Letters to the Editor: Letters & Announcements
The letter by Sinclair and Bajekal (1) in response to our previously published review of vagal nerve stimulation (VNS) (2) highlights an interesting side effect of VNS, namely relief of dyspepsia. While many disease processes for which VNS may be effective are currently undergoing extensive testing, to our knowledge, relief of dyspepsia is not one of these (2). Because the vagus nerve has extensive afferent and efferent connections with the gastrointestinal tract from the upper esophageal sphincter to the transverse colon, VNS may well become an adjunctive therapy for many diseases, including gastroesophageal reflux disease and irritable bowel syndrome (3).
Additionally, their case highlights the fact that varied responses to VNS have been reported in patients both within published reports and in our own experience at the University of Kentucky Chandler Medical Center (2,4). For this reason, a careful history of known or anticipated side effects remains an essential part of the preoperative evaluation for patients with an implanted vagal nerve stimulator.
Kevin W. Hatton, MD
Brenda G. Fahy, MD
Department of Anesthesiology
University of Kentucky College of Medicine
1. Sinclair R, Bajekal RR. Vagal nerve stimulation and reflux. Anesth Analg 2007;105:884–5
2. Hatton KW, McLarney JT, Pitmann T, Fahy BG. Vagal nerve stimulation: overview and implications for anesthesiologists. Anesth Analg 2006;103:1241–9
3. Andrews PL, Sanger GJ. Abdominal vagal afferent neurons: an important target for the treatment of gastrointestinal dysfunction. Curr Opin Pharmacol 2002;2:650–6
4. Handforth A, DeGiorgio CM, Schachter SC, Uthman BM, Naritoku DK, Tecoma ES, Henry TR, Collins SD, Vaughn BV, Gilmartin RC, Labar DR, Morris GL III, Salinsky MC, Osorio I, Ristanovic RK, Labiner DM, Jones JC, Murphy JV, Ney GC, Wheless JW. Vagus nerve stimulation therapy for partial-onset seizures: a randomized active-control trial. Neurology 1998;51:48–55