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Gastric pacemakers for gastroparesis?

Does anyone know about gastric pacemakers? I have had a pancreatic stent and bile duct stent, sphinctorectomies, now diag. with gastroparesis.
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replied May 8th, 2014
Thank you for asking!
Lets discuss some treatment and management options for gastroparesis.
Gastroparesis treatments include dietary measures, medications that accelerate emptying or blunt vomiting, nonmedication interventions, and psychological therapies. Predictors of inadequate therapeutic responses include severe overall symptoms, increased bloating, and significant distention but not gastroparesis cause or emptying rates.

Nonmedication Interventions

Traditional dietary recommendations include consuming frequent small meals and avoiding roughage and high fat foods. However, a recent survey noted that gastroparetics ingested 1.4 meals daily and only 13% complied with fat restrictions. Maintaining euglycemia is advocated as part of managing diabetic gastroparesis. A

Gastrokinetic and Antiemetic Therapies

Prokinetic agents act on diverse receptors to stimulate gastric emptying. Metoclopramide reduces symptoms by gastrokinetic serotonin 5-HT4 agonism and dopamine D2 antagonism and antiemetic brainstem D2 antagonism and vagal and brainstem 5-HT3 antagonism. Side effects limit metoclopramide use in 30%. Tardive dyskinesia is a catastrophic consequence occurring most often in older women a mean of 1.52 years after starting metoclopramide. Metoclopramide is the second most common cause of medication-induced tardive dyskinesia after haloperidol. Erythromycin improves symptoms by stimulating antral contractility via motilin receptor agonism. Patients commonly report tolerance to its benefits due to motilin receptor downregulation. Erythromycin may elicit pain, nausea, and vomiting at high doses by inducing spastic gut contractions and increases risks of sudden cardiac death by more than 100%. Intravenous azithromycin evokes more intense and prolonged antral and small bowel responses than erythromycin. The peripheral dopamine D2 antagonist domperidone does not cross the bloodbrain barrier, thus, central neural side effects are limited. In a systematic review in diabetic gastroparesis, 64% of patients noted symptom reductions, 67% reported decreased hospitalizations, and 60% exhibited accelerated emptying. Domperidone prolongs electrocardiographic QTc intervals and may increase risks of sudden cardiac death. Domperidone is not Food and Drug Administration (FDA) approved, but is available from foreign pharmacies and websites, compounding pharmacies, and an FDA-sanctioned Investigational New Drug process. The acetylcholinesterase inhibitor pyridostigmine decreased symptoms in autoimmune gastroparesis.

Newer prokinetics have theoretical benefits. A recent report of hepatitis C patients with interferon-induced gastroparesis observed emptying acceleration and symptom reductions with the 5-HT4 agonist mosapride. Other agents with stomach stimulating effects but unproved benefits in gastroparesis include new 5-HT4 agonists (prucalopride, velusetrag, naronapride) and acetylcholinesterase inhibitors (acotiamide). Ghrelin, an endogenous mediator of food intake, exhibits gastrokinetic actions. In diabetic gastroparetics, the intravenous ghrelin agonist TZP-101 decreased nausea and vomiting and overall symptoms versus placebo .
dopamine antagonist thiethylperazine, the neurokinin NK1 antagonist aprepitant, and the antidepressant agent mirtazapine. I tricylic antidepressants reduced nausea and vomiting in 88% of diabetics (29% with delayed emptying). The herbal extract STW5 (iberogast) reportedly is efficacious in functional dyspepsia and gastroparesis.

Endoscopic and Surgical Treatments

Case series of pyloric botulinum toxin injection report improved symptoms and accelerated emptying which persists 36 months. In the largest series, more patients responded to 200 unit botulinum toxin doses versus 100 units and women and idiopathics more often benefited. Pyloric botulinum toxin also was efficacious in children (mean age 9.98 years) with gastroparesis, especially in older boys with vomiting.Pneumatic pyloric dilation and venting gastrostomy are other endoscopic techniques that have been promoted.

Now last but not the least of your gastric stimulators.
Several thousand gastric electrical stimulator implantations have been performed, as obtaining FDA Humanitarian Device Exemption for refractory diabetic and idiopathic gastroparesis. Uncontrolled series note up to 80% reductions in nausea and vomiting with extended benefits more than 10 years and improvements in nutritional and metabolic status, quality of life, and healthcare utilization in some reports.Subgroups unlikely to respond include idiopathic patients and those with pain requiring chronic opiates. .
SOme other options to be considered are . Jejunostomy feedings improve overall health and show trends to reduced healthcare utilitization in diabetic gastroparetics. Total parenteral nutrition (TPN) can reverse rapid weight loss and ensure adequate sustenance, but usually is needed only for associated intestinal dysmotility. Psychological dysfunction may complicate gastroparesis care. In a recent investigation, depression, and anxiety scores correlated with gastroparesis severity. Medication use and hospitalizations paralleled depression and anxiety intensity. The role of mental health specialists in gastroparesis is undefined.

In nutshell, every case has its own predilection fo rthe best option and best option varies for different cases. Get to your gastroenterologist and hepatobiliary surgeon and let them help you with the best possible option.
Take care
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