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document
Central neuronal mechanisms of gastric electrical stimulation in diabetic gastroparesis . OBJECTIVE The mechanisms underlying symptom improvement in gastric electrical stimulation ( GES ) are not fully understood . Modulation of the central nervous system excitability may be involved . The objective of the study was to investigate the central effects of GES , including the possible modulation of the visceral sensory nervous system . MATERIAL AND METHODS A gastric electrical stimulator was implanted in seven diabetic patients with medically refractory gastroparesis . A double-blinded protocol was used to investigate the patients at baseline and one month after recovery with the stimulator turned on and off ( 1-month periods ) . The following assessments were carried out : mechanical , thermal and electrical stimulations with sensory recordings in the esophagus and duodenum , and standardized , self-administered , daily symptom questionnaires . RESULTS No difference was found between baseline and the on- and off periods in overall gut pain thresholds across all stimulus modalities in the esophagus ( p=0.63 ) , duodenum ( p=0.19 ) or esophagus and duodenum combined ( p=0.76 ) . No difference in the sensory response to mechanical stimulation was found in the esophagus before ( all p > 0.31 ) and after ( all p > 0.43 ) smooth muscle relaxation with butylscopolamine . Similar findings were observed in the duodenum . No differences were found in thermal sensitivity ( esophagus ( p=0.67 ) and duodenum ( p=0.17 ) ) , sensory response to electrical stimulation ( esophagus ( p=0.57 ) and duodenum ( p=0.52 ) ) or induced somatic referred pain areas ( esophagus ( p=0.75 ) and duodenum ( p=0.51 ) ) . No difference was seen in the induced somatic referred pain areas or self-reported symptoms . CONCLUSIONS No evidence was found for GES-induced modulation of the visceral sensory system and central excitability . However , GES has been proven to modulate the central nervous system in animal studies , necessitating further human experiments in order unambiguously to establish the possible central effects of GES .
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Intervention_Physical
gastric electrical stimulation
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Intervention_Surgical
gastric electrical stimulation ( GES )
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Intervention_Surgical
GES
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Intervention_Surgical
gastric electrical stimulator
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Intervention_Pharmacological
butylscopolamine
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Intervention_Surgical
GES-induced
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Intervention_Surgical
GES
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Intervention_Surgical
GES
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Outcome_Pain
overall gut pain
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Outcome_Physical
sensory response to mechanical stimulation
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Outcome_Physical
thermal sensitivity
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Outcome_Physical
sensory response to electrical stimulation
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Outcome_Pain
induced somatic referred pain areas
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Outcome_Pain
somatic referred pain areas
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Outcome_Physical
self-reported symptoms
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Participant_Condition
diabetic gastroparesis
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Participant_Sample-size
seven
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Participant_Condition
diabetic
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Participant_Condition
medically refractory gastroparesis