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. 2016 Feb;9(1):10-16.
doi: 10.14740/gr667w. Epub 2016 Mar 8.

Autonomic Evaluation of Patients With Gastroparesis and Neurostimulation: Comparisons of Direct/Systemic and Indirect/Cardiac Measures

Abigail Stocker  1 , Thomas L Abell  1 , Hani Rashed  1 , Archana Kedar  1 , Ben Boatright  1 , Jiande Chen  2
Affiliations

Autonomic Evaluation of Patients With Gastroparesis and Neurostimulation: Comparisons of Direct/Systemic and Indirect/Cardiac Measures

Abigail Stocker et al. Gastroenterology Res. 2016 Feb.

Abstract

Background: Disorders of nausea, vomiting, abdominal pain, and related problems often are manifestations of gastrointestinal, neuromuscular, and/or autonomic dysfunction. Many of these patients respond to neurostimulation, either gastric electrical stimulation or electroacupuncture. Both of these therapeutic techniques appear to influence the autonomic nervous system which can be evaluated directly by traditional testing and indirectly by heart rate variability.

Methods: We studied patients undergoing gastric neuromodulation by both systemic autonomic testing (39 patients, six males and 33 females, mean age 38 years) and systemic autonomic testing and heart rate variability (35 patients, seven males and 28 females, mean age 37 years) testing before and after gastric neuromodulation. We also performed a pilot study using both systemic autonomic testing and heart rate variability in a small number of patients (five patients, all females, mean age 48.6 years) with diabetic gastroparesis at baseline to compare the two techniques at baseline. Systemic autonomic testing and heart rate variability were performed with standardized techniques and gastric electrical stimulation was performed as previously described with electrodes implanted serosally in the myenteric plexus.

Results: Both systemic autonomic testing and heart rate variability measures were often abnormal at baseline and showed changes after gastric neuromodulation therapy in two groups of symptomatic patients. Pilot data on a small group of similar patients with systemic automatic nervous measures and heart rate variability showed good concordance between the two techniques.

Conclusions: Both traditional direct autonomic measures and indirect measures such as heart rate variability were evaluated, including a pilot study of both methods in the same patient group. Both appear to be useful in evaluation of patients at baseline and after stimulation therapies; however, a future full head-to-head comparison is warranted.

Keywords: Autonomic nervous system; Gastroparesis; Heart rate variability.

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Figures

Figure 1
Figure 1
Symptoms, autonomic and enteric measures at baseline and 1 year after gastric stimulation at center one. EGG: electrogastrography; Gp: gastroparesis; SAF: sympathetic adrenergic function; VCF: vagal cholinergic function.
Figure 2
Figure 2
Symptoms and heart rate variability measures in patients undergoing gastric electrical stimulation at center two. LF: adrenergic/low-frequency; HF: cholinergic/high-frequency.
Figure 3
Figure 3
Comparison of autonomic function testing and heart rate variability in five patients with diabetic gastroparesis at baseline at center three. VCF: vagal cholinergic function; RR: R-to-R interval; VR: Valsalva ratio; SAF: sympathetic adrenergic function; VC: vasoconstriction; PAR: postural adjustment ratio; EGG: electrogastrography; LF: adrenergic/low-frequency; HF: cholinergic/high-frequency; HRV: heart rate variability.
See this image and copyright information in PMC

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