Transcutaneous Electrical Acustimulation Improves Gastroparesis Symptoms and Ameliorates Gastric Pace-Making Activity in Patients With Diabetic Gastroparesis.

BACKGROUND: Gastroparesis is common in patients with diabetes. However, treatment options for diabetic gastroparesis are limited. Transcutaneous electrical acustimulation (TEA), a noninvasive method of delivering electrical stimulation via surface electrodes placed at certain acupuncture points that are in the vicinity of peripheral nerves, has been reported to exert therapeutic effects in patients with gastroesophageal reflux, functional dyspepsia, and constipation. The aim of this study was to explore the therapeutic potential of TEA for diabetic gastroparesis. METHODS: Eighteen patients with diabetes were enrolled in a single-center, placebo-controlled, randomized and crossover trial with TEA and sham-TEA. TEA was performed twice daily after lunch and dinner via acupoints, ST36 (below the kneecap in the vicinity of the peroneal, sciatic, and tibial nerves) and PC6 (wrist above the median nerve) for 4 weeks. A set of parameters previously reported to improve gastrointestinal motility was used for both TEA and sham-TEA (delivered via sham-points). The gastroparesis cardinal symptom index was used to assess symptoms. The electrogastrogram (EGG) was used to assess gastric pace-making activity (slow waves). KEY RESULTS: The TEA treatment improved each of the five major gastroparesis symptoms in comparison to baseline: nausea reduced by 29.7% (p = 0.005), retching by 31.1% (p = 0.006), vomiting by 39.3% (p = 0.005), abdominal fullness by 21.4% (p = 0.005), and bloating by 20.6% (p = 0.006). There was also a significant improvement in the "pain interfering with activity" score with the 4-week TEA treatment in comparison to baseline (p = 0.046). TEA improved gastric pace-making activity, reflected as a significant increase in the percentage of normal gastric slow waves in the postprandial state (69.5% ± 12.1% vs. 77.4% ± 16.5%, p = 0.039). Concurrently, TEA resulted in a trend of postprandial increase in vagal activity. CONCLUSIONS AND INFERENCES: TEA at acupuncture points ST36 and PC6 with appropriate parameters is effective in treating the major gastrointestinal symptoms in patients with diabetic gastroparesis. Further pivotal studies are warranted to determine its clinical efficacies.