Learn More: GP & Enterra Therapy

If you’re interested in the nitty gritty details of gastroparesis and/or Enterra Therapy (a.k.a. the gastric pacemaker), check out this lecture by Dr. Jon Gould from the University of Wisconsin-Madison.  Some parts are pretty technical but it’s quite informative overall.

If you don’t want to watch the entire 40-minute video, here are a few things that I found interesting:

• The majority of GP cases, about 35%, are Idiopathic (of unknown origin).   About 29% of cases are due to Diabetes.

 

• While gastroparesis causes poor glycemic control, swings in blood sugar can actually affect gastric emptying.  (my note — potentially some food for thought for us idiopathics who consume so many simple carbs and sugars)

 

• The incidence of gastroparesis is increasing.  Over the past 10 years, hospitalizations due directly to GP have increased threefold to 10,000 per year.  The increase in GP cases may be due to the rise in Diabetes over this same time period.

 

• Prokinetic medications (i.e. Reglan) are unsuccessful in 50% of cases.  This may be because prokinetic treatment is based on the premise that symptoms are directly related to inadequate gastric contractility — i.e. the failure of the stomach muscles to contract.  Some doctors, including Dr. Gould, believe that this isn’t really the main problem.

 

• Though many people (myself included!) refer to the Enterra Therapy* device as a “gastric pacemaker” that’s really a misnomer.  The device does not actually pace the stomach to empty.  While true gastric pacing can be done, it doesn’t provide significant symptomatic relief like gastric electrical stimulation does.

 

• Studies have consistently shown that Enterra Therapy significantly decreases vomiting, improves upper GI symptoms, improves glycemic control, decreases hospitalization, improves nutrition, improves quality of life, and is safe for both diabetics and idiopathic gastroparesis patients.

 

• The reason gastric electrical stimulation works isn’t entirely clear.  It might affect autonomic nervous system.  It has been shown to increase the discomfort threshold for pressure and volume in the stomach. It is also thought to affect the nausea and vomiting center of the brain.

 

• About 80% of all recipients notice improvement in their symptoms with the gastric neurostimulator.  Failure to respond might be due to technical error, such a misplaced leads, or a variety of other factors. It’s very difficult to predict who will respond to the treatment in advance.

 

• Though gastric emptying times may normalize with Enterra Therapy, it isn’t necessary for symptom relief and doesn’t seem to correspond to patients’ reported symptoms.

*I use the terms Enterra Therapy, gastric neurostimulator, gastric electrical stimulation, and gastric pacemaker interchangeably.  As I understand it:  Enterra Therapy is the brand name of the gastric neurostimulator device that is used for gastric electrical stimulation.  As I noted above “gastric pacemaker” is actually a misnomer.  I apologize if I’ve confused anybody!

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• Update: Gastric Pacemaker
• My Favorite Things: 2009
• Gastric Pacemaker: 3 Months
• Gastric Pacemaker: Abdominal Twitching
• Gastric Pacemaker: Back on Track!