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Gastric electrical stimulation for intractable vomiting in patients with chronic intestinal pseudoobstruction

Artikel i vetenskaplig tidskrift
Författare S. Andersson
Hans Lönroth
Magnus Simrén
G. Ringstrom
Anders Elfvin
Hasse Abrahamsson
Publicerad i Neurogastroenterology and motility
Volym 18
Nummer/häfte 9
Sidor 823-30
ISSN 1350-1925 (Print)
Publiceringsår 2006
Publicerad vid Institutionen för medicin, avdelningen för invärtesmedicin
Institutionen för kliniska vetenskaper
Sidor 823-30
Språk en
Länkar www.ncbi.nlm.nih.gov/entrez/query.f...
Ämnesord Adult, Aged, 80 and over, Chronic Disease, Diabetes Mellitus, *Electric Stimulation Therapy, Electrodes, Implanted, Female, Gastric Emptying/physiology, Gastrointestinal Motility/physiology, Gastroparesis/complications, Humans, Infant, Newborn, Intestinal Pseudo-Obstruction/*complications, Laparoscopy, Male, Manometry, Middle Aged, Nausea/etiology/therapy, Stomach/*physiology, Vomiting/*etiology/*therapy
Ämneskategorier Medicin och Hälsovetenskap

Sammanfattning

Gastric electrical stimulation (GES) is effective for medically refractory nausea and vomiting in patients with idiopathic or diabetic gastroparesis (DGP). We studied whether GES has similar effects in chronic intestinal pseudoobstruction (CIP). Patients referred for chronic small bowel (SB) motor dysfunction requiring parenteral nutrition and having a weekly vomiting frequency (WVF) >/=7 refractory to prokinetics and antiemetics were included. Patients were implanted for high-frequency GES 12 stimuli min(-1), laparoscopy being the first-line implantation procedure. Results were compared with those obtained in 11 DGP patients. Three patients with familial CIP and one patient with postsurgical CIP fulfilled the criteria. Gastric emptying was delayed in two and was normal in two patients. SB transit time was markedly delayed. Laparoscopy was used in three patients, one patient required laparotomy. During GES, WVF decreased from 24 (mean) before GES to 6.9 at 12 months and 7.5 at last visit. Vomiting reduction was 50-90% at last visit. For the DGP patients, WVF decreased from 23 before GES to 3.5 at 12 months and 3.5 (P < 0.01) at last visit. In patients with CIP and medically refractory vomiting, GES seems to have an anti-vomiting effect comparable to that seen in patients with severe DGP. GES should be considered as a therapeutic option for these patients.

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