STOMACH PACEMAKER MAY EASE CHRONIC NAUSEA.HTM>Pam

[Guest guest]

Hi Pam:

Here is the link that you were talking about on Aussie Anne's stomach pacemaker.

Stomach pacemaker may ease chronic nausea

Trying to save you some work

Hugs Vera

Temple tackles tummy troubles with new technology

Drs. Henry Parkman (left) and Meilahn display a “stomach pacemaker,” which they hope will improve the quality of life of individuals with a rare gastrointestinal illness.

Food poisoning. Stomach flu. Morning sickness. Most of us have suffered the ravages of gastrointestinal fury at some point. It's not pleasant to think about, much less talk about—and enduring several days of nausea and vomiting will make anyone miserable.

Imagine if it never got better.

But, thanks to a new pacemaker that stimulates the stomach, people with the debilitating condition known as gastroparesis are getting a new lease on life at Temple University. The new therapy, called Enterra, involves placing the two-inch square pacemaker into a pocket beneath the skin.

For nearly 100,000 people in the United States who have gastroparesis, including Byrd of Virginia Beach, Va., stomach discomfort is a daily battle. In 1998, Byrd was in the hospital 46 times for chronic nausea.

“I can eat hardly anything now,” said Byrd, whose gastroparesis was caused by diabetes. “I feed myself through a tube that goes directly into my small intestine. The first couple of weeks that you can't eat, you really crave everything. But I haven't really eaten in two and a half years.” Though the cravings do go away over time, he's tethered to his feeding tube for both nutrition and hydration. In gastroparesis, stomach contents do not move into the intestine quickly enough to be digested properly.

“When there's a lot of food in the stomach, it gets distended,” explained Dr. Henry Parkman, director of Temple's gastrointestinal motility laboratory. “The distention causes abdominal discomfort, and people will get nauseated because there is so much food in the stomach.”

Also, people with gastroparesis eat less because they constantly feel full. In severe cases, the condition leads to dehydration, weight loss, electrolyte imbalances and malnutrition.

To correct this, wires from the pacemaker are attached to the smooth muscle tissue in the stomach walls.

Electrical impulses stimulate the muscle of the stomach, leading to better stomach function. According to Parkman, the device treats gastroparesis in two ways.

“It increases [the rate of] gastric emptying, and it reduces their symptoms by acting on the sensory nerves of the stomach to suppress their nausea and vomiting,” he said, noting that clinical trials showed that 50 percent of patients treated with Enterra therapy experienced a significant reduction in vomiting after six months.

When a patient complains of constant nausea, Parkman uses an endoscope to check the interior of the stomach; other conditions such as ulcer disease can cause similar symptoms. If food is still in the stomach after an overnight fast, there may be reason to suspect gastroparesis.

He then determines the best course of treatment, which in addition to the pacemaker can include drugs, diet modification, tube feeding—and in extreme cases—parenteral (intravenous) nutrition or removal of the stomach.

But as medicines have been picked off the approval list because of dangerous side effects, treatment options have become more limited. And, some patients, like Byrd, do not respond to medicinal therapy.

For those rare patients, the FDA approved the Enterra gastric electrical stimulator for compassionate use. Temple is one of about five medical centers in the country performing the procedure.

The surgery, performed by Dr. Meilahn, can be done either laparoscopically through scopes, which takes longer but is less invasive, or by the traditional laparotomic method, in which everything is handled through an open incision and therefore takes longer to heal.

“What I get out of this is the chance to provide a new type of therapy that's not been available to some of these patients who are doing very poorly,” said Parkman. “It's amazing the satisfaction you get when they've been doing poorly for many years, and all of a sudden they're getting better.”

“We're offering them a chance at a new life,” agreed Meilahn. “These are people who haven't had the problem for just a couple of days—it's a chronic condition. Most of us don't have any appreciation of what that's like.”

Byrd remains optimistic; with the pacemaker he's been returning—slowly—to a liquid diet.With continued improvement, he will not be as dependent on the tube feedings and will be able to get his strength back. And, he's only had the pacemaker for a couple of months, so he won't see the full benefit for a while yet.

“I'm not planning on staying this way for the rest of my life,” said Byrd. “I really think this is the thing for me—that and a few prayers.”

For more information on gastroparesis and the Enterra stomach pacemaker, visit http://www.medtronic.com/neuro/enterra

— Helen H.

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