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Systematic Review
Revised

Transcutaneous stimulation as a niche theme in gastroparesis therapy

[version 2; peer review: 2 not approved]
ARMAN YURISALDI SALEH
https://orcid.org/0000-0001-5866-3585
1, Riezky Valentina1, Dwi Arwandi Yogi Saputra2
ARMAN YURISALDI SALEH
https://orcid.org/0000-0001-5866-3585
1, Riezky Valentina1, Dwi Arwandi Yogi Saputra2
PUBLISHED 22 Oct 2024
Author details Author details
OPEN PEER REVIEW
REVIEWER STATUS

Abstract

Introduction

Gastroparesis, a global condition causing bile salt accumulation, is prevalent globally. Diagnosis techniques like bile salt titration and nitric oxide sulfate can improve patient care. However, simptomatic control is needed to reduce inflammation and control potential diseases. Neurological techniques like gyroscope stimulation and endoscopy can diagnose refractive gastroparesis. Interdisciplinary collaboration and bibliometric research are crucial for finding effective treatments. Gastroparesis, a motility issue affecting 0.9-1.3% of diabetics, can be improved by new diagnostic methods like osmotic pressure and gastric emptying, enhancing patient treatment.

Methods

This study uses a literature review methodology to gather data from the Scopus database on neuroaid, analyzing it using Biblioshiny and VOSviewer software. The focus is on dietary adjustments, glucose regulation, and transcutaneous stimulation’s role in gastroparesis treatment, using quantitative and qualitative analysis.

Results

The research trend found are documents by year, most relevant sources, factorial map of the most cited documents, factorial map of The documents with the highest contributes, documents by author, documents by country or territory, documents by subject area, documents by affiliation, network visualization, overlay visualization of scopus database using vosviewer, density visualization, thematic map, thematic evolution, cluster analysis, topic dendogram, and country collaboration map. According to our analysis, transcutaneous stimulation holds great promise for treating gastroparesis. We also found the necessity of multidisciplinary collaboration in the management of this illness.

Conclusions

The study on gastroparesis highlights key themes like diet modification, glucose control, medication therapy, Cajal’s role in smooth muscle concentration, common causes, transcutaneous stimulation, motorcycle themes, vagus nerve, and emerging devices and electronics. Basic themes include gastrointestinal disorders, neuromodulation, patients, diabetes, and gastric electrical stimulation. The management of gastroparesis involves multidisciplinary approaches, lifestyle changes, medication therapy, and bedtime interventions, with further investigation into transcutaneous stimulation being warranted.

Keywords

gastroparesis, niche, therapy, nerve, stimulation, bibliometric

Corresponding author: ARMAN YURISALDI SALEH
Competing interests: No competing interests were disclosed.
Grant information: The author(s) declared that no grants were involved in supporting this work.
Copyright:  © 2024 SALEH AY et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
How to cite: SALEH AY, Valentina R and Saputra DAY. Transcutaneous stimulation as a niche theme in gastroparesis therapy [version 2; peer review: 2 not approved]. F1000Research 2024, 13:658 (https://doi.org/10.12688/f1000research.152889.2) First published: 18 Jun 2024, 13:658 (https://doi.org/10.12688/f1000research.152889.1) Latest published: 22 Oct 2024, 13:658 (https://doi.org/10.12688/f1000research.152889.2)

Revised Amendments from Version 1

Revisions are as follows:
Abstract:
Introduction:
A motility problem called gastroparesis is characterized by delayed stomach emptying. Between 0.9 and 1.3% of diabetic people are thought to have gastroparesis. Patient treatment may be enhanced by new diagnostic methods like osmotic pressure and gastric emptying.
Methods:
To find the most important subjects in the gastroparesis literature, we employed bibliometric analysis. Our attention was directed towards dietary adjustments, glucose regulation, and the function of transcutaneous stimulation in the treatment of gastroparesis.
Results:
According to our analysis, transcutaneous stimulation holds great promise for treating gastroparesis. We also found the necessity of multidisciplinary collaboration in the management of this illness.
Conclusion:
Further investigation into the topic of transcutaneous stimulation in the management of gastroparesis is warranted.
 
Introduction:
Gastroesophageal reflux disease, or GERD for short, is not the same as gastric electrical stimulation, or GES for short. Furthermore, to treat a possible pyloric obstruction, a minimally invasive endoscopic surgical procedure called G-POEM (Gastric Per-Oral Endoscopic Myotomy) is used.

Methods:
The primary subjects in the gastroparesis literature were determined by this study using bibliometric analysis. The techniques, findings, and primary themes presented in the publications determined their classification.

Results:
Our analysis's findings suggest that transcutaneous stimulation is a useful strategy for treating gastroparesis. This analysis also contained a significant paper that evaluated stomach electrical stimulation.

Aims:
This systematic review's objectives were to evaluate the body of research on transcutaneous stimulation and investigate its potential in the treatment of gastroparesis.

Conclusions:
The results reported in the review corroborate our findings. Confirming the efficacy of transcutaneous stimulation in the treatment of gastroparesis requires additional research.

See the authors' detailed response to the review by Heithem Soliman

Introduction

A disorder called gastroparesis is characterized by a delayed stomach emptying.1–3 The global prevalence of gastroparesis-like symptoms (GPLS) was 0.9% overall and 1.3% among individuals with diabetes.1,2 In the US, the prevalence of gastroparesis is estimated to be approximately 267.7 per 100,000 adults.1,2

Gastroparesis is usually diagnosed based on clinical symptoms and delayed gastric emptying demonstrated by imaging tests.1–3 New techniques for assessing gastric emptying, such as the gastric emptying breath test and wireless motility capsules, allow clinicians to better characterize their patients.2

The goals of symptomatic control, notwithstanding the limitations of existing treatments, are to improve stomach emptying, reduce nausea and vomiting, and manage related abdominal discomfort.4 Other possible treatments target bacterial overgrowth, enhance stomach accommodation or pyloric dysfunction, and lessen acid production.4

Gastroparesis can cause complications such as severe dehydration, malnutrition, and unpredictable blood sugar changes.5

Gastric electrical stimulation (GERD) and oral endoscopic pyloric myotomy (G-POEM) are some of the neurological techniques that can help treat refractory gastroparesis.6

Finding the right therapy for gastroparesis is essential because it can improve the patient's quality of life and reduce complications associated with this condition.2,4

Collaboration between interdisciplinary scientists is very important in overcoming the problem of gastroparesis. An interdisciplinary approach allows professionals to approach patient care from multiple perspectives.1

Bibliometric research is essential in the search for effective new therapies. By analyzing scientific publications in this field, researchers can identify research trends and discover areas that require further research.1,2

Gastroesophageal reflux disease, or GERD for short, is not the same as gastric electrical stimulation, or GES for short. Furthermore, to treat a possible pyloric obstruction, a minimally invasive endoscopic surgical procedure called G-POEM (Gastric Per-Oral Endoscopic Myotomy) is used.

Methods

Bibliometric research is a research method that uses scientific publication data to describe and analyze the development of a field of science. This research aims to identify and map trends, patterns, and relationships between scientific documents related to certain topics. In this research, the topic chosen was gastroparesis, therapy, and “nerve stimulation”. This research uses data from the website www.scopus.com, which is one of the largest and most trusted databases for scientific publications. This research was conducted on early June 2024.

To carry out bibliometric research, the steps to follow are as follows:

  • 1. Determine search keywords. In this research, the keywords used are gastroparesis, therapy, and “nerve stimulation”. These keywords are entered into the search column on the www.scopus.com site by selecting the topic field (title, abstract, keywords).

  • 2. Filter search results. In this study, were not filtered.

  • 3. Get data from search results. In this study, search result data is retrieved in three different formats:

    • • CSV (comma-separated value), which includes the title, author, affiliation, year, source, abstract, and keywords, among other basic document information.

    • • The Research Information System (RIS), which offers comprehensive details on a document, including the references it cites.

Data for this study were collected by one reviewer. Reviewers work independently in collecting data from each report. To ensure data accuracy and clutter. In addition, we use automated tools, namely the *VosViewer* and *Biblioshiny* applications, to assist in the data collection and analysis process.”

In this study we found are documents by year has been an increase in the number of documents; until 2023, there were 5 documents, most relevant sources is journal of neurogastroenterology and mobility, factorial map of the most cited documents following is a summary of a study entitled Bioelectric neuromodulation for gastrointestinal disorders: effectiveness and mechanisms by Payne SC, published in the journal Nature Reviews Gastroenterology & Hepatology, Factorial map of the documents with the highest contributes entitled Clinical trial: interferential electric stimulation in functional dyspepsia patients: a prospective randomized study by Koklu S, published in the journal Alimentary Pharmacology & Therapeutics.

Documents by author with 5 documents are Yin, J., documents by country or territory is United States is the country with the largest number of document producers 46 documents, documents by subject area, network visualization, overlay visualization of scopus database using vosviewer, density visualization, thematic map based on the title shows that the niche theme is the keyword mitochondria signaling pathway, effects neuroprotective effect, dan oxidative stres toxicity, thematic evolution, cluster analysis, qualitative analysis, and word cloud.

The primary subjects in the gastroparesis literature were determined by this study using bibliometric analysis. The techniques, findings, and primary themes presented in the publications determined their classification.

Data collection

We used the following terms to do a search on the Scopus website, taking into consideration that this website contains research that is considered to be valid: TITLE – ABS – KEY (gastroparesis) AND TITLE – ABS – KEY (therapy) AND TITLE – ABS – KEY (“nerve stimulation”) are the titles of the products that are under consideration. fifty-nine documents were received by us. We then save the document from Scopus in the form of a file with the extension.csv file following this step.

Data analysis

Both the Biblioshiny and Vosviewer software packages were utilised in the analysis process.

Quantitative analysis

Documents by year

Based on Figure 1, it appears that there has been an increase in the number of documents, until in 2023 there were 5 documents. The oldest document in 2002 was entitled Gastric electrical stimulation in intractable symptomatic gastroparesis., written by Abell, T. L et al.,7 Next is the article entitled Physiology and pathophysiology of the interstitial cells of cajal: From bench to bedside VI. Pathogenesis and therapeutic approaches to human gastric dysrhythmias written by Owyang, C., and Hasler, W.L.8 Meanwhile, the latest document in 2024 is entitled F Non-invasive neuromodulation: an emerging intervention for visceral pain in gastrointestinal disorders written by Alam, M.J. and Chen, J.D.Z.9 Next is the article entitled Transcutaneous electrical stimulation for gastrointestinal motility disorders written by Song, G. et al.,10 next article is Gastric peroral endoscopic myotomy for management of refractory gastroparesis in patients with gastric neurostimulator devices: a multicenter retrospective case control study written by Ichkhanian, Y. et al.11 next article is Electroceuticals for Neurogastroenterology and Motility Disorders written by Jiang, Y. and Soffer, E.12 And next article is Noninvasive electrical neuromodulation for gastrointestinal motility disorders written by Yin, J. and Chen, J.D.Z.13

e2b7f8ec-8b13-4d93-91b2-1d12fefcf0d4_figure1.gif

Figure 1. Documents by year.

Most relevant sources

Based on Figure 2, the following are the journals that publish the most important documents: The first is neurogastroenterology and mobility. This journal has been indexed in Scopus. The Journal of Neurogastroenterology and Motility is published by Wiley-Blackwell Publishing Ltd. The SJR (Scientific Journal Rankings) for Neurogastroenterology and Motility in 2023 is 0.944. The H-index for neurogastroenterology and mobility is 126. This journal accepts articles that focus on the fields of gastroenterology and neurology, especially those related to gastrointestinal motility. Some topics that frequently appear in publications in this journal include, but are not limited to, the pathophysiology and treatment of gastroparesis, esophageal smooth muscle phenotype in achalasia, retrograde cricopharyngeus dysfunction, and the effects of trimebutine and rifaximin on glucose breath testing in patients with functional bloating.

e2b7f8ec-8b13-4d93-91b2-1d12fefcf0d4_figure2.gif

Figure 2. Most relevant sources.

In second place is the journal Neuromodulation. This journal has been indexed in Scopus. The Journal of Neuromodulation is published by Elsevier on behalf of the International Neuromodulation Society. The SJR (Scientific Journal Rankings) for neuromodulation in 2023 is 0.827. The H-index for neuromodulation is 77. This journal accepts papers focused on the field of neuromodulation, including clinical, translational, and basic research. Some topics that frequently appear in this journal's publications include, but are not limited to, pain, headaches, movement disorders, spasticity, paralysis, psychiatric disorders, epilepsy, sensory deprivation, gastric dysfunction, obesity, and incontinence.

In third place is the American Journal of Physiology—Gastrointestinal. This journal has been indexed in Scopus since 1980. The American Journal of Physiology—Gastrointestinal is published by the American Physiological Society. The SJR (Scientific Journal Rankings) for the American Journal of Physiology-Gastrointestinal in 2023 is 1,383. The H-index for the American Journal of Physiology-Gastrointestinal is 191. Original research on any area of the gastrointestinal tract, hepatobiliary system, or pancreas, whether normal or pathological, is welcome to be published in this publication. Manuscripts pertaining to these organs' growth and development, digestion, secretion, absorption, metabolism, and motility are all welcome, as are research reports on immune and inflammatory processes, as well as those involving neural, endocrine, and circulatory control mechanisms.

Factorial map of the most cited documents

Based on Figure 3, the following is a summary of a study entitled Bioelectric neuromodulation for gastrointestinal disorders: effectiveness and mechanisms by Payne SC, published in the journal Nature Reviews Gastroenterology & Hepatology.14

e2b7f8ec-8b13-4d93-91b2-1d12fefcf0d4_figure3.gif

Figure 3. Factorial map of the most cited documents.

This study examines the use of electrical stimulation of nerves or brain centers as a therapeutic tool being tested in a variety of human diseases, including Parkinson's disease, arthritis, depressive disorders, schizophrenia, pain, and bladder dysfunction.14

Neuromodulation, bioelectrical neuromodulation, or electroceuticals are terms used to describe this therapy. The clinical community is very interested in the potential application of bioelectric neuromodulation to treat gastrointestinal-related illnesses, and several gastrointestinal tract sites have been studied for a variety of conditions.14

In many cases, The variability of outcomes and the lack of clarity around mechanisms of action pose significant therapeutic problems (such as the ideal stimulus settings) that have already been discussed in other reviews. Sacral nerve stimulation for fecal incontinence is still the sole widely utilized neuromodulation protocol for gastrointestinal problems, despite the fast advancements in bioelectrical neuromodulation technology during the past ten years.14

Success rates for treating various ailments like IBD, obesity, nausea, and gastroparesis have varied. By gaining more insight into the targeted brain circuits and their physiological and pathological roles, improving stimulation protocols, and identifying the patients who would benefit most from these therapies, the therapeutic effectiveness of these bioelectric neuromodulation therapies may be increased.14

Factorial map of the documents with the highest contributes

In Figure 4, the following is a summary of the study entitled Clinical trial: interferential electric stimulation in functional dyspepsia patients: a prospective randomized study by Koklu S, published in the journal Alimentary Pharmacology & Therapeutics.15

e2b7f8ec-8b13-4d93-91b2-1d12fefcf0d4_figure4.gif

Figure 4. Factorial map of the documents with the highest contributes.

This study aimed to analyze if transcutaneous electrical stimulation is a treatment that works for patients with functional dyspepsia. Functional dyspepsia patients were randomly assigned to vacuum interference flow (IFC) and placebo groups. Both treatments consisted of 12 sessions given over 4 weeks.15

The outcomes demonstrated that while heartburn and vomiting did not significantly change in the placebo group, all symptoms in the therapy group—aside from early satiety—improved during and after treatment sessions. During treatment sessions, it was demonstrated that IFC therapy was more effective than placebo in terms of pyrosis, bloating, early satiety, and post-meal satiety.15

Vacuum IFC was demonstrated to be more effective than a placebo one month following the treatment session in terms of early satiety and stomach ulcers. To sum up, vacuum IFC is a successful, non-invasive treatment for functional dyspepsia. Patients with drug-resistant functional dyspepsia may benefit from a novel kind of treatment called transcutaneous electrical stimulation.15

Documents by author

Based on Figure 5. the most authors with 5 documents are Yin, J., with the titles of several articles, namely: A novel approach in spinal cord stimulation for enhancing gastric motility: A preliminary study on canines, Emerging Gastric Stimulation for Dysmotility Disorder and Obesity, Electrical therapies for gastrointestinal motility disorders, Ameliorating effect of transcutaneous electroacupuncture on impaired gastric accommodation induced by cold meal in healthy subjects, and Gastric neuromodulation with Enterra system for nausea and vomiting in patients with gastroparesis.16–20

e2b7f8ec-8b13-4d93-91b2-1d12fefcf0d4_figure5.gif

Figure 5. Documents by author.

The next most author with 4 documents is Chen, J.D.Z., with the titles of several articles, namely: A novel approach in spinal cord stimulation for enhancing gastric motility: A preliminary study on canines, Electrical therapies for gastrointestinal motility disorders, Gastric neuromodulation with Enterra system for nausea and vomiting in patients with gastroparesis, and Effects and mechanisms of electrical stimulation of the stomach, duodenum, ileum, and colon on gastric tone in dogs.16,18,20,21

The next most author with 4 documents is McCallum, R.W., with the titles of several articles, namely Surgical approaches to treatment of gastroparesis: Gastric electrical stimulation, pyloroplasty, total gastrectomy and enteral feeding tubes, Gastric neuromodulation with Enterra system for nausea and vomiting in patients with gastroparesis, Treatment of Refractory Gastroparesis: Gastric and Jejunal Tubes, Botox, Gastric Electrical Stimulation, and Surgery, and Gastrointestinal Electrical Stimulation for Treatment of Gastrointestinal Disorders: Gastroparesis, Obesity, Fecal Incontinence, and Constipation.20,22–24

Documents by country or territory

Based on Figure 6, the United States is the country with the largest number of document producers 46 documents. Followed by Canada with 4 documents, China with 4 documents, and Germany with 3 documents.

e2b7f8ec-8b13-4d93-91b2-1d12fefcf0d4_figure6.gif

Figure 6. Documents by country or territory.

e2b7f8ec-8b13-4d93-91b2-1d12fefcf0d4_figure7.gif

Figure 7. Documents by subject area.

Table 1. Documents by subject area.

NoTitle
Field Of Medicine
1.Non-invasive neuromodulation: an emerging intervention for visceral pain in gastrointestinal disorders
2.Transcutaneous electrical stimulation for gastrointestinal motility disorders
3.Gastric peroral endoscopic myotomy for management of refractory gastroparesis in patients with gastric neurostimulator devices: a multicenter retrospective case control study
4.Electroceuticals for Neurogastroenterology and Motility Disorders
5.Noninvasive electrical neuromodulation for gastrointestinal motility disorders
6.Migraine and Gastroparesis
7.Pediatric gastrointestinal neuromodulation: A review
8.The vagus nerve: current concepts in anaesthesia and ICU management
9.Improvement in Symptomatic Gastroparesis with Increased Vagal Nerve Stimulation
10.Gastric Electrical Stimulation for Treatment of Refractory Gastroparesis: the Current Approach to Management
11.Effects of Gastric Neuromodulation on Crohn's Disease in Patients With Coexisting Symptoms of Gastroparesis
12.Open-label pilot study: Non-invasive vagal nerve stimulation improves symptoms and gastric emptying in patients with idiopathic gastroparesis
13.Sacral nerve stimulation increases gastric accommodation in rats: A spinal afferent and vagal efferent pathway
14.A novel approach in spinal cord stimulation for enhancing gastric motility: A preliminary study on canines
15.Diabetic Neuropathy and Foot Care: Standards of Medical Care in Diabetes-2019
16.Implantable electronic stimulation devices from head to sacrum: Imaging features and functions
17.Current and future treatment management strategies for gastroparesis
18.Cajal cell counts are important predictors of outcomes in drug refractory gastroparesis patients with neurostimulation
19.Bioelectric neuromodulation for gastrointestinal disorders: effectiveness and mechanisms
20.Gastricelectricstimulationforrefractorygastroparesis
21.Minimally-invasive temporary gastric stimulation: A pilot study to predict the outcome of electronic gastric stimulation with the Enterra™ system
22.Proof of concept: Short-term noninvasive cervical vagus nerve stimulation in patients with drugrefractory gastroparesis
23.Electrical therapies for gastrointestinal motility disorders
24.Comparing the effects of acupuncture and pharmacologic therapies on delayed gastric emptying: A prospective, block-randomized, single-blinded, parallel clinical trial
25.Some Non-FDA Approved Uses for Neuromodulation in Treating Autonomic Nervous System Disorders: A Discussion of the Preliminary Support
26.Complex regional pain syndrome and dysautonomia in a 14-year-old girl responsive to therapeutic plasma exchange
27.Ameliorating effect of transcutaneous electroacupuncture on impaired gastric accommodation induced by cold meal in healthy subjects
28.Endoscopic approaches to gastroparesis
29.Pregnancy and delivery in a woman with type 1 diabetes, gastroparesis, and a gastric neurostimulator
30.Prospective evaluation of gastric neurostimulation for diabetic gastroparesis in Canada
31.Neurostimulation of the gastrointestinal tract: Review of recent developments
32.Surgical approaches to treatment of gastroparesis: Gastric electrical stimulation, pyloroplasty, total gastrectomy and enteral feeding tubes
33.Rapid repetitive electric signals in a 12-lead ECG and in telemetry
34.Factors influencing admission and outcomes in gastroparesis
35.Diabetic gastroparesis
36.Gastric neuromodulation with Enterra system for nausea and vomiting in patients with gastroparesis
37.Clinical trial: Transcutaneous interferential electrical stimulation in individuals with irritable bowel syndrome-a prospective double-blind randomized study
38.Comparative gastric motility study of Enterra Therapy and neural gastric electrical stimulation in an acute canine model
39.Treatment of patients with diabetic gastroparesis
40.Clinical trial: Interferential electric stimulation in functional dyspepsia patients - A prospective randomized study
41.Effects and mechanisms of electrical stimulation of the stomach, duodenum, ileum, and colon on gastric tone in dogs
42.Methods of gastric electrical stimulation and pacing: A review of their benefits and mechanisms of action in gastroparesis and obesity
43.Treatment of Refractory Gastroparesis: Gastric and Jejunal Tubes, Botox, Gastric Electrical Stimulation, and Surgery
44.Gastric applications of electrical field stimulation
45.Changes in the gastric enteric nervous system and muscle: A case report on two patients with diabetic gastroparesis
46.Gastrointestinal involvement in systemic sclerosis
47.Gastrointestinal Electrical Stimulation for Treatment of Gastrointestinal Disorders: Gastroparesis, Obesity, Fecal Incontinence, and Constipation
48.Electrical stimulation as treatment for obesity and diabetes
49.Gastrointestinal motility disorders: An update
50.Nausea, gastroparesis, and aerophagia
51.Gastroparesis and electrical stimulation: Can we afford the power bill?
52.Transcutaneous electrical nerve stimulation for severe gastroparesis after lung transplantation
53.Diabetic neuropathy: An intensive review
54.Gastric electrical stimulation in intractable symptomatic gastroparesis
55.Physiology and pathophysiology of the interstitial cells of cajal: From bench to bedside VI. Pathogenesis and therapeutic approaches to human gastric dysrhythmias
Field Of Neuroscience
1.Transcutaneous electrical stimulation for gastrointestinal motility disorders
2.Migraine and Gastroparesis
3.Effects of Gastric Neuromodulation on Crohn's Disease in Patients With Coexisting Symptoms of Gastroparesis
4.An emerging method to noninvasively measure and identify vagal response markers to enable bioelectronic control of gastroparesis symptoms with gastric electrical stimulation
5.Open-label pilot study: Non-invasive vagal nerve stimulation improves symptoms and gastric emptying in patients with idiopathic gastroparesis
6.Emerging Gastric Stimulation for Dysmotility Disorder and Obesity
7.Neuromodulation for Gastrointestinal Dysmotility in Pediatric Patients
8.Some Non-FDA Approved Uses for Neuromodulation in Treating Autonomic Nervous System Disorders: A Discussion of the Preliminary Support
9.Neurostimulation of the gastrointestinal tract: Review of recent developments
10.Neurostimulation of the gastrointestinal tract: Review of recent developments
11.Gastric neuromodulation with Enterra system for nausea and vomiting in patients with gastroparesis
12.Comparative gastric motility study of Enterra Therapy and neural gastric electrical stimulation in an acute canine model
13.Methods of gastric electrical stimulation and pacing: A review of their benefits and mechanisms of action in gastroparesis and obesity
14.Gastroparesis and electrical 2005 stimulation: Can we afford the power bill?

Documents by subject area (Table 1, Figure 7)

Documents by affiliation

Based on Figure 8, in first place, the producer of the most documents is affiliated with the John Hopkins University with 5 documents, next in second place is affiliated with John Hopkins University School of Medicine with 4 documents and next is the Texas Tech University Health Sciences Center with 4 documents.

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Figure 8. Documents by affiliation.

Network visualization

Based on Figure 9, it can be seen that the areas studied are still not related to other areas that are divided into edges. That field is: stomach motility, electrode, electrodes implanted, diabetic stomach paresis, heart arrhythmia, diet therapy, animal experiment, irritable colon, and gabapentin.

e2b7f8ec-8b13-4d93-91b2-1d12fefcf0d4_figure9.gif

Figure 9. Network visualization.

Overlay visualization of scopus, database using Vosviewer

Based on Figure 10. In the overlay visualization, it appears that the keywords that are being researched a lot approaching 2018 are the parts colored yellow, namely: diabetic stomach paresis, abdominal pain, physiology, procedures, electrotherapy, innervation, neuromodulation, sacral nerve stimulation, gastrointestinal disease, and gastrointestinal diseases.

e2b7f8ec-8b13-4d93-91b2-1d12fefcf0d4_figure10.gif

Figure 10. Overlay visualization of scopus, database using Vosviewer.

Density visualization

Based on Figure 11. In the visual circulation density, it appears that the part that is already saturated with research is yellow, while the part that is not yet saturated is slightly yellow and dominantly green, namely keywords: clinical article, stomach motility, young adult, electrodes implanted, electrode, animal experiment, diabetic stomach paresis, major clinical study, abdominal pain, diabetes mellitus, physiology, animals, disease severity, therapy effect case report, antiemetic agent, pyloroplastu, prokinetic agent, pyloromyotomy, gastrecromy, tegaserod, domperidone, clinical feature, cisapride, heart arrhtymia, diet therapy, gabapentin, prevalence, electrostimulation therapy, dyspepsia, irritable colon, gastrointestinal motility diso, gastrointestinal disease, gastrointestinal diseases. Sacral nerve stimulation, gastrointestinal tract, neuromodulation, electroacunpuncture, intestine innervation, innervation, animal, animals, and gastrointestinal motility.

e2b7f8ec-8b13-4d93-91b2-1d12fefcf0d4_figure11.gif

Figure 11. Density visualization.

Thematic map

Based on Figure 12, Based on the thematic map, it can be explained as follows: Upper Left Quadrant (Niche and Emerging/Declining Themes): This quadrant contains keywords such as “pain,” “transcutaneous,” “prospective clinical study,” and “cable approaches.” This indicates a focus on innovative clinical studies related to pain management via transcutaneous methods.

e2b7f8ec-8b13-4d93-91b2-1d12fefcf0d4_figure12.gif

Figure 12. Thematic map.

Top Right Quadrant (Motor and Emerging/Declining Themes)*: This quadrant is empty, indicating that there may be little innovation currently or waning interest in this area. Bottom Left Quadrant (Niche and Basic Themes)*: This quadrant includes keywords such as “arterra electronic devices,” indicating a focus on electronic devices in the context of medical applications that are considered niche but basic.

Lower Right Quadrant (Motor and Basic Themes): This quadrant represents basic motor themes with keywords such as “vagal nerve emerging,” “gastric electrical stimulation,” and larger keyword clusters including “diabetic gastroparesis” and “gastrointestinal neuromodulation." This represents an established medical practice that focuses on electrical stimulation for conditions such as diabetic gastroparesis.

Each keyword or keyword cluster provides insight into a specific area of medical research or practice, indicating what is currently niche or basic and what is considered emerging or declining within this thematic area.

Thematic evolution

Based on Figure 13, There was an evolution of changes in themes in research in 2002–2016 with the keywords motility, gastrointestinal, diabetic, gastroparesis, and prospective. The theme then changed in 2017–2023 to gastrointestinal, stimulation, gastroparesis, and management.

e2b7f8ec-8b13-4d93-91b2-1d12fefcf0d4_figure13.gif

Figure 13. Thematic evolution.

Topic dendogram

Based on Figure 14. There are 2 large clusters based on keywords. There are 2 clusters of blue and red.

e2b7f8ec-8b13-4d93-91b2-1d12fefcf0d4_figure14.gif

Figure 14. Dendogram.

Qualitative analysis

Country collaboration map

Based on Figure 15. Intense cooperation in this field is only carried out by China and the United States.

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Figure 15. Country collaboration map.

Table 2. Based on location of electric stimulation.

TitleDocumentReference No.
Cutaneous11 documents7,9,10,12,13,15,19,25–30
Non cutaneus48 documents1–6,8,11,14,16–18,20–24,31–71

Discussion

The most important thing in bibliometric studies on the topic of gastroparesis therapy with nerve stimulation is to look for niche themes and map things that researchers have started to leave behind.

The following is a more detailed and sequential explanation of the keywords in the thematic map:

Niche Themes

The approach to treating gastroparesis involves a variety of strategies, including diet modification, blood glucose control, and pharmacologic therapy with prokinetics and antiemetics.41,66,70

Cajal refers to the Interstitial Cells of Cajal (ICC), which act as pacemaker cells in the digestive tract and play an important role in coordinating smooth muscle contractions. Disruption or loss of ICC has been associated with several GI motility disorders, including gastroparesis.66

Pain is a common symptom of gastroparesis. The pain usually occurs in the upper abdominal area and can vary from dull to sharp.37

Transcutaneous refers to therapy that involves nerve stimulation through the skin without the need for surgery. In the context of gastroparesis, transcutaneous therapies such as transcutaneous vagus nerve stimulation have been investigated and show potential for reducing symptoms.66,70

In the context of gastroparesis, accommodation refers to the stomach's ability to relax and adjust to the volume of incoming food. Impairments in gastric accommodation may contribute to the symptoms of gastroparesis.41,66

Much research has been and is being conducted to better understand this condition and develop more effective therapies.43,57

In the context of medical research, a prospective study is a type of research that follows subjects over time to observe specific outcomes. Prospective studies are often used in gastroparesis research to better understand how this condition develops and responds to therapy.37,66

Motor themes

The vagus nerve is a cranial nerve that plays an important role in various body functions, including the control of muscle movements in digestion. In the context of gastroparesis, damage to the vagus nerve can cause delayed gastric emptying.37,41 Some therapies in development include relamorelin, prucalopride, and aprepitant.41,66,70

Emerging or declining themes

The word devices may refer to the tools or devices used in gastric electrical stimulation therapy. However, more specific information may require further research.41,66,70

The word electronic may refer to the electronic aspects of gastric electrical stimulation therapy, such as how the device generates and sends electrical signals to the stomach muscles.41,66,70

Enterra refers to Enterra Therapy, a medical treatment designed to help control chronic nausea and vomiting associated with gastroparesis. This therapy works through what is known as gastric electrical stimulation (GES). Gastric electrical stimulation involves stimulating the smooth muscles in the lower abdomen with mild electrical pulses.70

Basic themes

The word gastrointestinal refers to the digestive system, which includes the stomach and intestines. Gastroparesis is a gastrointestinal disorder that affects the normal function of the stomach.66

The word disorders” refers to disorders or medical conditions that affect the normal function of the stomach and digestive tract. Gastroparesis is a gastrointestinal disorder that affects the normal function of the stomach.

Neuromodulation is a technique used to regulate neural activity by stimulating or inhibiting nerve signals. In the context of gastroparesis, neuromodulation may be used to help control symptoms.41,66,70

Gastroparesis is a condition characterized by delayed gastric emptying and symptoms such as nausea, vomiting, early satiety, bloating, and upper abdominal pain.43,50,57

Patients, This refers to individuals diagnosed with gastroparesis and undergoing treatment. Management of patients with gastroparesis involves a multidisciplinary approach that includes lifestyle changes, pharmacologic therapy, and, in some cases, surgical intervention.50

Gastroparesis often occurs in individuals with diabetes, and this condition is known as diabetic gastroparesis. Diabetes can cause damage to the vagus nerve, which controls muscle movement in digestion, causing gastroparesis.37

Gastric electrical stimulation is a procedure in which a small device that produces mild electrical pulses is implanted in the patient's body. This device helps promote the movement of food through the stomach more easily and controls symptoms associated with gastroparesis such as nausea and vomiting.66

Our analysis’s findings suggest that transcutaneous stimulation is a useful strategy for treating gastroparesis. This analysis also contained a significant paper that evaluated stomach electrical stimulation.

This systematic review’s objectives were to evaluate the body of research on transcutaneous stimulation and investigate its potential in the treatment of gastroparesis.

Conclusion

The bibliometric topic study on gastroparesis focuses on identifying niche themes and discussing factors currently being studied. Key themes include interventions like diet modification, glucose control, and medication therapy with prokinetics and antiemetics. Cajal, or interstitial cajal, is crucial in coordinating smooth muscle concentration. Neighbors are common causes of gastroparesis, and transcutaneous stimulation, such as transcutaneous vagus stimulation, has been studied to develop more effective treatments. Prospective studies take time to analyze specific results. Motorcycle themes involve the vagus nerve, which controls muscle flow in medicine, and damage to it can cause gastroparesis. Emerging or declining themes include devices, electronics, and Enterra stimuli used in gastroparesis treatment. Basic themes include gastrointestinal disorders, neuromodulation, patients, diabetes, and gastric electrical stimulation. Gastroparesis, a condition affecting normal bowel function, is often associated with diabetes. Management involves multidisciplinary approaches, lifestyle changes, medication therapy, and bedtime interventions.

The results reported in the review corroborate our findings. Confirming the efficacy of transcutaneous stimulation in the treatment of gastroparesis requires additional research.

Software availability

VOSviewer software is an open-access tool that can be used as a cost-effective method for any scientometric analysis72

Author contribution

AYS conducts research, gathers data, performs statistical analysis, and produces discussions and conclusions, RV and DAYS editing.

Data availability statement

Underlying data

Figshare: Transcutaneous stimulation as a niche theme in gastroparesis therapy

DOI: https://doi.org/10.6084/m9.figshare.25991923.v1. 73

Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).

Extended data

Open Science Framework: PRISMA checklist & Flow Diagram: Transcutaneous stimulation as a niche theme in gastroparesis therapy

DOI: https://doi.org/10.6084/m9.figshare.25991968.v1. 74

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Hareesha Rishab Bharadwaj, The University of Manchester, Manchester, England, UK 
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https://doi.org/10.5256/f1000research.167699.r303094
Thank you for the opportunity to peer review this manuscript. Whilst the topic has the potential to provide well-structured contribution to the field, with significant potential to influence future research in neuromodulation and gastroparesis treatments, I am afraid I do ... Continue reading
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There are some issues in the English language that make some sentences difficult to understand.
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The title refers to transcutaneous stimulation, thus, this treatment should be more highlighted in the results, ... Continue reading
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  • Author Response 02 Sep 2024
    ARMAN YURISALDI SALEH, Neurology Department, Universitas Pembangunan Nasional Veteran Jakarta, Jakarta, 12450, Indonesia
    02 Sep 2024
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    Dear Reviewer Board

    Thank you for your feedback. We will make improvements in the future. This study uses the bibliometric methods which does not use statistical analysis in this ... Continue reading
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    ARMAN YURISALDI SALEH, Neurology Department, Universitas Pembangunan Nasional Veteran Jakarta, Jakarta, 12450, Indonesia
    22 Oct 2024
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    Transcutaneous Stimulation as a Niche Theme in Gastroparesis Therapy: A Bibliometric Analysis

    Revised Results:
    We discovered that transcutaneous stimulation holds great promise for treating gastroparesis. Patients' quality of life ... Continue reading
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  • Author Response 02 Sep 2024
    ARMAN YURISALDI SALEH, Neurology Department, Universitas Pembangunan Nasional Veteran Jakarta, Jakarta, 12450, Indonesia
    02 Sep 2024
    Author Response
    Dear Reviewer Board

    Thank you for your feedback. We will make improvements in the future. This study uses the bibliometric methods which does not use statistical analysis in this ... Continue reading
    Report a concern
  • Author Response 22 Oct 2024
    ARMAN YURISALDI SALEH, Neurology Department, Universitas Pembangunan Nasional Veteran Jakarta, Jakarta, 12450, Indonesia
    22 Oct 2024
    Author Response
    Transcutaneous Stimulation as a Niche Theme in Gastroparesis Therapy: A Bibliometric Analysis

    Revised Results:
    We discovered that transcutaneous stimulation holds great promise for treating gastroparesis. Patients' quality of life ... Continue reading
    Report a concern

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