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Gouveia FV, Silk E, Davidson B, Pople CB, Abrahao A, Hamilton J, Ibrahim GM, Müller DJ, Giacobbe P, Lipsman N, Hamani C. A systematic review on neuromodulation therapies for reducing body weight in patients with obesity. Obes Rev 2021; 22:e13309. [PMID: 34337843 DOI: 10.1111/obr.13309] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 06/01/2021] [Accepted: 06/02/2021] [Indexed: 12/11/2022]
Abstract
The global prevalence of obesity increases yearly along with a rising demand for efficacious, safe, and accessible treatments. Neuromodulation interventions (i.e., deep brain stimulation [DBS], transcranial magnetic stimulation [TMS], transcranial direct current stimulation [tDCS], percutaneous neurostimulation [PENS], vagus nerve stimulation [VNS], and gastric electrical stimulation [GES]) have been proposed as novel therapies. This systematic review sought to examine the safety and efficacy of neuromodulation therapies in reducing body weight in patients with obesity. Using PRISMA guidelines, we performed a systematic review for studies on neuromodulation for the treatment of obesity, resulting in 60 trials included (7 DBS, 5 TMS, 7 tDCS, 17 PENS and VNS, and 24 GES; a total of 3,042 participants). While promising results have been reported in open label studies, double-blinded randomized clinical trials often did not reach their primary endpoints, with no technique inducing a striking reduction in body weight. Bearing in mind the complexity and multifactorial nature of obesity, it is possible that a single treatment may not be enough for patients to lose or maintain the weight lost at long term.
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Affiliation(s)
| | - Esther Silk
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Benjamin Davidson
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Christopher B Pople
- Sunnybrook Research Institute, Toronto, Ontario, Canada.,Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Agessandro Abrahao
- Sunnybrook Research Institute, Toronto, Ontario, Canada.,Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jill Hamilton
- Division of Endocrinology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - George M Ibrahim
- Division of Neurosurgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Daniel J Müller
- Pharmacogenetics Research Clinic, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Peter Giacobbe
- Sunnybrook Research Institute, Toronto, Ontario, Canada.,Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Nir Lipsman
- Sunnybrook Research Institute, Toronto, Ontario, Canada.,Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Clement Hamani
- Sunnybrook Research Institute, Toronto, Ontario, Canada.,Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Abstract
Gastrointestinal (GI) motility disorders are common in clinical settings, including esophageal motility disorders, gastroesophageal reflux disease, functional dyspepsia, gastroparesis, chronic intestinal pseudo-obstruction, post-operative ileus, irritable bowel syndrome, diarrhea and constipation. While a number of drugs have been developed for treating GI motility disorders, few are currently available. Emerging electrical stimulation methods may provide new treatment options for these GI motility disorders. Areas covered: This review gives an overview of electrical therapies that have been, and are being developed for GI motility disorders, including gastroesophageal reflux, functional dyspepsia, gastroparesis, intestinal motility disorders and constipation. Various methods of gastrointestinal electrical stimulation are introduced. A few methods of nerve stimulation have also been described, including spinal cord stimulation and sacral nerve stimulation. Potentials of electrical therapies for obesity are also discussed. PubMed was searched using keywords and their combinations: electrical stimulation, spinal cord stimulation, sacral nerve stimulation, gastrointestinal motility and functional gastrointestinal diseases. Expert commentary: Electrical stimulation is an area of great interest and has potential for treating GI motility disorders. However, further development in technologies (devices suitable for GI stimulation) and extensive clinical research are needed to advance the field and bring electrical therapies to bedside.
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Affiliation(s)
- Jiande D Z Chen
- a Division of Gastroenterology and Hepatology, Department of Medicine , Johns Hopkins University , Baltimore , MD , USA.,b Department of Medicine , VA Medical Center , Oklahoma City , OK , USA
| | - Jieyun Yin
- a Division of Gastroenterology and Hepatology, Department of Medicine , Johns Hopkins University , Baltimore , MD , USA
| | - Wei Wei
- c Division of Gastroenterology , Wangjing Hospital of Chinese Medical Academy , Beijing , China
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Abstract
The definition of malnutrition in the published standards of the American Society of Parenteral and Enteral Nutrition (A.S.P.E.N.) is any derangement in the normal nutrition status and includes overnutrition, commonly referred to as obesity. The incidence of obesity is increasing and reaching epidemic proportions in the United States and even worldwide. This has significant financial impact as our society spends billions of dollars on fad diets, commercial weight-loss programs, nutrition and dietary supplements, prescription and over-the-counter medications, and health clubs. Another approximately dollars 100 billion are spent to treat the medical consequences of obesity. Currently, for those patients with intractable morbid obesity, defined as having a body mass index >40 kg/m2, surgery offers the only option for achieving meaningful and sustainable weight loss. The resultant weight loss dramatically improves health and decreases the cost of health care for these patients. Years of refinement in technology and the introduction of safer and less invasive procedures have dramatically reduced the short-term morbidities and long-term metabolic consequences of these procedures. This address will review the field of weight loss (bariatric) surgery and will offer a compelling request for A.S.P.E.N. to include obesity in its fabric.
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Affiliation(s)
- Scott A Shikora
- Tufts University School of Medicine, Bariatric Surgery, Tufts-New England Medical Center, Boston, Massachusetts 02111, USA.
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Guo X, Li Y, Yao S, Chen S, Du Y, Wang Z. Parameter selection and stimulating effects of an adjustable gastric electrical stimulator in dogs. Obes Surg 2014; 24:78-84. [PMID: 23868140 PMCID: PMC3889984 DOI: 10.1007/s11695-013-1037-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Gastric electrical stimulation (GES) has been proposed as a promising therapeutic option in treating obesity for 20 years. Currently, the available device of GES cannot meet the clinical needs. The purpose of this study is to verify the effect of a new type of adjustable gastric electrical stimulator in reducing food intake and body weight. METHODS Eight beagle dogs randomly followed GES and sham GES for 3 months in a crossover design. Parameters were adjusted and individualized during the experiment. Symptoms of GES were recorded, and the effective parameters were selected. Resistance to GES was assessed. Food intake and body weight were measured to evaluate the effect of GES. RESULTS The effective parameters were varied among the dogs. Resistance to GES was observed in different periods in dogs. Parameters needed to be adjusted every 10.2 ± 2.1 days during the period of GES. Food intake during GES for 3 months was significantly reduced than that during sham GES of 3 months (P < 0.05). With the decreased food intake, body weight was significantly reduced by the end of GES of 3 months compared with that of sham GES of 3 months (P < 0.05). CONCLUSIONS Food intake and body weight of dogs are significantly reduced by adjustable GES. Individual parameters and resistance during GES are required to be considered. The new adjustable device may have good prospects of clinical application for obesity.
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Affiliation(s)
- Xiaojuan Guo
- Graduate School, Peking Union Medical College and Chinese Academy of Medical Sciences, 9 Dong Dan San Tiao, Dongcheng District, Beijing, 100730 People’s Republic of China
- Department of Gastroenterology, China‐Japan Friendship Hospital, 2 Yinghua East Road, Chaoyang District, Beijing, 100029 People’s Republic of China
| | - Yanmei Li
- Department of Gastroenterology, China‐Japan Friendship Hospital, 2 Yinghua East Road, Chaoyang District, Beijing, 100029 People’s Republic of China
| | - Shukun Yao
- Graduate School, Peking Union Medical College and Chinese Academy of Medical Sciences, 9 Dong Dan San Tiao, Dongcheng District, Beijing, 100730 People’s Republic of China
- Department of Gastroenterology, China‐Japan Friendship Hospital, 2 Yinghua East Road, Chaoyang District, Beijing, 100029 People’s Republic of China
| | - Shaoxuan Chen
- Department of Gastroenterology, China‐Japan Friendship Hospital, 2 Yinghua East Road, Chaoyang District, Beijing, 100029 People’s Republic of China
| | - Yuhui Du
- Noted Technology Development Co. Ltd, 7 Gao Xin Nan, Nanshan District, Shenzhen, 518057 People’s Republic of China
| | - Zhihua Wang
- Institute of Microelectronics, Tsinghua University, 30 Shuangqing Road, Haidian District, Beijing, 100084 People’s Republic of China
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Zhang J, Sha W, Zhu H, Chen JDZ. Blunted Peripheral and Central Responses to Gastric Mechanical and Electrical Stimulations in Diet-induced Obese Rats. J Neurogastroenterol Motil 2013; 19:454-66. [PMID: 24199005 PMCID: PMC3816179 DOI: 10.5056/jnm.2013.19.4.454] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2013] [Revised: 07/28/2013] [Accepted: 08/09/2013] [Indexed: 01/26/2023] Open
Abstract
Background/Aims The increase in the prevalence of obesity is attributed to increased food intake and decreased physical activity in addition to genetic factors. Altered gut functions have been reported in obese subjects, whereas, little is known on the possible alterations in brain-gut interactions in obesity. The aim of the study was to explore possible alterations in gastric myoelectrical activity, gastric emptying, autonomic functions and central neuronal responses to gastric stimulations in diet-induced obese rats. Methods Gastric myoelectrical activity, gastric emptying and heart rate variability were recorded in lean and obese rats; extracellular neuronal activity in the ventromedial hypothalamus and its responses to gastric stimulations were also assessed. Results (1) Gastric emptying was significantly accelerated but gastric myoelectrical activity was not altered in obese rats; (2) the normal autonomic responses to feeding were absent in obese rats, suggesting an impairment of postprandial modulation of autonomic functions; and (3) central neuronal responses to gastric stimulations (both balloon distention and electrical stimulation) were blunted in obese rats, suggesting impairment in the brain-gut interaction. Conclusions In diet-induced obese rats, gastric emptying is accelerated, postprandial modulations of autonomic functions is altered and central neuronal responses to gastric stimulations are attenuated. These alterations in peripheral, autonomic and brain-gut interactions may help better understand pathogenesis of obesity and develop novel therapeutic approaches for obesity.
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Affiliation(s)
- Jing Zhang
- Veterans Research and Education Foundation, VA Medical Center, Oklahoma City, OK, USA
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Li S, Maude-Griffin R, Sun Y, Starkebaum W, Chen JDZ. Food intake and body weight responses to intermittent vs. continuous gastric electrical stimulation in diet-induced obese rats. Obes Surg 2013; 23:71-9. [PMID: 23001597 DOI: 10.1007/s11695-012-0773-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Gastric electrical stimulation (GES) has recently been introduced as a potential therapy for the treatment of obesity. The main challenge for the new generation of devices is to achieve desired clinical outcomes at a suitably low level of energy consumption. The aim of this study is to compare the effectiveness of GES with continuous and intermittent duty cycles in reducing food intake and body weight in diet-induced obesity-prone rats. METHODS In macro duty cycle experiment, 40 rats were divided into groups to receive a sham GES, continuous GES, or intermittent GES (15 min On-45 min Off or 15 min On-15 min Off) for 28 days. In micro duty cycle experiment, 18 rats received cross-over treatment of continuous stimulation, 60 % time cycle or 40 % time cycle. Food intake, body weight, gastric emptying and ghrelin level were measured to evaluate the effect of different GES. RESULTS GES with macro duty cycle intensity-dependently reduced mean daily food intake increase by 18.6, 10.2 and -6.0 % compared to 42.7 % with sham GES and body weight gain by 6.1 %, 3.4 and -0.8 % compared to 5 % with sham GES. Daily food intake decreased with increasing micro duty cycle intensity, averaging 16.5, 15.6 and 13.7 g/day under 40 % cycle, 60 % cycle and continuous stimulation respectively. Gastric emptying was intensity-dependently delayed by GES. GES has no effect in modulating plasma ghrelin level. CONCLUSIONS GES energy-dependently reduces food intake, body weight and gastric emptying. Peripheral modulation of plasma ghrelin level is not related to the GES effects.
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Affiliation(s)
- Shiying Li
- Veterans Research and Education Foundation, VA Medical Center, Oklahoma City, OK, USA
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Mizrahi M, Ben Ya'acov A, Ilan Y. Gastric stimulation for weight loss. World J Gastroenterol 2012; 18:2309-19. [PMID: 22654422 PMCID: PMC3353365 DOI: 10.3748/wjg.v18.i19.2309] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Revised: 09/02/2011] [Accepted: 04/28/2012] [Indexed: 02/06/2023] Open
Abstract
The prevalence of obesity is growing to epidemic proportions, and there is clearly a need for minimally invasive therapies with few adverse effects that allow for sustained weight loss. Behavior and lifestyle therapy are safe treatments for obesity in the short term, but the durability of the weight loss is limited. Although promising obesity drugs are in development, the currently available drugs lack efficacy or have unacceptable side effects. Surgery leads to long-term weight loss, but it is associated with morbidity and mortality. Gastric electrical stimulation (GES) has received increasing attention as a potential tool for treating obesity and gastrointestinal dysmotility disorders. GES is a promising, minimally invasive, safe, and effective method for treating obesity. External gastric pacing is aimed at alteration of the motility of the gastrointestinal tract in a way that will alter absorption due to alteration of transit time. In addition, data from animal models and preliminary data from human trials suggest a role for the gut-brain axis in the mechanism of GES. This may involve alteration of secretion of hormones associated with hunger or satiety. Patient selection for gastric stimulation therapy seems to be an important determinant of the treatment’s outcome. Here, we review the current status, potential mechanisms of action, and possible future applications of gastric stimulation for obesity.
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Yin J, Abell TD, McCallum RW, Chen JD. Gastric Neuromodulation With Enterra System for Nausea and Vomiting in Patients With Gastroparesis. Neuromodulation 2012; 15:224-31; discussion 231. [DOI: 10.1111/j.1525-1403.2012.00429.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Abstract
Bariatric surgery is a field in rapid evolution, and the speed of this evolution has been accelerating over the last several decades. A thorough understanding of past developments is crucial to anticipating the future intelligently. The trends that have driven evolution historically often persist, and continue to be influential in the future. With this in mind, this article briefly outlines the historical and current trends in bariatric surgery, and follows the trajectory of these trends into the future to anticipate the technologies and techniques that will be most important to the field in the coming years.
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Affiliation(s)
- Sean M Lee
- Department of Surgery, Duke University Medical Center, Box 3443, Durham, NC 27710, USA
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Zhang J, Maude-Griffin R, Zhu H, Sun Y, Starkebaum W, Firestone E, Chen JDZ. Gastric electrical stimulation parameter dependently alters ventral medial hypothalamic activity and feeding in obese rats. Am J Physiol Gastrointest Liver Physiol 2011; 301:G912-8. [PMID: 21852365 DOI: 10.1152/ajpgi.00487.2010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Gastric electrical stimulation (GES) has been used to treat obesity with unclear mechanisms and limited parameter ranges. This study explores effects of GES parameters on ventral medial hypothalamic (VMH) activity, feeding, and body weight in diet-induced obese (DIO) rats. For experiment 1, discharge rates were recorded in 39 gastric distension-responsive (GD-R) neurons in 12 DIO rats. Basal rates were compared with rates under GES using varied pulse amplitudes, widths, frequencies, and train-on times. For experiment 2, a crossover experiment in 16 DIO rats measured food intake and weight effects of GES pulse width, the parameter with the steepest neuronal response gradient in experiment 1. Treatments were sham and 0.5-, 2.0-, and 5.0-ms pulse GES. In experiment 1, 11 of 13 GES parameter sets tested produced significantly (P < 0.05) altered discharge rates of GD-R neurons. Increases in pulse amplitude (P < 0.05) and width (P < 0.0001) produced significant upward linear trends in response over the range tested, with the trend being strongest for pulse width. In experiment 2, over 4 days of 0.5-, 2.0-, and 5.0-ms GES treatment, food intake was 9.6% (P < 0.05), 21.0% (P < 0.0001), and 47.3% (P < 0.0001) lower than under sham-GES, whereas body weight changes were 0.7 (P = 0.48), 2.2 (P < 0.05), and 3.5 (P < 0.002) percentage points lower, respectively. We concluded that GES pulse width increases had the largest effect on VMH neuronal activity, and these effects were paralleled by pulse width-dependent reductions in food intake and body weight. Lengthening pulse width beyond the range used in prior clinical studies may be critical to making GES a viable obesity treatment.
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Affiliation(s)
- Jing Zhang
- Veterans Research and Education Foundation, VA Medical Center, Oklahoma City, Oklahoma, USA
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Korner J, Nandi A, Wright SM, Waitman J, McMahon DJ, Bessler M, Aronne LJ. Implantable gastric stimulator does not prevent the increase in plasma ghrelin levels that occurs with weight loss. Obesity (Silver Spring) 2011; 19:1935-9. [PMID: 21681227 PMCID: PMC4041394 DOI: 10.1038/oby.2010.162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
UNLABELLED The SHAPE (Screened Health Assessment and Pacer Evaluation) trial was a 24 month randomized multicenter placebo-controlled study to determine the efficacy of an implantable gastric stimulator (IGS) for weight loss. This report is an investigator-initiated sub-study at one site designed to assess whether IGS affects plasma levels of ghrelin and peptide YY (PYY). The device was implanted in all subjects but was activated in the TREATMENT group (n = 7, BMI = 41.5 ± 2.0 kg/m2) and remained inactive in the CONTROL (n = 6, BMI = 39.5 ± 1.7 kg/m2) during the first 12 months. IGS was activated in both groups during months 12-24. Fasting venous blood was drawn at months 0, 12, and 24 and an oral glucose tolerance test (OGTT) was performed at month 12. Although there was no difference in weight loss at 6 months ( CONTROL -6.6 ± 1.5% vs. TREATMENT -6.2 ± 1.4%), at 24 months the CONTROL group exhibited weight gain from baseline (+2.2 ± 1.5%) that was significantly different from the weight loss in the TREATMENT group (-1.9 ± 1.4%; P < 0.05). At 12 months, fasting ghrelin was significantly increased (P < 0.05) in the TREATMENT group (285 ± 35 to 336 ± 35 pg/ml; weight change, -4.9 ± 1.4%), but not in the CONTROL (211 ± 36 to 208 ± 35 pg/ml; weight change, -3.4 ± 1.5%). No significant change was observed in postprandial suppression of plasma ghrelin or in fasting and postprandial PYY levels. In conclusion, IGS does not prevent the increase in fasting plasma ghrelin levels associated with weight loss. Further studies are needed to determine whether changes in technology can improve weight loss and maintenance, perhaps using gut hormones as biomarkers of possible efficacy.
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Affiliation(s)
- Judith Korner
- Department of Medicine, Columbia University College of Physicians & Surgeons, New York, New York, USA.
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Abstract
Because bariatric surgery is becoming increasingly common, gastroenterologists need to be familiar with the surgical and endoscopic anatomy of the operations in use today. This review focuses on the 4 most commonly performed bariatric operations in the United States: Roux-en-Y gastric bypass, adjustable gastric band, sleeve gastrectomy, and biliopancreatic diversion with duodenal switch. The anatomy and mechanism of action of each procedure is discussed and illustrated. Emphasis is placed on the endoscopic anatomy, with review of the commonly encountered complications. Emerging techniques and devices are reviewed.
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Affiliation(s)
- Daniel M Herron
- Department of Surgery, Mount Sinai School of Medicine, 1 Gustave L. Levy Place, #1259, New York, NY 10029, USA.
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Wang J, Song J, Hou X, Liu J, Chen JDZ. Effects of cutaneous gastric electrical stimulation on gastric emptying and postprandial satiety and fullness in lean and obese subjects. J Clin Gastroenterol 2010; 44:335-339. [PMID: 20195164 DOI: 10.1097/mcg.0b013e3181d34572] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
GOALS The aim of this study was to investigate the therapeutic potential of cutaneous gastric electrical stimulation (CGES) at a tachygastrial frequency for obesity. BACKGROUND Implantable gastric electrical stimulator has been proposed for the treatment of obesity and it has recently been reported that the gastric electrical stimulation at a tachygastrial frequency inhibits gastric motility. STUDY METHODS Ten lean and 10 obese healthy volunteers were studied in 3 randomized sessions: no CGES, CGES at the physiologic frequency (3 cycles/min), and CGES at tachygastrial frequency (12 cycles/min). Electrical stimulation was performed using sinusoidal waves. The protocol included the following sequence: 20-minute baseline, 30-minute CGES, 30-minute recording without CGES, 30-minute CGES, ingestion of a 500 kcal liquid meal, and 30-minute CGES. Gastric slow waves were recorded using cutaneous electrogastrography during the periods without CGES. Gastric emptying was assessed by ultrasound. Dyspeptic symptoms were recorded. RESULTS (1) The half-time of gastric emptying was longer with CGES at the tachygastrial frequency than CGES at the physiologic frequency in both lean subjects (75.0+/-16.5 min vs. 41.0+/-8.7 min, P<0.01) and obese subjects (64.1+/-13.3 min vs. 32.7+/-5.0 min, P<0.01). (2) Postprandial dyspeptic symptom score (mainly satiety and fullness) was significantly higher with CGES at the tachygastrial frequency than CGES at the physiologic frequency in both lean (3.2+/-1.47 vs. 1.7+/-0.94, P<0.01) and obese (3.9+/-1.89 vs. 1.8+/-1.15, P<0.01) subjects. CONCLUSIONS CGES at a tachygastrial frequency enhances postprandial fullness and satiety, and delays gastric emptying. Its therapeutic potential for obesity needs to be studied.
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Affiliation(s)
- Jing Wang
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
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Bodenlos JS, Kose S, Borckardt JJ, Nahas Z, Shaw, O'Neil PM, Pagoto SL, George MS. Vagus nerve stimulation and emotional responses to food among depressed patients. J Diabetes Sci Technol 2009; 1:771-9. [PMID: 19885147 DOI: 10.1177/193229680700100524] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Approved for treatment of treatment-resistant depression and for epilepsy, vagus nerve stimulation (VNS) therapy involves stimulation of the vagus nerve, affecting both mood and appetite regulating systems. VNS is associated with changes in food intake and weight loss in animals. Studies of its impact on food intake and weight with humans are limited. It is not known whether or how VNS influences emotional response to food, but vagus afferents project to regions in the insula involving satiety and taste. METHOD Thirty-three participants were recruited for three groups: depressed patients undergoing VNS therapy, depressed patients not undergoing VNS therapy, and healthy controls. All participants viewed images of foods twice in random order. When applicable, VNS devices were turned on for one viewing and off for the other. Participants were instructed to rate immediately after the viewings how each picture made them feel on a visual analog on three dimensions (unhappy to happy, calm to aroused, and small/submissive to big/domineering). RESULTS Controlling for time since last meal, a significant main effect was found for arousal ratings in response to sweet food images. Post-hoc analyses indicated that the VNS group demonstrated significant changes in arousal ratings between paired food image viewings compared to controls. Sixty-four percent of VNS participants demonstrated increases and 36% demonstrated decreases in arousal. Higher body mass indexes and greater levels of self-reported sweet cravings were associated with increased arousal during VNS activation. CONCLUSIONS This study was the first to examine the effects of acute left cervical VNS on emotional ratings of food in adults with major depression. Results suggest that VNS device activation may be associated with acute alteration in arousal response to sweet foods among depressed patients. Future research is needed to replicate these findings and to assess how activation of the vagus nerve affects eating and weight.
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Affiliation(s)
- Jamie S Bodenlos
- Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, Massachusetts 01655, USA.
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Song GQ, Lei Y, Xu X, Chen JDZ. Gastric electrical stimulation with long pulses in humans and animals: can data obtained in animals be replicated in humans? Neuromodulation 2009; 13:87-92. [PMID: 21992779 DOI: 10.1111/j.1525-1403.2009.00241.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AIMS The aim of this study was to investigate and compare effective parameters for gastric electrical stimulation (GES) to modulate gastric muscle functions in different species. METHODS Four species: Pigs, dogs, rats, and mice implanted with two pairs of electrodes on the serosal surface of the stomach were studied, respectively. Experiment 1 was designed to entrain/pace gastric slow waves and included a series of 5-min periods with long-pulse GES of different pulse widths and frequencies. Experiment 2 was designed to induce gastric dysrhythmia with long-pulse GES of different frequencies. Gastric slow waves were recorded during the entire experiment. RESULTS 1) The minimum pulse width for GES to completely entrain the slow waves was similar (100-400 msec) in all four species. 2) With fixed amplitude (4 mA) and pulse width (400 msec), the highest frequency at which slow waves could be paced was similar (about 10-60% higher than the intrinsic slow wave frequency) in all species. 3) With fixed pulse width of 400 msec and amplitude of 6 mA, GES with nine to 18 cycles per min (cpm) was able to induce dysrhythmia in dogs. In addition, there was no significant difference among these frequencies of 9-18 cpm. 4) GES with 400 msec, 6 mA, and 9 cpm was able to induce dysrhythmia in all species. These effective GES parameters in results 1-4 were similar to those used in humans in the literature. CONCLUSIONS There is no significant difference in stimulation parameters when GES is applied to alter gastric slow waves in different animal models. Furthermore, the effective parameters for GES to alter slow waves are similar between the humans and various animal models. These findings suggest that stimulation parameters obtained from animal studies are applicable in humans.
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Affiliation(s)
- Geng-Qing Song
- Veterans Research Foundation, VA Medical Center, Oklahoma City, OK, USA; and Division of Gastroenterology, University of Texas Medical Branch at Galveston, Galveston, TX, USA
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Yin J, Chen JD. Intestinal Electrical Stimulation. Neuromodulation 2009. [DOI: 10.1016/b978-0-12-374248-3.00076-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Sevcencu C. Gastric Stimulation for Dysmotility Disorders and Obesity. Neuromodulation 2009. [DOI: 10.1016/b978-0-12-374248-3.00075-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Zhao X, Yin J, Chen J, Song G, Wang L, Zhu H, Brining D, Chen JDZ. Inhibitory effects and mechanisms of intestinal electrical stimulation on gastric tone, antral contractions, pyloric tone, and gastric emptying in dogs. Am J Physiol Regul Integr Comp Physiol 2008; 296:R36-42. [PMID: 18945955 DOI: 10.1152/ajpregu.90627.2008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The aim of this study was to investigate the effects and mechanisms of intestinal electrical stimulation (IES) on gastric tone, antral and pyloric contractions, and gastric emptying in dogs. Female hound dogs were equipped with a duodenal or gastric cannula, and one pair of serosal electrodes was implanted in the small intestine. The study consisted of five different experiments. Liquid gastric emptying was assessed by collection of chyme from the duodenal cannula in a number of sessions with and without IES and with and without N-nitro-l-arginine (l-NNA). Postprandial antral and pyloric contractions were measured with and without IES and in the absence and presence of l-NNA or phentolamine by placement of a manometric catheter into the antrum and pylorus via the duodenal cannula. Gastric tone was assessed by measurement of gastric volume at a constant pressure. Gastric emptying was substantially and significantly delayed by IES or l-NNA compared with the control session. IES-induced delay of gastric emptying became normal with addition of l-NNA. IES reduced gastric tone, which was blocked by l-NNA. IES also inhibited antral contractions (frequency and amplitude), and this inhibitory effect was not blocked by l-NNA but was blocked by phentolamine. IES alone did not affect pyloric tone or resistance, but IES + l-NNA decreased pyloric tone. In conclusion, IES reduces gastric tone via the nitrergic pathway, inhibits antral contractions via the adrenergic pathway, does not affect pyloric tone, and delays liquid gastric emptying. IES-induced delay of gastric emptying is attributed to its inhibitory effects on gastric motility.
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Affiliation(s)
- Xiaotuan Zhao
- Division of Gastroenterology, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas 77555-0632, USA
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Sallam HS, Chen JDZ, Pasricha PJ. Feasibility of gastric electrical stimulation by percutaneous endoscopic transgastric electrodes. Gastrointest Endosc 2008; 68:754-9. [PMID: 18718585 DOI: 10.1016/j.gie.2008.04.060] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2008] [Accepted: 04/19/2008] [Indexed: 12/14/2022]
Abstract
BACKGROUND Gastric electrical stimulation has been used for the treatment of drug refractory GI motility disorders and for the treatment of obesity. Both these indications have involved surgical placement of gastric electrodes, which adds to the complexity and cost of the procedure. Endoscopic placement is therefore an attractive alternative approach for this therapy. OBJECTIVE Our purpose was to investigate the feasibility, safety, and efficacy of percutaneous endoscopic electrodes for gastric electrical stimulation. DESIGN AND SETTING Experimental animal study in hound dogs. INTERVENTIONS Percutaneous endoscopic transgastric electrode (PETE) placement was carried out by using a pair of gastric pacing wires attached to a percutaneous endoscopic gastrostomy tube. In addition, 4 pairs of gastric serosal electrodes were implanted surgically for comparison. The efficacy of the percutaneous endoscopic electrodes was defined by their ability to entrain gastric slow waves and the induction of dysrhythmia. RESULTS (1) The PETE recorded gastric slow waves comparable to the serosal electrodes. (2) Gastric electrical stimulation with long pulses delivered by the PETE, at a frequency of 10% higher than the intrinsic gastric slow wave frequency, entrained gastric slow waves. (3) Gastric electrical stimulation delivered by the PETE, at a tachygastric frequency, induced gastric dysrhythmia. LIMITATIONS This was an animal study; however, its results are expected to be reproducible in humans, with PETE kept in place for even a longer duration than 6 to 8 weeks. CONCLUSION PETE placement is both feasible and safe. PETEs are effective, having a potential for use in treatment of both gastroparesis and obesity.
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Affiliation(s)
- Hanaa S Sallam
- Division of Gastroenterology, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas 77555-0632, USA
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Zhang J, Liu S, Tang M, Chen JDZ. Optimal locations and parameters of gastric electrical stimulation in altering ghrelin and oxytocin in the hypothalamus of rats. Neurosci Res 2008; 62:262-9. [PMID: 18940208 DOI: 10.1016/j.neures.2008.09.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2008] [Revised: 08/26/2008] [Accepted: 09/08/2008] [Indexed: 01/12/2023]
Abstract
UNLABELLED Gastric electric stimulation (GES) has been shown to decrease gastric tone and antrum motility, delay gastric empty, suppress appetite and induce weight loss in animal models. Our previous studies have shown that GES activates gastric-distension responsive neurons in several satiety related hypothalamic nuclei; Two hour acute GES at gastric antrum can alter the expression of anorexigenic and orexigenic peptides in the hypothalamus of rats. AIM To investigate the effects of GES with different stimulation parameters and locations on the neuronal expression of a hunger hormone, ghrelin and a satiety hormone, oxytocin (OT) in the hypothalamus of rats. METHODS With immunohistochemical technique, changes in expression of satiety-related peptides-containing (OT- and ghrelin-) neurons with GES in the rodent hypothalamus were assessed. GES was performed for 2h using six different sets of parameters at three different locations. RESULTS (1) The number of ghrelin/OT-immunoreactive (IR) neurons was significantly decreased/increased with GES of the standard parameters (pulse trains: train on-time of 2s, off-time of 3s, pulse amplitude of 6 mA, width of 0.3 ms and frequency of 40 Hz) in both the paraventricular nucleus (PVN) and the superoptical nucleus (SON) compared with the control group, but not with GES of reduced pulse amplitudes, frequencies or train-on times. (2) GES with the standard parameters at the antrum resulted in a significant decrease/increase in the expression of ghrelin/OT in the PVN and the SON. However, GES at other locations (middle of lesser curvature or greater curvature) was not effective in altering the expression of ghrelin/OT. CONCLUSIONS GES with the standard parameters delivered at the distal antrum increases/decreases oxytocin/ghrelin in the hypothalamus of rats. GES with reduced parameters or delivered at the middle of the stomach is ineffective in altering these peptides.
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Affiliation(s)
- Jing Zhang
- Veterans Research and Education Foundation, VA Medical Center, Oklahoma City, OK, United States
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Lei Y, Xing J, Chen J. The effect on gastric tone of gastric electrical stimulation with trains of short pulses varies with sites and stimulation conditions. Dig Dis Sci 2008; 53:2066-71. [PMID: 18481178 DOI: 10.1007/s10620-008-0282-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2005] [Accepted: 04/09/2008] [Indexed: 12/27/2022]
Abstract
BACKGROUND Gastric electrical stimulation (GES) can improve symptoms in patients with gastroparesis and induce weight loss in obese subjects. AIMS To evaluate the effect on gastric tone of GES under different conditions at different sites of the stomach. METHODS Eleven dogs were implanted with a gastric cannula and two pairs of stimulation electrodes (in the middle of the lesser curvature and of the greater curvature, 10 cm from the pylorus). Gastric tone was assessed with a barostat. GES was applied using: (1) Enterra conditions (14 Hz, 5 mA, 0.3 ms, 0.1 s on, 5 s off); (2) modified Enterra conditions (40 Hz, 5 mA, 0.3 ms, 0.1 s on, 5 s off); and (3) implantable gastric stimulation (IGS) conditions (40 Hz, 5 mA, 0.3 ms, 2 s on, 3 s off). Six sessions were performed randomly with each animal on six separate days. RESULTS (1) At the lesser curvature, GES with modified Enterra conditions significantly elevated gastric volume from 96.9 +/- 8.3 ml at baseline to 133.9 +/- 11.7 ml (P = 0.015) and a similar effect was observed with IGS (91.3 +/- 7.1 ml vs. 186.3 +/- 27.1 ml, P = 0.013). GES with Enterra conditions had no such an effect. (2) At the greater curvature, GES with Enterra conditions significantly increased gastric volume from basal 94.1 +/- 4.4 ml to 122.1 +/- 11.3 ml (P = 0.032); modified Enterra conditions had the opposite effect (96.5 +/- 9.0 ml vs. 77.4 +/- 11.7 ml, P = 0.025) and no significant effect was observed with IGS conditions. CONCLUSION The effects of GES on gastric tone vary with the conditions and sites of stimulation. These findings may help to explain the distinct effects of GES therapy in patients with gastroparesis and obesity.
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Affiliation(s)
- Yong Lei
- Veterans Research Foundation, Oklahoma City, OK, USA
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Affiliation(s)
- Deron J Tessier
- Staff Surgeon, Kaiser Permanente Medical Center, Fontana, California, USA
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Xu X, Pasricha PJ, Chen JDZ. Feasibility of gastric electrical stimulation by use of endoscopically placed electrodes. Gastrointest Endosc 2007; 66:981-6. [PMID: 17963885 DOI: 10.1016/j.gie.2007.05.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2006] [Accepted: 05/04/2007] [Indexed: 12/14/2022]
Abstract
BACKGROUND Gastric electrical stimulation (GES), which has been reported to have therapeutic potentials for gastroparesis and obesity, involves the surgical placement of electrodes with the patient under general anesthesia. New methods are needed for implanting GES electrodes in a safer and more feasible way. OBJECTIVE Our purpose was to investigate the safety and feasibility of placing electrodes endoscopically for GES. DESIGN AND SETTING A pilot study. SUBJECTS Six female hound dogs that weighed 13 to 22 kg. INTERVENTIONS Endoscopically placed electrodes passed through the abdomen and the stomach wall. MAIN OUTCOME MEASUREMENTS The study was performed in dogs surgically implanted with gastric serosal electrodes and endoscopically implanted electrodes. The experiment consisted of a 30-minute baseline, a 30-minute GES, and a 30-minute recovery. GES was performed through endoscopically placed electrodes. Gastric slow waves were simultaneously recorded with the serosal electrodes and the endoscopically placed electrodes. RESULTS (1) The slow wave frequency recorded from the endoscopically placed electrodes was significantly correlated with that from the serosal electrodes (r = 0.97, P < .002). (2) GES through the endoscopically placed electrodes was able to entrain gastric slow waves. (3) No gastric leakage into the abdominal cavity was noted and the dogs were healthy and comfortable. (4) The endoscopically placed electrodes remained for 2 to 3 weeks. LIMITATIONS The fixation of the electrodes needs to be improved for longer-term uses. CONCLUSIONS GES may be accomplished without surgery by inserting the electrode wire through the abdomen under endoscopy. The study results indicate that the endoscopically placed electrodes are effective for GES and do not result in any adverse events.
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Affiliation(s)
- Xiaohong Xu
- Division of Gastroenterology, University of Texas Medical Branch, Galveston, Texas, USA
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Cigaina V, Hirschberg AL. Plasma ghrelin and gastric pacing in morbidly obese patients. Metabolism 2007; 56:1017-21. [PMID: 17618944 DOI: 10.1016/j.metabol.2007.03.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2006] [Accepted: 03/29/2007] [Indexed: 11/26/2022]
Abstract
Gastric pacing is a new treatment of morbid obesity. Patients experience increased satiety, the ability to reduce food intake, and a resultant weight loss. We hypothesized that the appetite-stimulating hormone ghrelin is involved in the changed appetite and eating behavior resulting from gastric pacing. Eleven morbidly obese patients (mean body mass index of 46 kg/m2) were treated with gastric pacing. The peripheral blood levels of ghrelin were studied 1 month before gastric pacer implantation, 1 month after implantation, and 6 months after activation of electrical stimulation. Blood samples were drawn 12 hours after fasting and in response to a hypoenergetic meal (1130 kJ [270 kcal]). Patients were followed monthly for vital signs and weight level. Gastric pacing resulted in a significant weight loss of a mean 10.4 kg or 4.4 body mass index units after 6 months of treatment. No negative side effects or complications were observed during the treatment. Ghrelin levels decreased significantly in response to food intake at all visits. After activation of the pacemaker, levels of ghrelin were significantly increased (P<.01) as compared with before activation. Weight loss correlated significantly with increased ghrelin levels (R=0.69, P<.05). Gastric pacing is a promising therapy for morbid obesity. It is suggested that increased ghrelin after gastric pacing is an adaptation to negative energy balance without a causal role in weight loss or body weight maintenance.
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Affiliation(s)
- Valerio Cigaina
- Department of General Surgery, District of Venice, Mestre Hospital, Venice, Italy, and Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden.
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Xu J, McNearney TA, Chen JDZ. Gastric/intestinal electrical stimulation modulates appetite regulatory peptide hormones in the stomach and duodenum in rats. Obes Surg 2007; 17:406-13. [PMID: 17546851 DOI: 10.1007/s11695-007-9049-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Gastric/intestinal electrical stimulation (GIES) has been used to suppress appetite in the treatment of obesity with promising results. However, the mechanisms by which GIES benefits obese patients are not completely understood. This study investigated the acute effects of GIES on gastric and intestinal tissue levels of peptide hormones related to satiety and appetite in rats. METHODS 32 rats were divided into 4 groups: 1) sham stimulation, 2) gastric electrical stimulation (GES) with pulse trains, 3) GES with long pulse, and 4) duodenal electrical stimulation (DES) with pulse trains. After 2 hours of GIES, the rats were sacrificed immediately, and gastric fundus, duodenum and distal colon were harvested and extracted. Hormone levels of ghrelin, obestatin, cholecystokinin-8 (CCK-8) and peptide YY (PYY) were measured by radioimmunoassay (RIA). RESULTS 1) The mean gastric fundus ghrelin level was 1789.04+/-362.81 pg/mg in the sham stimulation and significantly decreased with GES of pulse trains (597.85+/-195.33 pg/mg, P=0.012), GES of long pulse (754.6+/-282.6 pg/mg, P=0.039) and DES (731.69+/-110.84 pg/mg, P=0.037). 2) The mean duodenal CCK-8 concentration was 413.27+/-42.14 pg/mg in the sham stimulation and significantly increased by DES (762.6+/-98.75 pg/mg, P=0.013) but not in others. 3) Neither gastric obestatin nor distal colonic PYY was altered by any of GES or DES. CONCLUSIONS GIES significantly impacts appetite-related peptide hormones in gastric and duodenal tissues. Acute GIES-induced manipulation of gut peptide hormones related to appetite and satiety is a nonpharmacologic, well-tolerated clinical procedure that could substantially contribute to the successful treatment and long-term management of obesity.
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Affiliation(s)
- Junying Xu
- Departments of Internal Medicine Gastroenterology, University of Texas Medical Branch, Galveston, TX, USA
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Song GQ, Hou X, Sun Y, Yang B, Qian W, Chen JDZ. Effects of retrograde gastric electrical stimulation with pulse trains on gastric emptying of solids and plasma hormones in dogs. Am J Surg 2007; 194:122-127. [PMID: 17560923 DOI: 10.1016/j.amjsurg.2006.12.036] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2006] [Revised: 12/13/2006] [Accepted: 12/13/2006] [Indexed: 02/04/2023]
Abstract
BACKGROUND Retrograde gastric electrical stimulation (RGES) is proposed as a novel therapy for obesity. However, mechanisms of RGES are not fully investigated. The aim of this study was to investigate the effects of RGES with trains of pulses on gastric slow waves, gastric emptying of solids, and plasma concentrations of satiety-related peptides and glucose. METHODS Seven female beagle dogs implanted with 4 pairs of gastric electrodes on the gastric serosa were studied (control and RGES). Gastric emptying, gastric slow waves, and signs were recorded in each session. Plasma leptin, insulin, glucagons, and glucose were also measured. RESULTS RGES with pulse trains (a pulse width of 2 milliseconds) significantly decreased gastric emptying of solids and plasma insulin but has no effect on plasma leptin, glucagons, and glucose. CONCLUSION Acute gastric electrical stimulation with pulse trains is able to decrease gastric emptying of solids and plasma insulin but has no effects on plasma leptin, glucagons, and glucose.
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Affiliation(s)
- Geng-Qing Song
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1307 Luoyu Road, Wuhan, P.R. 430074, China
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Ouyang H, Chen JDZ. Long-pulse gastric electrical stimulation at tachygastrial frequency reduces food intake by inhibiting proximal gastric tone. Scand J Gastroenterol 2007; 42:702-7. [PMID: 17505992 DOI: 10.1080/00365520601076140] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To investigate the effects of long pulse gastric electrical stimulation (GES) at a tachygastrial frequency on food intake, gastric tone and gastric myoelectrical activity (GMA). MATERIAL AND METHODS Of twelve dogs implanted with electrodes and a gastric cannula, 6 underwent truncal vagotomy. Stimulus consisted of long pulses with a frequency of 9 cycles/min. Experiment one was performed in all dogs to test for food intake with or without GES. Experiment two on six normal dogs consisted of baseline, GES and recovery periods. Gastric volume and GMA were recorded. RESULTS 1) GES reduced food intake in both normal (398.5+/-111.7 g versus 573.0+/-97.9 g; p<0.02) and vagotomized dogs (170.6+/-100.4 g versus 401.0+/-97.3 g; p<0.05). 2) Gastric volume was increased with stimulation from 168.4+/-17.7 ml to 301.1+/-34.1 ml (p<0.02 ANOVA) and maintained at 271.8+/-27.6 ml. 3) The percentages of normal slow waves before, during and after GES were 83.3+/-4.6%, 38.0+/-3.5% and 61.0+/-12.5%, respectively (p=0.02 ANOVA). CONCLUSION Long-pulse GES at tachygastrial frequency substantially reduces food intake, and is not mediated by the vagal pathway but attributed to relaxation of the stomach and impairment of intrinsic GMA.
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Affiliation(s)
- Hui Ouyang
- Transneuronix and Veterans Research and Education Foundation, Oklahoma City, Oklahoma, USA
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Sevcencu C. A Review of Electrical Stimulation to Treat Motility Dysfunctions in the Digestive Tract: Effects and Stimulation Patterns. Neuromodulation 2007; 10:85-99. [DOI: 10.1111/j.1525-1403.2007.00097.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Bodenlos JS, Kose S, Borckardt JJ, Nahas Z, Shaw D, O'Neil PM, George MS. Vagus nerve stimulation acutely alters food craving in adults with depression. Appetite 2007; 48:145-53. [PMID: 17081655 DOI: 10.1016/j.appet.2006.07.080] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2006] [Revised: 07/17/2006] [Accepted: 07/19/2006] [Indexed: 01/11/2023]
Abstract
Vagus nerve stimulation (VNS) is now available as a treatment for epilepsy and treatment-resistant depression. The vagus nerve plays a central role in satiety and short-term regulation of food intake and research suggests a relationship between VNS and weight loss. The underlying mechanisms of this relationship are unknown. The purpose of the current study was to determine whether acute cervical VNS might temporarily alter food cravings. Thirty-three participants were recruited for three groups; depression VNS, depression non-VNS, and healthy controls. Participants viewed 22 computerized images of foods twice in one session and completed ratings for food cravings after each image. The VNS participants' devices were turned on for one viewing of an image and off for the other (randomized order). Participants were blind to VNS condition (on versus off). Acute VNS device activation was associated with a significant change in cravings-ratings for sweet foods. A significant proportion of variability in VNS-related changes in cravings was accounted for by patients' clinical VNS device settings, acute level of depression, and body mass. Further studies are warranted addressing how acute or chronic VNS might modify eating behavior and weight.
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Affiliation(s)
- Jamie S Bodenlos
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 165 Cannon Street, 3rd Floor, P.O. Box 250852, Charleston, SC 29425, USA.
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Xing JH, Lei Y, Ancha HR, Harty RF, Chen JD. Effect of acute gastric electrical stimulation on the systemic release of hormones and plasma glucose in dogs. Dig Dis Sci 2007; 52:495-501. [PMID: 17211697 DOI: 10.1007/s10620-006-9562-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2006] [Accepted: 08/04/2006] [Indexed: 12/12/2022]
Abstract
This study evaluated the effect of gastric electrical stimulation (GES) with various parameters on plasma concentrations of satiety-related peptides and glucose. GES was performed in nine healthy dogs via electrodes implanted in the middle of the lesser curvature. Four sessions were performed in each animal: control, stimulation with IGS (implantable gastric stimulation for obesity, 0.3 m sec), modified IGS (2 msec), and long pulses (300 msec). Blood samples were collected at 15 and 0 min before the meal and at 15, 30, and 60 min after the meal. GES was initiated 30 min before the first blood sample and maintained throughout collection. Plasma ghrelin, leptin, insulin and glucose were measured. The total AUCs of plasma ghrelin and leptin were not significantly affected by GES. The total AUC of plasma insulin was significantly lower with IGS and long pulse parameters (P < 0.05). The total AUC for plasma glucose was significantly lower in sessions with long pulses and modified IGS parameters (P < 0.05). We conclude that acute GES is able to change the release of some satiety-related peptides. Whether this is associated with the changed eating behavior and weight loss in obese patients needs further investigation.
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Affiliation(s)
- J H Xing
- Veterans Research Foundation, Oklahoma City, OK, USA
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Abstract
OBJECTIVE Tachygastria is known to be associated with gastric hypomotility. This study investigated the effect of tachygastrial electrical stimulation (TES) on food intake and its effects on gastric motility. RESEARCH METHODS AND PROCEDURES Five experiments were performed to study the effects of TES on gastric slow waves, gastric tone, accommodation, and antral contractions, gastric emptying, acute food intake, and chronic food intake in dogs. RESULTS TES at tachygastrial frequencies induced tachygastria and reduced normal slow waves. TES significantly reduced gastric tone or induced gastric distention, impaired gastric accommodation, and inhibited antral contractions. TES significantly delayed gastric emptying. Acute TES reduced food intake but did not induce any noticeable symptoms. Chronic TES resulted in a 20% reduction in food intake, and the effect of TES was found to be related to specific parameters. DISCUSSION TES at the distal antrum results in a significant reduction in food intake in dogs, and this inhibitory effect is probably attributed to TES-induced reduction in proximal gastric tone, gastric accommodation, antral contractility, and gastric emptying. These data suggest a therapeutic potential of the specific method of TES for obesity.
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Affiliation(s)
- Jing Zhang
- Veterans Research Foundation, VA Medical Center, Oklahoma City, Oklahoma, USA
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Wang GJ, Yang J, Volkow ND, Telang F, Ma Y, Zhu W, Wong CT, Tomasi D, Thanos PK, Fowler JS. Gastric stimulation in obese subjects activates the hippocampus and other regions involved in brain reward circuitry. Proc Natl Acad Sci U S A 2006; 103:15641-5. [PMID: 17023542 PMCID: PMC1592230 DOI: 10.1073/pnas.0601977103] [Citation(s) in RCA: 125] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
The neurobiological mechanisms underlying overeating in obesity are not understood. Here, we assessed the neurobiological responses to an Implantable Gastric Stimulator (IGS), which induces stomach expansion via electrical stimulation of the vagus nerve to identify the brain circuits responsible for its effects in decreasing food intake. Brain metabolism was measured with positron emission tomography and 2-deoxy-2[18F]fluoro-D-glucose in seven obese subjects who had the IGS implanted for 1-2 years. Brain metabolism was evaluated twice during activation (on) and during deactivation (off) of the IGS. The Three-Factor Eating Questionnaire was obtained to measure the behavioral components of eating (cognitive restraint, uncontrolled eating, and emotional eating). The largest difference was in the right hippocampus, where metabolism was 18% higher (P < 0.01) during the "on" than "off" condition, and these changes were associated with scores on "emotional eating," which was lower during the on than off condition and with "uncontrolled eating," which did not differ between conditions. Metabolism also was significantly higher in right anterior cerebellum, orbitofrontal cortex, and striatum during the on condition. These findings corroborate the role of the vagus nerve in regulating hippocampal activity and the importance of the hippocampus in modulating eating behaviors linked to emotional eating and lack of control. IGS-induced activation of regions previously shown to be involved in drug craving in addicted subjects (orbitofrontal cortex, hippocampus, cerebellum, and striatum) suggests that similar brain circuits underlie the enhanced motivational drive for food and drugs seen in obese and drug-addicted subjects, respectively.
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Affiliation(s)
- Gene-Jack Wang
- Medical Department, Brookhaven National Laboratory, Upton, NY 11973, USA.
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Abstract
BACKGROUND Over the past 20 years, gastric electrical stimulation has received increasing attention among researchers and clinicians. AIM To give a systematic review on the effects, mechanisms and applications of gastric electrical stimulation. METHODS Medline was used to identify the articles to be included in this review. Key words used for the search included gastric electrical stimulation, gastric pacing, electrical stimulation, stomach, gastrointestinal motility, central nervous system, gastroparesis, nausea and vomiting; obesity and weight loss. Combinational uses of these keywords were made to identify relevant articles. Most of the articles included in this review ranged from 1985 to 2006. RESULTS Based on the general search, the review was structured as follows: (i) peripheral and central effects and mechanisms of gastric electrical stimulation; (ii) clinical applications of gastric electrical stimulation for gastroparesis and obesity and (iii) future development of gastric electrical stimulation. CONCLUSIONS Great progress has been made during the past decades. Gastric electrical stimulation has been shown to be effective in normalizing gastric dysrhythmia, accelerating gastric emptying and improving nausea and vomiting. Implantable device has been made available for treating gastroparesis as well as obesity. However, development of a new device and controlled clinical studies are required to further prove clinical efficacy of gastric electrical stimulation.
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Affiliation(s)
- J Zhang
- Veterans Research and Education Foundation, VA Medical Center, Oklahoma City, OK, USA
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Sun X, Tang M, Zhang J, Chen JDZ. Excitatory effects of gastric electrical stimulation on gastric distension responsive neurons in ventromedial hypothalamus (VMH) in rats. Neurosci Res 2006; 55:451-7. [PMID: 16766073 DOI: 10.1016/j.neures.2006.05.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2006] [Revised: 04/28/2006] [Accepted: 05/02/2006] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Gastric electrical stimulation (GES) has been used for the treatment of obesity with unclear central mechanisms. The purpose of this study was to investigate the effects of GES on the neuronal activity in the ventromedial hypothalamus (VMH). METHODS Extracellular potentials of single neurons in VMH were recorded in 52 anesthetized rats. Neurons were classified as gastric distension-excitatory (GD-E) neurons or GD-inhibitory (GD-I) neurons. GES with four sets of parameters was applied for comparison. RESULTS Eighty two neurons out of 96 (85.41%) in VMH responded to gastric distension (GD). 37.8% were GD-E neurons and 51(62.2%) were GD-I neurons. 55.0%, 17.6%, 77.8%, 14.3% of GD-E neurons were excited by four sets of parameters: GES1 (standard), GES2 (reduced pulse numbers), GES3 (increased pulse width) and GES4 (reduced frequency), respectively. More GD-E neurons were excited by GES3 (P < 0.05 versus GES2 or GES4) and by GES1 (P < 0.02 versus GES2 or GES4). Among the GD-I neurons, 63.6, 37.9, 73.3, and 51.9% neurons were excited by GES1-4, respectively. CONCLUSION GES with parameters used for treating obesity excites GD-responsive neurons in VMH. The excitatory effect of GES is related to the strength of stimulation, including pulse frequency and width as well as pulse train on-time.
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Affiliation(s)
- Xiangrong Sun
- Department of Pathophysiology, Medical College of Qingdao University, China
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Abstract
The prevalence of obesity in the United States has reached epidemic proportions. With more than 30 million Americans clinically obese, the younger population has also been affected. Surgical therapy should be offered to the severely obese patient who is refractory to nonsurgical therapy, as established by the 1991 NIH Consensus Conference on Gastrointestinal Surgery for Severe Obesity. Surgery is currently the most effective therapy for weight loss. It is far more effective than any other treatment modality, both in terms of the amount of weight loss and in terms of durability in maintaining weight loss.
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Affiliation(s)
- Dan Eisenberg
- Department of Surgery, Yale University School of Medicine, 40 Temple St. Suite 3A, New Haven, CT 06510, USA
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Xing JH, Chen JDZ. Effects and mechanisms of long-pulse gastric electrical stimulation on canine gastric tone and accommodation. Neurogastroenterol Motil 2006; 18:136-43. [PMID: 16420292 DOI: 10.1111/j.1365-2982.2005.00748.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Gastric electrical stimulation (GES) has been applied to treat gastroparesis and morbid obesity. The aims of this study were to evaluate the sites of stimulation and the mechanisms of GES on gastric tone and accommodation. Gastric tone and accommodation were evaluated with a barostat in surgically prepared dogs. GES was applied at seven different locations, and gastric tone was assessed at each site. The effect of truncal vagotomy on gastric tone and accommodation and the role of the nitrergic pathway were also evaluated. We have found: 1) GES induced varying degrees of gastric relaxation at all tested locations in normal dogs; 2) Gastric volume was also significantly increased with GES in vagotomized dogs and the change tended to be lower than that of normal animals; 3) Gastric accommodation was reduced during GES in both the normal and vagotomized dogs and the reduction tended to be more in the vagotomized animals; 4) The GES-induced increase in gastric volume was partially abolished by intravenous nitric oxide synthase inhibitor. GES at various sites of the stomach exerts inhibitory effect on gastric tone; the most effective sites are in the antrum along the lesser or greater curvature; the inhibitory effect of GES on gastric tone is partially mediated by the vagal and nitrergic pathway.
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Affiliation(s)
- J H Xing
- Veterans Research Foundation, Oklahoma City, OK, USA
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Liu S, Liu J, Chen JDZ. Neural mechanisms involved in the inhibition of intestinal motility induced by intestinal electrical stimulation in conscious dogs. Neurogastroenterol Motil 2006; 18:62-8. [PMID: 16371084 DOI: 10.1111/j.1365-2982.2005.00739.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The effects and mechanisms of intestinal electrical stimulation (IES) with long pulses on intestinal motility were investigated in conscious dogs. Eighteen dogs were equipped with serosal electrodes and an intestinal cannula in the small bowel. The first experiment was designed to study the effect of one-channel IES on intestinal motility and the extent of this effect. The second experiment was conducted to study the effect of IES on intestinal motility and the involvement of neural pathway. The IES with long pulses significantly inhibited intestinal motility. Intestinal motility of the entire measured segment (40-220 cm distal to the stimulation electrodes) was inhibited by 60-74% with the single-channel IES with long pulses. Hexamethonium, guanethidine, phentolamine, propranolol partially, but not N(omega)-nitro-L-arginine (L-NNA), ondansetron and naloxone prevented the inhibitory effect of IES on intestinal motility. We conclude that single-channel IES inhibits intestinal motility within a distance of at least 2 m. This inhibitory effect induced by IES with long pulses is mediated via sympathetic but not nitrergic, serotoninergic 5-HT(3) and opiate pathway.
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Affiliation(s)
- S Liu
- Division of Gastroenterology, University of Texas Medical Branch, Galveston, USA
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Yin J, Chen JDZ. Retrograde gastric electrical stimulation reduces food intake and weight in obese rats. ACTA ACUST UNITED AC 2005; 13:1580-7. [PMID: 16222061 DOI: 10.1038/oby.2005.194] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To investigate the therapeutic potential of retrograde gastric electrical stimulation (RGES) for obesity in a rodent model of obesity. RESEARCH METHODS AND PROCEDURES The study was performed in 12 obese Zucker rats implanted with two pairs of gastric serosal electrodes, one pair for stimulation and the other for recording intrinsic gastric myoelectrical activity. It was composed of an acute study in three sessions to study the effect of RGES on intrinsic gastric myoelectrical activity and acute food intake and a chronic phase to study the short-term effect of RGES on weight. RGES was performed through the distal stomach using long pulses at a frequency of tachygastria (known to induce gastric hypomotility). RESULTS RGES completely entrained intrinsic gastric myoelectrical activity and turned it into tachygastria at a certain strength. RGES reduced acute food intake compared with the control (p < 0.01). A 2-week treatment of RGES resulted in a significant reduction in food intake (p = 0.002) and a significantly greater weight loss than sham stimulation (p = 0.004). DISCUSSION RGES at a tachygastrial frequency reduces food intake and results in weight loss in obese Zucker rats, and its effect is probably attributed to the introduction of tachygastria in the stomach.
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Affiliation(s)
- Jieyun Yin
- Veterans Research and Education Foundation, Veterans Administration Medical Center, Oklahoma City, Oklahoma, USA
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Abstract
An increasing number of morbidly obese patients are presenting for surgery, with the potential for increased perioperative morbidity and mortality. This article reviews surgical and nonsurgical options in the management of morbidly obese patients. Overweight and obese individuals should be treated with diet, exercise, and behavioral therapy. The failure of this approach is an indication for pharmacologic therapy. Bariatric surgery reduces obesity-related complications and reduces long-term morbidity, mortality, and health care resources use.
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Affiliation(s)
- Patrick J Neligan
- Department of Anesthesia, University of Pennsylvania School of Medicine, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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Yao SK, Ke MY, Wang ZF, Xu DB, Zhang YL. Visceral response to acute retrograde gastric electrical stimulation in healthy human. World J Gastroenterol 2005; 11:4541-4546. [PMID: 16052685 PMCID: PMC4398705 DOI: 10.3748/wjg.v11.i29.4541] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2004] [Revised: 12/01/2004] [Accepted: 12/03/2004] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the visceral response to acute retrograde gastric electrical stimulation (RGES) in healthy humans and to derive optimal parameters for treatment of patients with obesity. METHODS RGES with a series of effective parameters were performed via a bipolar mucosal electrode implanted along the great curvature 5 cm above pylorus of stomach in 12 healthy human subjects. Symptoms associated with dyspepsia and other discomfort were observed and graded during RGES at different settings, including long pulse and pulse train. Gastric myoelectrical activity at baseline and during different settings of stimulation was recorded by a multi-channel electrogastrography. RESULTS The gastric slow wave was entrained in all the subjects at the pacing parameter of 9 cpm in frequency, 500 ms in pulse width, and 5 mA in amplitude. The frequently appeared symptoms during stimulation were satiety, bloating, discomfort, pain, sting, and nausea. The total symptom score for each subject significantly increased as the amplitude or pulse width was adjusted to a higher scale in both long pulse and pulse train. There was a wide diversity of visceral responses to RGES among individuals. CONCLUSION Acute RGES can result in a series of symptoms associated with dyspepsia, which is beneficial to the treatment of obesity. Optimal parameter should be determined according to the individual sensitivity to electrical stimulation.
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Affiliation(s)
- Shu-Kun Yao
- Department of Gastroenterology, Peking Union Medical College Hospital, Beijing 100730, China
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Liu S, Wang L, Chen JDZ. Cross-talk along gastrointestinal tract during electrical stimulation: effects and mechanisms of gastric/colonic stimulation on rectal tone in dogs. Am J Physiol Gastrointest Liver Physiol 2005; 288:G1195-8. [PMID: 15691864 DOI: 10.1152/ajpgi.00554.2004] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Gastric electrical stimulation (GES) has been shown to alter motor and sensory functions of the stomach. However, its effects on other organs of the gut have rarely been investigated. The study was performed in 12 dogs implanted with two pairs of electrodes, one on the serosa of the stomach and the other on the colon. The study was composed of two experiments. Experiment 1 was designed to study the effects of GES on rectal tone and compliance in nine dogs compared with colonic electrical stimulation (CES). Rectal tone and compliance were assessed before and after GES or CES. Experiment 2 was performed to study the involvement of sympathetic pathway in 8 of the 12 dogs. The rectal tone was recorded for 30-40 min at baseline and 20 min after intravenous guanethidine. GES or CES was given for 20 min 20 min after the initiation of the infusion. It was found that both GES and CES reduced rectal tone with comparable potency. Rectal compliance was altered neither with GES, nor with CES. The inhibitory effect of GES but not CES on rectal tone was abolished by an adrenergic blockade, guanethidine. GES inhibited rectal tone with a comparable potency with CES but did not alter rectal compliance. The inhibitory effect of GES on rectal tone is mediated by the sympathetic pathway. It should be noted that electrical stimulation of one organ of the gut may have a beneficial or adverse effect on another organ of the gut.
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Affiliation(s)
- Shi Liu
- Division of Gastroenterology, University of Texas Medical Branch, Galveston, TX 77555-0632, USA
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Shikora SA, Storch K. Implantable gastric stimulation for the treatment of severe obesity: The American experience. Surg Obes Relat Dis 2005; 1:334-42. [PMID: 16925244 DOI: 10.1016/j.soard.2005.03.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2005] [Revised: 03/04/2005] [Accepted: 03/04/2005] [Indexed: 01/08/2023]
Affiliation(s)
- Scott A Shikora
- Tufts-New England Medical Center, Boston, Massachusetts 02111, USA.
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Liu S, Hou X, Chen JDZ. Therapeutic potential of duodenal electrical stimulation for obesity: acute effects on gastric emptying and water intake. Am J Gastroenterol 2005; 100:792-796. [PMID: 15784020 DOI: 10.1111/j.1572-0241.2005.40511.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES No satisfactory treatment is available for obesity. Previous animal studies suggested the therapeutic potential of intestinal electrical stimulation for obesity. The aim of this study was to investigate the effects of duodenal electrical stimulation (DES) on gastric emptying and water intake in healthy humans. METHODS The study was performed in 12 healthy volunteers intubated with a feeding tube in the duodenum under endoscopy. There were three ring electrodes at the end tip of the tube and the two distal electrodes were used for recording and electrical stimulation. On two separate days, each subject underwent a session of DES with various stimulation parameters, a water-intake test with DES or with sham-DES, and a gastric-emptying test with DES or with sham-DES. RESULTS DES did not induce any noticeable dyspeptic symptoms. The amount of water drunk by the subjects was significantly reduced from 897 +/- 88 ml with sham-DES to 673 +/- 63 ml with DES (p < 0.002). The mean T(50) of gastric emptying was significantly increased from 113.1 +/- 10.0 min with sham-DES to 176.5 +/- 20.8 min with DES state (p < 0.005). The gastric retention at 2 h was increased with DES (42.8 +/- 4.5% vs 61.4 +/- 4.7%; p < 0.02). CONCLUSIONS DES delays gastric emptying and reduces water intake. It may have a potential application for the treatment of obesity.
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Affiliation(s)
- Shi Liu
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong Science and Technology University, Wuhan, China
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Shikora SA. "What are the yanks doing?" the U.S. experience with implantable gastric stimulation (IGS) for the treatment of obesity - update on the ongoing clinical trials. Obes Surg 2005; 14 Suppl 1:S40-8. [PMID: 15479589 DOI: 10.1007/bf03342137] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The prevalence of obesity is growing worldwide. Medical therapies are often ineffective, and surgical treatments have significant risk. IGS(R) offers a novel approach to weight loss that was found to be safe and effective in European trials. In the U.S., 2 consecutive trials have been undertaken. METHODS In 2000, a multicenter, prospective, randomized, placebo-controlled trial involving 103 morbidly obese patients (U.S. O-01) was undertaken. In 2002, a prospective, open label trial involving 30 morbidly obese patients was initiated (DIGEST). Patients were followed for complications, postoperative untoward events, and weight loss. RESULTS In O-01, there were no significant perioperative complications. However, 20 patients were found to have had lead dislodgements. At 7 months, there was no significant difference in weight loss between the activated and non-activated groups. After 29 months, loss of excess weight (EWL) approached 20%. With DIGEST, there was 1 operative complication (a lost needle retrieved surgically). There were no untoward events or known lead dislodgements. EWL was 23% after only 16 months follow-up. With the introduction of a preoperative screening algorithm, almost 40% EWL was achieved for selected patients in both trials. CONCLUSIONS In the U.S., the IGS system for the treatment of obesity has been shown to be safe. Technical improvements and better patient selection resulted in improved weight loss. The preliminary results of these trials suggest that IGS may be a suitable surgical option for selected patients.
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Abstract
An implantable gastric stimulator (IGS(R)) has been used for the treatment of obesity with promising results. However, possible mechanisms involved with the treatment of obesity using an IGS are not well understood. According to recent clinical and basic studies, it seems that an IGS reduces appetite and increases satiety, attributed to its inhibitory effects on gastric motility and its direct effects on the central nervous system and hormones related to satiety and/or appetite. It has been indicated that chronic gastric stimulation impairs intrinsic gastric myoelectrical activity in the fed state, induces gastric distention in the fasting state and inhibits postprandial antral contractions. The impairment of gastric myoelectrical activity and contractions is associated with impaired digestion and emptying of the stomach, which may lead to early satiety and reduced food intake. The induction of gastric distention in the fasting state results in activation of stretch receptors, causing satiety. It has also been shown that an IGS may have direct regulatory effects on the central nervous system and certain hormones. Modulation of neuronal activities and release of certain hormones with an IGS may also explain the reduction of appetite and the increase of satiety.
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Affiliation(s)
- Jiande Chen
- Division of Gastroenterology, University of Texas Medical Branch, Galveston, TX 77555-0632, USA.
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Xu X, Zhu H, Chen JDZ. Pyloric electrical stimulation reduces food intake by inhibiting gastric motility in dogs. Gastroenterology 2005; 128:43-50. [PMID: 15633122 DOI: 10.1053/j.gastro.2004.09.079] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
BACKGROUND & AIMS The pylorus plays an important role in regulating gastric emptying. The aim of this study was to investigate the therapeutic potential of pyloric electrical stimulation (PES) for obesity in dogs. METHODS The study was composed of 3 separate experiments. The first experiment was designed to study the effects of PES with various parameters on gastric emptying and gastric slow waves in 5 sessions. The second experiment was used to test the effects of PES on antral contractions. The acute effect of PES on food intake was studied in the third experiment. RESULTS (1) Pyloric myoelectrical recording showed dual frequencies. The lower frequency was identical to the frequency of the gastric slow waves, and the higher frequency was similar to that of the intestinal slow waves. (2) Gastric emptying was significantly delayed with PES, and the delay in gastric emptying was significantly and negatively correlated with stimulation energy ( r = -.673; P < .001). (3) PES significantly impaired the regularity and coupling of the intrinsic gastric myoelectrical activity in an energy-dependent manner. The delayed gastric emptying was significantly correlated with the impairment of the coupling of gastric myoelectrical activity ( r = .441; P < .02). (4) Antral contractions on the fed state were significantly and substantially inhibited with PES. (5) Acute PES significantly reduced food intake. CONCLUSIONS PES reduces food intake that may be attributed to its inhibitory effects on intrinsic gastric myoelectrical activity, antral contractions, and gastric emptying.
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Affiliation(s)
- Xiaohong Xu
- Division of Gastroenterology, University of Texas Medical Branch at Galveston, 301 University Boulevard, Galveston, TX 77555-0632, USA
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Sun Y, Chen J. Intestinal electric stimulation decreases fat absorption in rats: therapeutic potential for obesity. ACTA ACUST UNITED AC 2004; 12:1235-42. [PMID: 15340106 PMCID: PMC1440327 DOI: 10.1038/oby.2004.157] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Effective treatment of obesity is based on the restriction of food intake or reduction of absorption or both. The aim of this study was to study whether intestinal electric stimulation (IES) would reduce fat absorption and, thus, would be a potential therapy for obesity. RESEARCH METHODS AND PROCEDURES Forty rats implanted with serosal electrodes and two jejunal cannulas were divided into 4 groups of 10 each: control (no stimulation), IES with long pulses, IES with trains of short pulses, and IES with trains of short pulses plus treatment with lidocaine. Jejunal transit and fat absorption of a 20-cm jejunal segment (between two cannulas) were investigated during a 45-minute period with or without IES. RESULTS It was found that both methods of IES accelerated intestinal transit measured by recovery of phenol red and increased the percentage of triglycerides recovered from the distal cannula in comparison with the control group. IES with trains of short pulses was more effective than IES with long pulses in accelerating jejunal transit and reducing fat absorption. Neither of the two IES methods altered the output of fatty acids from the distal cannula. The effects of IES with trains of short pulses on the transit and fat absorption were partially abolished with the treatment of lidocaine. DISCUSSION It was concluded that IES accelerates intestinal transit and reduces fat absorption, suggesting a therapeutic potential for obesity. IES with trains of short pulses is more effective than IES with long pulses, and its effects are partially mediated by enteric nerves, jejunum.
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Affiliation(s)
- Ying Sun
- Transneuronix Research and Veterans Research, 301 University Boulevard, 221 Microbiology Building, 1108 The Strand, Galveston, TX 77555-0632, USA
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