gastroparesis new horizons - foma district 2...enterra experience @bg clinic and bmc 2013-2014...

Gastroparesis New horizons

Gastric Emptying

Gastroparesis

Pathophysiology of Gastroparesis

• 82% are female..?progesterone….mean age onset GP= 34

Diabetic Gastroparesis Pathophysiology

Interstitial cells of Cajal loss or dysfunction:

Gastroparesis---Etiologies

• Diabetes—juvenile and adult onset

• Idiopathic…..post infectious..hypoganglionosis

• Autonomic system dysfunction

• PSS

• Infiltrative diseases..eg Amyloidosis

• Pseudo-obstruction

• CNS diseases

• Cyclic vomiting syndrome

GASTROPARESIS--Etiologies

• Functional GI disorders

• Post-Vagotomy states

• Hypothyroidism

• ESRD

• Medications

• Anorexia Nervosa/Bulimia

• Autoimmune: SLE, RA, Myositis

• Pregnancy

Medication Culprits

SYMPTOMS

Diagnostic Studies

Management of Gastroparesis An overview

ENTERRA

Prokinetics for Gastroparesis

Gastric electrical stimulation vs. “Pacing”

Gastric Electrical Stimulation

Enterra…How does it work?

How does GES work?? Profound anti-emetic benefits

Literature review of GES

What have we learned from 2000 to present?

WAVES Worldwide anti-vomiting and Electrical Stimulation Study

National Enterra Study

Enterra “Magic”

Enterra experience @BG clinic and BMC 2013-2014

• Outcomes : 80% improved GI sx, QOL, SF 36 scores; 75% off prokinetics; all off narcotics @ 1 yr

Predictors of a positive Enterra implant

ENTERRA---ADVERSE EVENTS

New Horizons in Gastroparesis Treatment