Klinge Mette W, Rask Peter, Mortensen Lene S, Lassen Kathrine, Ejskjaer Niels, Ehlers Lars H, Krogh Klaus
Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.
Department of Abdominal Surgery, Aarhus University Hospital, Aarhus, Denmark.
J Neurogastroenterol Motil. 2017 Oct 30;23(4):541-549. doi: 10.5056/jnm16179.
BACKGROUND/AIMS: Recurrent nausea and/or vomiting are common complications of diabetes mellitus. The conditions severely impact the quality of life of patients and often cause repeated admissions to hospital incurring significant healthcare costs. If standard treatment fails, gastric electrical stimulation (GES) may be offered in selected cases, as a minimally invasive, but expensive, therapeutic option. Our aims are to evaluate the clinical effect and the cost-utility of GES as a treatment for severe diabetic recurrent nausea and/or vomiting.
Among 33 diabetes patients implanted with GES because of recurrent nausea and/or vomiting, 30 were available for evaluation. The effect of treatment was assessed prospectively using symptom-diaries and the SF-36 questionnaires at baseline, after 6 and 12 months, and thereafter yearly. The number of days in hospital due to symptoms related to gastrointestinal dysfunction was calculated using hospital records 12 months prior to and 12 months after implantation.
The surgical procedures were performed without mortality or major complications. Six months after surgery 78% of the respondents had at least 50% reduction in time with nausea and 48% had at least 50% reduction in days with vomiting. Symptom relief persisted at follow-up after at least 4 years. Quality adjusted life years improved after GES, which was cost-effective after 24 months.
GES reduces symptoms and improves quality of life in diabetes patients with recurrent nausea and/or vomiting. The procedure is supposed as cost-effective over a 2-year time horizon.
背景/目的：反复恶心和/或呕吐是糖尿病常见的并发症。这些情况严重影响患者的生活质量，并常常导致患者反复住院，产生高昂的医疗费用。如果标准治疗失败，在某些特定情况下可采用胃电刺激（GES），这是一种微创但昂贵的治疗选择。我们的目的是评估GES治疗重度糖尿病性反复恶心和/或呕吐的临床效果及成本效益。
在33例因反复恶心和/或呕吐而植入GES的糖尿病患者中，有30例可供评估。在基线、6个月、12个月时以及之后每年，采用症状日记和SF-36问卷对治疗效果进行前瞻性评估。利用植入前12个月和植入后12个月的医院记录计算因胃肠功能障碍相关症状而住院的天数。
手术过程中无死亡或重大并发症发生。术后6个月，78%的受访者恶心时间至少减少50%，48%的受访者呕吐天数至少减少50%。症状缓解在至少4年的随访中持续存在。GES治疗后质量调整生命年有所改善，24个月后具有成本效益。
GES可减轻糖尿病性反复恶心和/或呕吐患者的症状并改善生活质量。该手术在2年时间范围内被认为具有成本效益。
