptying properly. For some people, this condition results in serious nausea and vomiting that cannot be adequately controlled with standard medications.  Keeping a log of your diet and symptoms can greatly assist with getting you the best possible treatment.  The following link has a copy of a daily log which  you can use to record your symptoms.  Gastroparesis Daily Log

Causes

Most often, this condition is a complication of diabetes. Gastroparesis is caused when the vagus nerve, which controls the movement of food through the digestive tract, is damaged or stops working. When this happens, the stomach's ability to move food is slowed down or stopped. The vagus nerve becomes damaged in persons with diabetes when blood glucose (sugar) levels remain high over a long period of time.

Other causes of gastroparesis include the following:

  • anorexia nervosa;
  • surgery on the stomach or vagus nerve;
  • postviral syndromes;
  • certain medications, particularly those that slow contractions in the intestine;
  • smooth muscle or connective-tissue disorders, such as amyloidosis and scleroderma;
  • diseases of the nervous system, such as abdominal migraine and Parkinson's disease;
  • metabolic disorders, including hypothyroidism.

It is not uncommon for no specific cause to be found or identified.  These cases are termed as ideopathic, and include almost 40% of the patients we see.  If gastroparesis is the result of a viral infection, patients may see improvement over a few years time.

Typical symptoms include:

  • Nausea
  • Vomiting
  • Abdominal bloating
  • Abdominal pain
  • Feeling of fullness after only a few bites of food
  • Heartburn or gastroesophageal reflux disease (GERD)
  • Changes in blood sugar levels
  • Lack of appetite
  • Excessive weight loss

Impact of Gastroparesis

The impact of gastroparesis on physical well-being can be devastating. It can cause chronic nausea and vomiting and lead to malnutrition and inadequate blood sugar levels. Living with gastroparesis also affects emotional well-being. The constant discomfort of chronic nausea and vomiting can affect school and work performance, family and personal relationships, and social activities.

Diagnosis

Diagnosis is based on a complete medical history, physical examination, and tests that may include:

  • Upper gastrointestinal endoscopy
  • Gastric emptying test (GET)
  • Gastroduodenal manometry
  •  Electrogastrography (EGG)

 

Treatment Options for Gastroparesis

There is no cure for gastroparesis, but there are treatments that may help provide relief from the symptoms of nausea and vomiting.  The optimal treatment includes the combination of diet, medication, and possibly surgery, including the use of a gastric pacer.

 

Diet Changes

Treatment usually begins with learning about nutrition and modifying diet. The goal is to reduce symptoms and maintain adequate fluids and nutrition. A modified diet typically consists of liquids, restricted fats and plant fiber, and frequent small meals.  The following llink has more specific diet information.  Gastroparesis Diet

Drugs

The most common drugs used to treat gastroparesis or its symptoms include:
Prokinetic drugs – used to improve the rate of stomach emptying
Antiemetic drugs – used to control nausea and vomiting but have no effect on stomach emptying

Domperidone is a prokinetic and anti-nausea medication that can be very helpful in the treatment of gastroparesis.  Unfortunately it is not available in the United States.  The medication can be purchased on the internet from Canada.

Enteral Nutrition

This therapy involves the delivery of liquid nutrients via a tube placed directly into the stomach or small intestine. Feeding tubes are usually temporary and used only when gastroparesis is severe.

Total Parenteral Nutrition

Total parenteral nutrition (TPN) supplies nutrients to a person’s bloodstream through an intravenous (IV) infusion. TPN is used only if enteral feeding is not tolerated or is insufficient to meet caloric needs.

Gastric or Intestinal Surgery

Gastric or intestinal surgery is usually only performed after other options have failed. All or part of the stomach can be removed (gastrectomy). A feeding tube may be placed through the abdominal wall into the stomach (gastrostomy) or small intestine (jejunostomy).

Gastric Electrical Stimulation

Gastric electrical stimulation is for people with chronic, drug-refractory (resistant to medication) nausea and vomiting due to gastroparesis of diabetic or idiopathic origin.  Gastric electrical stimulation works by sending a small electrical current to the muscle of the stomach. This option requires surgical implantation of the Medtronic Enterra® Therapy system and is only appropriate for people who have gastroparesis symptoms that do not improve after taking medication. The Enterra Therapy system uses an implanted neurostimulator to generate mild electrical pulses that are sent through insulated wires (leads) to the lower stomach. The gastric pacer may relieve chronic nausea and vomiting symptoms associated with gastroparesis.


 

Which Patients May Receive a Gastric Pacer ?                                                                                                          

This therapy has been approved by the Food and Drug Administration as a Humanitarian Device.         Because of this status, patients must meet specific criteria. To qualify for a gastric electrical stimulator, patients must:

  1. Have an abnormal gastric emptying study.
  2. Have failed to show any improvement with the two categories of drug treatments.
  3. Be losing weight to the point that feeding tubes or other emergency feeding methods are needed.

All three of these conditions must be met for a patient to qualify for a gastric pacer.

 

About Gastric Electrical Stimulation

Enterra® Therapy may relieve chronic nausea and vomiting symptoms associated with gastroparesis of diabetic or idiopathic origin.

Gastroparesis Support and Web Sites:

  • Gastroparesis and Dysmotilities Association
  • Gastroparesis Patient Association for Cures & Treatments (G-PACT)
  •  Gastroparesis & Dysmotility Foundation (GPD Foundation)
  • Association of Gastrointestinal Motility Disorders, Inc