My brother has been diagnosed with delayed stomach emptying (gastroparesis). We were told of an operation in which a pacemaker device is inserted into the stomach to control the muscle. Can you tell me more about this operation?

Clark

Gastroparesis is a condition in which food does not move through the stomach properly due to muscle malfunctions. Normally, the stomach muscle churns food to allow it to mix with acid and enzymes. Ultimately, waves of muscle contractions propel the food down to the upper intestine (duodenum) and on to the next stage of digestion. This allows the stomach to empty so it is ready to receive more food at the next meal.

If food sits in the stomach too long, patients experience pain and bloating, often with a feeling of excessive "gas" in the upper abdomen. Also, patients may feel full after eating only a small amount of food, a symptom known as early satiety. Some people with gastroparesis also vomit after meals because their stomachs are unable to handle and digest a large meal.

There are many possible causes of gastroparesis, including diabetes, complications of stomach surgery, viral infections and neurological disorders. Gastroparesis is diagnosed through a test that measures the effectiveness of stomach emptying. In this test, patients eat food containing a radioactive marker. X-ray pictures of the stomach are then taken at various time intervals to see how quickly the food moves through the stomach.

There are not many good drugs available to treat gastroparesis. One effective medication was cisapride (Propulsid), which stimulated gastric contractions. However, Propulsid was taken off the market recently because of concerns about potentially life-threatening side effects involving the heart.

In the last few years, we have learned much more about the stomach's nerve system. Much like their counterparts in the heart, the nerves near the stomach transmit electrical impulses that trigger muscle contraction. Stomach pacemakers designed along the lines of heart pacemakers are being tested on gastroparesis patients at a few medical research centers. Although the early data seem promising, the only way a patient can currently receive one of these pacemakers is to take part in a clinical trial at one of these centers. Your brother should talk to his gastroenterologist to find out if that may be a possibility for him.