Gastric Electrical Stimulation For Refractory Vomiting, IBD Resources & MMWR COVID-19 Report

A recent yard sign from my wife for neighborhood walkers during the pandemic

P Ducrotte el al (Gastroenterol 2020; 158: 506-14, editorial 461-3) examined the use of an implanted gastric electrical stimulation (GES) in 172 patients in a randomized crossover trial (mean age 45 years).  GES device was implanted and left unactivated until patients were randomized in a double-blind manner to receive stimulation (for 4 months) or not.  Patients had vomiting that was either idiopathic, postsurgical or associated with diabetic gastroparesis (n=72).

Key findings:

  • A significant decrease in vomiting occurred with the device on based on a nonvalidated vomiting score.  During the ON period, vomiting was improved with score of 2.2 compared to vomiting score of 1.8 with device off.  30.6% of patients reported at least a 1 point improvement with device ON compared to device OFF.  However, 16.5% of patients reported improvement with device OFF compared to device ON.
  • Gastric emptying was not accelerated during treatment (device on) compared to no treatment
  • GES was NOT associated with increased quality of life
  • GES was not associated with improved nutritional parameters
  • Adverse effects included pain (n=26) or infection (n=16) at the insertion site of GES; 3 patients required GES removal.

My take (from editorial): “Taking into account the modest magnitude of therapeutic benefit, the cost of the treatment and the potential for adverse events with GES, it seems advisable to exhaust all (symptomatic) therapeutic options” beforehand.

Related blog posts:

IBD Resources (from David Rubin, MD):

COVID-19 March 2020: MMWR Report (Link to report from Bryan Vartabedian 33mail)

  • March 1-28 2020, 84% of hospitalized U.S. patients had underlying diseases -he most common being obesity, hypertension, chronic lung disease, diabetes mellitus, and cardiovascular disease.
  • Hospitalization rates increased with age, with a rate of 0.3 (per 100,000) in persons aged 0–4 years, 0.1 in those aged 5–17 years, 2.5 in those aged 18–49 years, 7.4 in those aged 50–64 years, and 13.8 in those aged ≥65 years

 

Patient Assistance for Lab Testing

Since 2015, “a partnership of several leading consumer health organizations announced the launch of Patient Assistance for Lab Services (PALS).” (Gastroenterol & Endoscopy News, March 2016, pg 54).  PALS offers access to more than 85 lab tests, most costing only $5 and all of the tests at a fraction of the cost of pricing at competing labs. (See request-a-test for competing costs: requestatest.com)

PALS website: Patient Assistance for Lab Services

Some examples of costs:

$5 tests: (There is a $15 shipping fee as well which covers all testing)

  • Hepatic Function Panel
  • CBC/d
  • Complete Metabolic Panel (CMP)
  • Hemoglobin A1C
  • Cholesterol
  • TSH w reflex to T4

Some tests are more expensive but still heavily discounted:

  • Hepatitis C RNA PCR Quantitative $100

The process of filling out the paperwork & having signed by a physician along with getting the testing complete will likely take a few weeks; so this testing right now is not useful for urgent testing.

My take:  Due to cost constraints, some patients are not receiving lab monitoring as frequently as recommended.  This discounted testing could be a useful for option in this scenario.

Key words:

  • Patient assistance
  • Cheap
  • Inexpensive
  • Lab test
  • Bloodwork
  • No insurance

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