Mechanisms of Action for the Enterra Medical Gastric Electrical Stimulator
- Conditions
- GastroparesisVomitingNausea
- Interventions
- Diagnostic Test: Effect of different gastric electrical stimulator stimulation paragdimes on brain, heart, and stomach.
- Registration Number
- NCT06582576
- Lead Sponsor
- University of Aarhus
- Brief Summary
Background: Gastric electrical stimulation applied by a surgically implanted device effectively alleviates upper gastrointestinal symptoms in the majority of individuals with medically refractory gastroparesis. Despite its efficacy, the mechanisms of action have been minimally explored in previous studies, and it is unknown why some individuals experience limited symptom-lowering effects.
Aim: We aim to investigate two of the potential mechanisms of action leading to symptom-reducing effects of gastric electrical stimulation: 1) possible central effects in the brainstem and brain by enhanced parasympathetic vagal activity, and 2) peripheral effects in the stomach by improved gastric accommodation.
Methods: Up to thirty individuals with drug-refractory gastroparesis having an implanted gastric electrical stimulator will be enrolled in this cross-sectional and observational study. Of these, 15 will be responders (substantial symptomatic improvement) and 15 non-responders (minor symptomatic improvement). Electroencephalography (EEG) will evaluate the stimulation-induced activity in the brain and brainstem to assess whether the gastric stimulation generates evoked potentials. Electrocardiography (ECG) will investigate stimulation-induced changes in the autonomic regulation of the heart. Gastric ultrasound will investigate the effect of stimulation on stomach accommodation, contractions, and wall tension. These central and peripheral measures will be assessed during one study day before and after activating the gastric electrical stimulator, following an increase in stimulation intensity and post-meal consumption. Furthermore, results will be compared between responders and non-responders.
Perspectives: Adjusting the parameters of gastric electrical stimulation based on objective markers in the brain, heart, or stomach, rather than relying on symptom fluctuations, may enhance the effectiveness of symptom improvement. In the future, these objective markers may aid in differentiating between responders and non-responders, which may lead to optimised selection criteria for surgery.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 30
- Age 18 and above
- Able to read and understand Danish
- Have an implanted gastric electrical stimulator for treating gastroparesis
- Answering 0 or 1 (non-responders) or 3 or 4 (responders) on the Likert scale describing the symptom improvement gained by gastric electrical stimulation.
- Personally signed and dated the informed consent documents ("Informeret samtykke") indicating that the patient has been informed of all pertinent aspects of the trial
- Are willing and able to comply with the scheduled visit and trial procedures
- Previous surgery on the vagus nerve, including cervical vagotomy
- Prior thoracic, abdominal or brain surgeries that, in the opinion of the investigator, could limit data collection or interpretation.
- Previous diagnosis or history of orthostatic intolerance, e.g. POTS, neurocardiogenic syncope, orthostatic hypotension or autonomic dysfunction.
- Patients with an implanted cardiac device (e.g. pacemaker, CRT, etc.) or vagal nerve stimulator (VNS).
- History of neurological disease that, in the opinion of the investigator, could limit data collection or interpretation.
- Participants with any clinical abnormalities that, in the opinion of the investigator, may increase the risk associated with trial participation or may interfere with the interpretation of the trial results
Study & Design
- Study Type
- OBSERVATIONAL
- Study Design
- Not specified
- Arm && Interventions
Group Intervention Description Responders Effect of different gastric electrical stimulator stimulation paragdimes on brain, heart, and stomach. Individuals who have a gastric pacemaker for treating gastroparesis and have experienced a "substantial or full" symptomatic improvement after the implantation. Non-responders Effect of different gastric electrical stimulator stimulation paragdimes on brain, heart, and stomach. Individuals who have a gastric pacemaker for treating gastroparesis and answered have experienced "some or none" symptomatic improvement after the implantation.
- Primary Outcome Measures
Name Time Method Evoked brain potentials 5min during maximum stimulation intensity Amplitude of evoked brain potentials induced by gastric electrical stimulation
- Secondary Outcome Measures
Name Time Method ECG measures between ON/OFF stimulation 5min Heart rate variability, periodic repolarisation dynamic, and the deceleration capacity of the heart rate when comparing the OFF and ON stimulation modes.
ECG measures between stimulation intensities 5min Heart rate variability, periodic repolarisation dynamic, and the deceleration capacity of the heart rate following different stimulation intensities.
Meal-related ECG measures 5min Heart rate variability, periodic repolarisation dynamic, and the deceleration capacity of the heart rate in response to an ingested meal when comparing the OFF and ON stimulation modes.
Meal-related gastric accomodation 5min Gastric accommodation in response to an ingested meal comparing OFF and ON stimulation.
Meal-related gastric tension 5min Gastric tension in response to an ingested meal comparing OFF and ON stimulation.
Meal-related gastric contraction frequency 5min Gastric contraction frequency in response to an ingested meal comparing OFF and ON stimulation.
Symptoms and gastric measures 5min Correlation between gastroparesis symptoms (Gastroparesis Cardinal Symptom Index) and changes in gastric accommodation/tension when turning the stimulation ON after meal ingestion.
EEG measures between ON/OFF stimulation 5min EEG frequency distribution when comparing the OFF and ON stimulation modes
Meal-related EEG measures 5min EEG frequency distribution in response to an ingested meal when comparing the OFF and ON stimulation modes.
Trial Locations
- Locations (1)
Department of hepatology and gastroenterology, Aarhus University Hospital
🇩🇰Aarhus N, Denmark