Severe Gastroparesis: Medical Therapy or Gastric Electrical Stimulation

A 33-year-old woman is referred for evaluation of refractory nausea and vomiting of 8 months' duration. She has a 20-year history of type I diabetes mellitus complicated by retinopathy and peripheral neuropathy. Her glycemic control is suboptimal and occasionally blood sugars are in the 20-mmol/L (360 mg/dL) range and the recent hemoglobin A1c level is 9.8%. Her symptoms occur postprandially about 30 minutes after a meal and are characterized by nausea, epigastric fullness, bloating, and pain. Vomiting is less frequent (2–3 days/wk); however, when it does occur, it is usually 2 to 4 hours after eating and on several occasions she has identified food in the vomitus that she consumed the previous day. Her severe nausea and vomiting have led to 12 emergency department visits and 4 hospitalizations in the past year. She is not able to work and take care of her family because of those symptoms. She spends most of her day lying in bed or sitting in a chair. She also lost 9 kg in this time frame.