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