Under normal condition, there would be proper muscle movements in the stomach to complete the process of digestion and expulsion properly. But certain conditions like gastroparesis can seriously affect the normal muscle movement in the stomach causing vomiting, indigestion and problems of bowel movement. Without proper movement of muscles, complete emptying of bowel is not possible. It can also alter normal levels of blood sugar and nutrition. People with prolonged diabetes are prone to develop gastroparesis.
Oral medications can be given for treating this condition but in some cases medications cannot provide relief. In such cases, an electrical device called gastric pacemaker is kept inside the stomach for sending electrical impulses that stimulates proper muscular movement giving considerable relief to the patients from various symptoms.
Gastroparesis Symptoms :
Improper muscular movement in the stomach can cause symptoms like nausea, vomiting, bloated sensation and mild to moderate stomach pain. This can cause improper absorption of nutrients resulting in weight loss. Due to the feeling of “fullness” in the stomach there would be no appetite. There would not be complete emptying of bowel resulting in mixing of toxins in the blood.
Gastroparesis Causes :
Prolonged diabetes can cause restricted mobility of muscles in the stomach. Some people can develop gastroparesis due to neurological diseases or metabolic problems. For many people, there is no cause (idiopathic) for gastroparesis.
In the initial stages medications are given to accelerate regular muscle movement in the stomach. In severe case of symptoms like severe vomiting and weight loss, a feeding tube is inserted into the stomach to ensure that the patient gets proper nutrition. Continuous lack of nutrition can cause serious problems like dehydration and malnutrition.
Not all the patients are suitable candidates for getting gastric pacemaker. Cases that are not responding to medical treatment and patients with severe symptoms are considered for implantation surgery of pacemaker inside the stomach. Using minimal invasive procedures, the surgeon would implant a small electrical device called gastric pacemaker in the stomach which triggers the normal muscle movement thus reducing the symptoms.
Gastric pacemaker implant is done as in-patient treatment and requires hospitalization. Routine blood tests and other tests are done before the day of surgery. The patient will be explained about the process of surgery well in advance and about what one can expect after the implant surgery. The patient is stabilized under general anesthesia and the surgeon would make small incision in the stomach.
Gastric pacemaker is about 2-2.5 inches long and it consists of two small electrodes for producing electrical impulses. Through the incision the surgeon would carefully implant the pacemaker beneath the skin in the stomach. The neuro-stimulator is placed beneath the rib cage and just above the stomach belt line. The surgery may last from 1-3 hours depending on the health condition of the patient. The patient’s condition will be closely monitored for the next few days.
Follow Up :
Symptoms like vomiting and bloated feeling will reduce gradually and most of the patients show remarkable improvement in about 3 months after surgery. They should follow the instructions of the doctor in making follow-up visits to the hospital. Gastric electrical stimulation shortly called as GES triggers production of mild electrical impulses in the lower part of the stomach thus stimulating the nerves. It helps in contracting the stomach muscles thus relieving the symptoms of recurrent vomiting and bloated feeling. The battery of gastric pacemaker may lasts for about 10 years.
Before the Surgery :
Temporary stimulator is kept in the stomach of the patient by endoscopy to test whether gastric stimulator can be implanted permanently. The other end of electrode is passed though nose and connected with the same GES device kept externally. The patient can notice reduction of symptoms even with temporary electrical stimulator. The end of electrodes is attached to the abdominal wall under the skin of the patient. This gastric pacemaker acts very much like that of cardiac pacemaker that regulates the function of your heart. Functioning of GES can be adjusted by your doctor in non-invasive procedure. After the surgery, the stimulator is turned on and in most of the patients serious symptoms will reduce drastically. However for some patients, it may take 6-8 months for the therapy to take effect.
Like many other surgical procedures, gastric pacemaker surgery also carries some risk. Generally it is considered safe procedure, but in rare cases infection can occur. In very rare instance the lead electrode may perforate through the stomach wall causing injury or bleeding. In that case the pacemaker has to be removed. You have to follow the instructions of your doctor after operation and should avoid stressful activities. And the patient cannot undergo MRI scanning after getting implanted with gastric pacemaker.