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Care Coordinator (Internal) Resource: Supporting Patients Receiving Gastric Electrical Stimulation for Gastroparesis

Gastroparesis

Gastroparesis is a condition where the stomach empties more slowly than normal, without a blockage. Common symptoms include feeling full quickly after starting a meal, staying full long after eating, nausea, and vomiting. Diabetes is one of the most common known causes.

Gastroparesis can affect nutrition, hydration, weight, quality of life, and blood sugar control. Possible complications include dehydration from repeated vomiting, malnutrition, low calorie intake, unintentional weight loss, bezoars, and harder-to-control blood glucose levels in patients with diabetes.

Understanding Gastric Electrical Stimulation

Gastric electrical stimulation, sometimes called a gastric stimulator or “gastric pacemaker,” is an implanted device that may be used for certain patients with difficult-to-manage gastroparesis symptoms, especially chronic nausea and vomiting.

The FDA-approved indication for the GES system is treatment of chronic, intractable, drug-refractory nausea and vomiting secondary to gastroparesis of diabetic or idiopathic etiology. Enterra Therapy lists its indication for patients ages 18 to 70 with chronic, drug-refractory nausea and vomiting associated with diabetic or idiopathic gastroparesis.

The device sends mild electrical pulses to nerves and muscles in the lower stomach. A surgeon places the device under the skin, usually in the lower abdomen, and attaches leads to the stomach wall.

It is important for care coordinators to understand that this treatment does not cure gastroparesis. Patients may still need ongoing follow-up, nutrition support, medication management, diabetes management when applicable, and monitoring for symptom changes.

Key Points For Care Coordinators

What the device is intended to help with

GES is primarily used to help reduce chronic nausea and vomiting in selected patients with gastroparesis. It is not a cure for gastroparesis, and patients may still need diet changes, medications, hydration support, diabetes management, and close GI follow-up.

What it may not fully resolve

Patients may continue to experience:

  • Nausea
  • Vomiting
  • Early fullness
  • Bloating
  • Abdominal discomfort
  • Poor appetite
  • Weight loss or difficulty maintaining weight
  • Difficult maintaining hydration
  • Blood sugar variability, especially in diabetic gastroparesis
  • Need for medication adjustments or nutrition support
Why ongoing monitoring matters

Symptoms may fluctuate over time. A patient may feel better for a period and then have worsening symptoms due to illness, diet changes, hydration issues, medication side effects, constipation, blood sugar changes, or other medical concerns, infection, or device-related issues.

Care Coordinator Support

The care coordinator’s role is to support the care plan established by the patient’s providers.

CC Support May Include:

  • Monitoring symptoms and asking about symptom changes
    • Ask about nausea, vomiting, appetite, early fullness, bloating, abdominal pain, hydration, bowel patterns, and weight changes.
  • Asking about provider follow-up
    • Confirm whether the patient is following up with GI, surgery/device clinic, primary care, endocrinology, dietitian, or other specialists as recommended.
  • Asking about nutrition and hydration support
    • Reinforce the patient’s provider-approved nutrition plan. Many patients are advised to eat smaller, more frequent meals, chew food well, choose easier-to-digest foods, consider softer or liquid options when appropriate, and work with a dietitian. Mayo Clinic notes that the main treatment goal is maintaining calories and nutrition while improving symptoms.
  • Diabetes coordination, when applicable
    • For patients with diabetes, ask about blood sugar trends, hypoglycemia or hyperglycemia episodes, changes in eating patterns, and whether they have reported significant glucose variability to their diabetes provider. NIDDK notes that high blood glucose can further delay stomach emptying, and patients may need individualized diabetes instructions from their clinician.
  • Asking about medication and treatment adherence
    • Confirm whether the patient is taking medications as prescribed, has refills, understands timing instructions, and has reported side effects or lack of relief to the provider.
  • Asking device-related questions
    • Ask whether the patient has noticed new pain near the device site, signs of infection, shocking or jolting sensations, loss of symptom control, or questions about MRI/safety precautions.
  • Reviewing whether the patient has questions or barriers related to their care plan
  • Encouraging the patient to contact the appropriate provider for new or worsening concerns
  • Identifying possible red flags that require escalation
  • Communicating concerns to the clinical team according to company protocol

Care coordinators should avoid giving individualized medical, diet, medication, or device-management instructions unless those instructions are already part of the patient’s documented care plan.

Symptoms That May Need Provider Follow-Up

Care coordinators should follow company protocol for escalation. The following symptoms may need provider review, especially if they are new, worsening, or different from the patient’s usual baseline:

  • Increased nausea or vomiting
  • Difficulty keeping fluids down
  • Reduced food intake
  • Unplanned weight loss
  • New or worsening abdominal pain
  • New or worsening bloating or constipation
  • Vomiting that interferes with medications
  • Frequent blood sugar lows or highs in patients with diabetes
  • Missed specialist follow-up
  • New discomfort near the device site
  • Sudden return or worsening of symptoms after prior improvement

Symptoms That May Require Urgent Escalation

Follow company policy and clinical escalation pathways for urgent concerns. Patients may need urgent medical attention if they report:

  • Inability to keep fluids down
  • Signs of dehydration, such as dizziness, fainting, confusion, very little urination, or severe weakness
  • Vomiting blood or material that looks like coffee grounds
  • Black or tarry stools
  • Severe or worsening abdominal pain
  • Fever with abdominal pain or device-site symptoms
  • Redness, warmth, swelling, drainage, or opening near the device/incision area
  • Device or hardware appearing to push against or through the skin
  • Severe low blood sugar or very high blood sugar symptoms
  • Chest pain, shortness of breath, fainting, or new neurologic symptoms

Patients should always be advised to ask their healthcare provider for specific advice on when to call to report symptoms, and when to seek urgent/emergency care.

General Talking Points

Explaining the treatment

“You have a device that sends mild electrical pulses to the stomach area. The goal is usually to help reduce severe nausea and vomiting related to gastroparesis. It does not cure gastroparesis, so it is still important to follow your nutrition plan, medication plan, and specialist follow-up schedule.”

Setting realistic expectations

“Some patients notice symptom improvement with a gastric stimulator, but the response can vary. Symptoms can still come and go. Please let your GI provider or device specialist know if your symptoms are getting worse or if you are having trouble eating, drinking, or keeping medications down.”

Reinforcing nutrition support

“With gastroparesis, eating enough and staying hydrated can be hard. Smaller, more frequent meals and softer or liquid options may be easier for some people, but your provider or dietitian should guide your specific plan.”

Diabetes-related talking point

“When gastroparesis and diabetes happen together, blood sugars can be harder to predict because food may leave the stomach more slowly. Please let your diabetes provider know if you are having more highs, lows, or trouble eating normally.”

Device safety reminder

“Because you have an implanted device, it is important to tell every healthcare provider, imaging center, dentist, or procedural team about it before tests or procedures. Keep your device card with you.”

“Because this is an implanted device, it is important to keep your follow-up appointments with the provider or clinic managing the device.”

MRI/procedure reminder

“Do not assume every MRI or procedure is automatically safe with your device. Your care team needs to check your specific device information and safety instructions first. Your specialist or device team can confirm what precautions are needed.”

Suggested Monthly Check-In Questions

Symptom Check
  • “Since we last spoke, have your stomach symptoms been better, worse, or about the same?”
  • “How often are you feeling nauseated?”
  • “Have you had any vomiting since we last spoke?”
  • “Are you able to keep fluids down?”
  • “Are you able to eat about the same amount as usual for you?”
  • “Are you feeling full sooner than usual?”
  • “Have you had more bloating, pressure, or abdominal discomfort?”
  • “Have you noticed any unplanned weight loss?”
  • “Have your symptoms caused you to miss medications, appointments, or regular activities?”
Hydration and Nutrition Check
  • “Are you having any trouble drinking enough fluids?”
  • “Are liquids or softer foods easier for you than solid foods right now?”
  • “Are you following a nutrition plan from your provider or dietitian?”
  • “Have you been told to avoid or limit any specific foods?”
  • “Do you feel like you are getting enough nutrition most days?”
Device-Related Check
  • “Have you noticed any new pain or discomfort near the device area?”
  • “Any redness, swelling, warmth, drainage, or tenderness near the incision or device site?”
  • “Have you felt any unusual jolting, shocking, burning, or uncomfortable sensations?”
  • “Have your symptoms suddenly worsened after being more controlled?”
  • “Do you have follow-up scheduled with the provider or clinic managing your device?”
  • “Do you have your device identification card available for medical visits?”
Diabetes Check, If Applicable
  • “Have your blood sugars been harder to manage recently?”
  • “Have you had any low blood sugars when you were not able to eat normally?”
  • “Have you had any high blood sugars during symptom flares?”
  • “Does your diabetes provider know about any recent changes in your eating pattern or vomiting?”
  • “Do you have instructions from your provider for what to do if you cannot eat normally?”
Medication and Follow-Up Check
  • “Are you taking your medications as prescribed?”
  • “Are you having any side effects or trouble tolerating your medications?”
  • “Do you need any refills?”
  • “Have any new medications been started recently?”
  • “Have you had any ER visits, urgent care visits, or hospital stays since we last spoke?”

Care Team Coordination Checklist

Consider whether the patient may need support with:

  • GI follow-up
  • Device clinic or surgeon follow-up
  • Dietitian referral or follow-up
  • Diabetes provider/endocrinology follow-up
  • Medication refill coordination
  • Nutrition/hydration concerns
  • Transportation barriers
  • Recent ER visits or hospitalizations
  • Weight loss or poor intake
  • Home health needs, if applicable
  • Patient education about when to call the provider

Key Takeaway for Care Coordinators

Patients with gastric electrical stimulation may have complex, ongoing gastroparesis symptoms. Care coordinators can play an important role by monitoring symptom trends, reinforcing provider-directed care plans, identifying concerning changes, and escalating appropriately.

Important focus areas are:

  • Changes in nausea or vomiting
  • Ability to keep fluids down
  • Nutrition and weight changes
  • Blood sugar changes, when applicable
  • Medication adherence or barriers
  • Device-site concerns
  • Follow-up with GI, surgery, or device clinic
  • Any symptoms that are new, worsening, or outside the patient’s usual pattern

The goal is to support the patient, identify concerns early, and keep the appropriate providers informed.

⚠️ Medical Disclaimer

This resource is provided for educational and informational purposes only and is not intended to replace professional medical advice, diagnosis, or treatment. The information presented is general in nature and may not apply to every individual or health situation.

Individuals should consult their physician or other qualified healthcare professional for personalized medical advice, diagnosis, or treatment recommendations related to their specific health conditions and should not begin any new exercise program or change their diet or medications without consulting their healthcare professional.

Call 911 if you are experiencing a medical emergency.

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