November 25, 2019
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Gastric electrical stimulation reduces frequency of refractory vomiting

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Patients with refractory vomiting who received gastric electrical stimulation therapy experienced a reduction in the frequency of vomiting episodes, according to study results.

Despite some conflicting evidence, high-frequency gastric electrical stimulation (GES) is considered an option for treatment of patients with chronic refractory vomiting, Guillaume Gourcerol, MD, PhD, of the department of physiology at Rouen University Hospital in France, and colleagues wrote.

“AGA recommendations stated there was a moderate level of evidence to use GES in gastroparesis,” they wrote. “In fact, while several open trials have suggested that GES could be effective for the relief of refractory vomiting, whether associated or not with [gastric emptying], short randomized trials, conducted in gastroparetic patients alone, produced negative results.”

Researchers conducted a double-blind, crossover trial comprising 172 patients — including 133 with gastroparesis — with chronic refractory vomiting (idiopathic, associated with diabetes or postsurgical). They implanted a GES device in every patient and left it inactive until randomization.

Investigators placed patients into two groups. One received 4 months of stimulation parameters (14 Hz, 5 mA, pulses of 330 µsec) or no stimulation. After 4 months, 149 patients crossed over to the other group for another 4 months of therapy.

Researchers assessed patients at the end of each 4-month period. The primary outcomes of the study were vomiting score ranging from 0 (daily vomiting) to 4 (no vomiting) and quality of life assessed by the GIQLI scoring system.

Gourcerol and colleagues found that vomiting scores were higher in the group with the active device during both phases of the study (median score, 2) compared with the control group (median score, 1; P < .001). The results were consistent among patients with and without diabetes. Both patients with delayed and normal gastric emptying also experienced increased vomiting scores (P < .01 and P = .05, respectively).

Despite less frequent vomiting, GES did not accelerate gastric emptying or improve quality of life.

“This trial demonstrates that GES is effective in reducing the frequency of refractory vomiting and nausea in a subset of patients with chronic vomiting,” Gourcerol and colleagues wrote. “Further studies are warranted to determine predictive factors of favorable response and the technique’s cost-effectiveness.” – by Alex Young

Disclosures: Gourcerol reports receiving consultant fees from Allergan and serving as a speaker for Covidien and Kyowa. Please see the study for all other authors’ relevant financial disclosures.