The Q&A: Rinarani Sanghavi

With each issue, Trib+Health brings you an interview with experts on issues related to health care. Here is this week's subject:

Dr. Rinarani Sanghavi is an associate professor of pediatrics and director of the Neurogastroenterology and Pediatric Gastrointestinal Motility Program at UT Southwestern Medical Center. We spoke with her about a recent surgery involving the first pediatric patient in North Texas successfully receiving a gastric electrical stimulator and what lies ahead for the relatively new form of treatment. 

Editor's note: This interview has been edited for length and clarity.

Trib+Health: Can you explain what a gastric electrical stimulator is and why people sometimes need it?

Rinarani Sanghavi: A gastric electrical stimulator is a pacemaker, but instead of putting it in the heart, you put it in the stomach. Similar to the heart pacemaker, it delivers electrical stimulation to the north of the stomach. It helps the muscles of the stomach contract and move better, which seems to help a lot with function of the stomach.

By stimulating the nerve, the stimulator seems to have a central effect on the brain, and it works on the center in the brain that controls nausea and vomiting, which relieves a lot of the symptoms of nausea and vomiting. 

Trib+Health: Hunter Pye, a patient of yours, was the first pediatric patient to receive a gastric electrical stimulator in North Texas. How were you able to diagnose Pye, and was the situation different given Pye is a pediatric patient?

Sanghavi: Doing electrical stimulation in the stomach is a fairly new technique. There are some really small studies with adults and even smaller studies with pediatric patients. 

When this patient came to see me from Arkansas, he had been through a lot of the available diagnostic therapies for vomiting and weight loss, and they had come to the conclusion that the problem was within his stomach. When he came to me, he had tried every medicine that is known for this condition and had failed it.

We have advanced diagnostic methods where we could pinpoint that the problem was with the muscles of his stomach not getting enough electrical stimulation from the nerves. That's why we decided he would be a very good candidate to get relief with the gastric stimulator. 

Trib+Health: The gastric electrical stimulator is FDA approved for adults but not for pediatric patients. Do you anticipate that changing in the future? 

Sanghavi: I hope it would. The problem is you need a large number of studies and good outcomes for the FDA to feel comfortable. This condition is really rare in pediatrics patients to begin with. Very few of these patients actually reach the point where they would need gastric stimulation, and even fewer centers have the ability or the expertise to do it like we do here at UT Southwestern.

It seems like it’s a long road ahead. It's my hope that it becomes available for the right kind of pediatric patients. 

Trib+Health: Are you and fellow doctors planning to study this subject further? 

Sanghavi: Yes, we are doing some studies on reasons for emptying the stomach and then we’re also part of a national study for gastroparesis. There are lots of other centers looking at electrical stimulation of the stomach and outcomes of that. Most of them are adult studies, but we do some over here. 

Trib+Health: Since Pye's successful surgery, have additional pediatric patients reached out to you for this surgery? 

Sanghavi: Yes, a lot of people who have heard or read about this that have come to our center. I always stress to them that this is not the first line of therapy — there are diagnostic algorithms, other medicine and therapies we can use before we get to this.

As of right now, we have two patients we think will potentially be helped by this therapy, but I’m still waiting to see how certain medicines they’ve tried have worked before initiating this therapy.