gastroparesis new horizons - foma district 2...enterra experience @bg clinic and bmc 2013-2014...
TRANSCRIPT
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Gastroparesis New horizons
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Gastric Emptying
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Gastroparesis
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Pathophysiology of Gastroparesis
• 82% are female..?progesterone….mean age onset GP= 34
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Diabetic Gastroparesis Pathophysiology
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Interstitial cells of Cajal loss or dysfunction:
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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
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GASTROPARESIS--Etiologies
• Functional GI disorders
• Post-Vagotomy states
• Hypothyroidism
• ESRD
• Medications
• Anorexia Nervosa/Bulimia
• Autoimmune: SLE, RA, Myositis
• Pregnancy
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Medication Culprits
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SYMPTOMS
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Diagnostic Studies
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Management of Gastroparesis An overview
ENTERRA
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Prokinetics for Gastroparesis
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Gastric electrical stimulation vs. “Pacing”
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Gastric Electrical Stimulation
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Enterra…How does it work?
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How does GES work?? Profound anti-emetic benefits
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Literature review of GES
What have we learned from 2000 to present?
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WAVES Worldwide anti-vomiting and Electrical Stimulation Study
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National Enterra Study
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Enterra “Magic”
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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
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Predictors of a positive Enterra implant
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ENTERRA---ADVERSE EVENTS
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New Horizons in Gastroparesis Treatment