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. 2016 Oct 30;22(4):643-649.
doi: 10.5056/jnm15135.

Gastric Electrical Stimulation Is an Option for Patients with Refractory Cyclic Vomiting Syndrome

Inderpreet Grover  1 , Richard Kim  2 , Danielle C Spree  3 , Christopher J Lahr  4 , Archana Kedar  2 , Shivangi Kothari  3 , David Fleisher  5 , Thomas L Abell  2
Affiliations

Gastric Electrical Stimulation Is an Option for Patients with Refractory Cyclic Vomiting Syndrome

Inderpreet Grover et al. J Neurogastroenterol Motil. .

Abstract

Background/aims: Cyclic vomiting syndrome (CVS) is a disabling migraine variant manifesting as severe episodes of nausea and vomiting and often refractory to many therapies. Gastric electrical stimulation (GES), which can reduce nausea and vomiting in gastroparesis, may provide symptomatic relief for drug-refractory CVS. This study assessed the utility GES in reducing the symptoms of CVS and improving the quality of life.

Methods: A one-year, non-randomized, clinical study was conducted. Eleven consecutive patients with drug refractory, cyclic vomiting syndrome based on Rome III criteria and North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN), underwent treatment with temporary GES (Temp GES) and permanent GES (Perm GES). Post-treatment follow up was done up to one year after permanent gastric electrical stimulation therapy.

Results: Total symptom score decreased by 68% and 40% after temporary and permanent GES therapies, respectively. Hospital admission events significantly decreased to 1.50 (± 1.00) events from 9.14 (± 7.21) annual admissions prior to treatment with permanent GES. Vomiting episodes fell by 83% post Temp GES and 69% after Perm GES treatments. Mucosal electrogram values also changed after temporary stimulation.

Conclusions: In a small group of drug-refractory CVS patients, treatments with temporary and permanent GES significantly reduced the severity of gastrointestinal symptoms and frequency of hospital admissions.

Keywords: Cyclic vomiting syndrome; Gastric electrical stimulation; Nausea; Vomiting.

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Figures

Figure 1
Figure 1
Changes in mucosal frequency vs pre-temporary gastric electrical stimulation (Pre-tGES; baseline) mucosal frequency at temporary GES treatment initiation. Pre stimulation frequency = 4.72, post stimulation frequency = 4.54, slope = −1.02 (−1.68, −0.37), P = 0.009, R2 = 0.71.
Figure 2
Figure 2
Average change in vomiting scores before and after temporary gastric electrical stimulation (GES). Significant improvements were seen in vomiting scores for all patients with treatment with temporary GES. An average decrease in vomiting score by −2.24 units (−3.18, −1.29) was observed during our study at the end of a 5-day trial with temporary GES.
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