Vagal nerve stimulation improves symptoms in gastroparesis patients

USA: The use of short-term non-invasive vagal nerve stimulation (VNS) improves cardinal symptoms and accelerates gastric emptying in gastroparesis patients, according to a recent study published in the journal Neurogastroenterology & Motility. This may do away with the need for using invasive surgery, making VNS an attractive therapeutic modality for gastroparesis.

Gastroparesis is a condition affecting the normal spontaneous movement of the muscles (motility) in the stomach. Signs and symptoms include weight loss, abdominal pain, lack of appetite, abdominal bloating vomiting, nausea, a feeling of fullness, and acid reflux. Medical therapy is limited reflecting the complex physiology of gastric sensorimotor function. Prior methods for gastroparesis required invasive surgery.

This open-label pilot study by Andres Gottfried‐Blackmore, Department of Medicine, Stanford University, Stanford, CA, USA, and colleagues aimed to assess the benefit of non-invasive VNS in patients with mild to moderate idiopathic gastroparesis.

For the study, the patients self-administered the gammaCore vagal nerve stimulator for 4 weeks. The gastroparesis cardinal symptom index daily diary (GCSI‐dd) was assessed during a two‐week run‐in period, ≥4 weeks of therapy, and 4 weeks after therapy was completed. Gastric emptying and autonomic function testing were also performed. The primary endpoint was an absolute reduction in CGSI‐dd of 0.75 after nVNS.

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Key findings of the study include:

• There was a total improvement in symptom scores (2.56 ± 0.76 to 1.87 ± 1.05), with 6/15 (40%) participants meeting the primary endpoint.


• Therapy was associated with a reduction in gastric emptying (T^1/2 155 vs 129 minutes).


• Therapy did not correct autonomic function abnormalities but was associated with modulation of reflex parasympathetic activity.

"Responders had a more severe gastric delay at baseline and clinical improvement correlated with duration of therapy, but not with improvements in gastric emptying. Larger randomized sham‐controlled trials of greater duration are needed to confirm the results of this pilot study," concluded the authors.

The study, "Open‐label pilot study: Non‐invasive vagal nerve stimulation improves symptoms and gastric emptying in patients with idiopathic gastroparesis," is published in the journal Neurogastroenterology & Motility.

DOI: https://doi.org/10.1111/nmo.13769