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Xu W, Wang T, Foong D, Schamberg G, Evennett N, Beban G, Gharibans A, Calder S, Daker C, Ho V, O'Grady G. Characterization of gastric dysfunction after fundoplication using body surface gastric mapping. J Gastrointest Surg 2024; 28:236-245. [PMID: 38445915 DOI: 10.1016/j.gassur.2023.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 12/09/2023] [Accepted: 12/22/2023] [Indexed: 03/07/2024]
Abstract
BACKGROUND Adverse gastric symptoms persist in up to 20% of fundoplication operations completed for gastroesophageal reflux disease, causing significant morbidity and driving the need for revisional procedures. Noninvasive techniques to assess the mechanisms of persistent postoperative symptoms are lacking. This study aimed to investigate gastric myoelectrical abnormalities and symptoms in patients after fundoplication using a novel noninvasive body surface gastric mapping (BSGM) device. METHODS Patients with a previous fundoplication operation and ongoing significant gastroduodenal symptoms and matched controls were included. BSGM using Gastric Alimetry (Alimetry Ltd) was employed, consisting of a high-resolution 64-channel array, validated symptom-logging application, and wearable reader. RESULTS A total of 16 patients with significant chronic symptoms after fundoplication were recruited, with 16 matched controls. Overall, 6 of 16 patients (37.5%) showed significant spectral abnormalities defined by unstable gastric myoelectrical activity (n = 2), abnormally high gastric frequencies (n = 3), or high gastric amplitudes (n = 1). Patients with spectral abnormalities had higher Patient Assessment of Upper Gastrointestinal Disorders-Symptom Severity Index scores than those of patients without spectral abnormalities (3.2 [range, 2.8-3.6] vs 2.3 [range, 2.2-2.8], respectively; P = .024). Moreover, 7 of 16 patients (43.8%) had BSGM test results suggestive of gut-brain axis contributions and without myoelectrical dysfunction. Increasing Principal Gastric Frequency Deviation and decreasing Rhythm Index scores were associated with symptom severity (r > .40; P < .05). CONCLUSION A significant number of patients with persistent postfundoplication symptoms displayed abnormal gastric function on BSGM testing, which correlated with symptom severity. Our findings advance the pathophysiologic understanding of postfundoplication disorders, which may inform diagnosis and patient selection for medical therapy and revisional procedures.
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Affiliation(s)
- William Xu
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Tim Wang
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Daphne Foong
- Alimetry Ltd, Auckland, New Zealand; School of Medicine, Western Sydney University, Penrith, Australia
| | - Gabe Schamberg
- Department of Surgery, University of Auckland, Auckland, New Zealand; Alimetry Ltd, Auckland, New Zealand
| | - Nicholas Evennett
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Grant Beban
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Armen Gharibans
- Alimetry Ltd, Auckland, New Zealand; Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Stefan Calder
- Alimetry Ltd, Auckland, New Zealand; Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Charlotte Daker
- Alimetry Ltd, Auckland, New Zealand; Department of Gastroenterology, North Shore Hospital, Auckland, New Zealand
| | - Vincent Ho
- School of Medicine, Western Sydney University, Penrith, Australia; Department of Gastroenterology and Hepatology, Campbelltown Hospital, Campbelltown, Australia
| | - Greg O'Grady
- Department of Surgery, University of Auckland, Auckland, New Zealand; Alimetry Ltd, Auckland, New Zealand; Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand.
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Xu W, Gharibans AA, Calder S, Schamberg G, Walters A, Jang J, Varghese C, Carson D, Daker C, Waite S, Andrews CN, Cundy T, O’Grady G. Defining and Phenotyping Gastric Abnormalities in Long-Term Type 1 Diabetes Using a Novel Body Surface Gastric Mapping Device. GASTRO HEP ADVANCES 2023; 2:1120-1132. [PMID: 39131562 PMCID: PMC11307485 DOI: 10.1016/j.gastha.2023.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 08/04/2023] [Indexed: 08/13/2024]
Abstract
Background and Aims Diabetic gastroenteropathy is associated with poor glycemic control and morbidity in people with type 1 diabetes (T1D). There is a lack of noninvasive techniques to assess and monitor gastric abnormalities. We aimed to define phenotypes of gastric myoelectrical abnormalities in people with longstanding T1D with and without symptoms using a novel noninvasive body surface gastric mapping (BSGM) device. Methods BSGM was performed on people with T1D of >10 years duration and matched controls, employing Gastric Alimetry (Alimetry, New Zealand), comprising of a high-resolution 64-channel array, validated symptom-logging App, and wearable reader. Results Thirty-two people with T1D were recruited (15 with a high symptom burden), and 32 controls. Those with symptoms showed more unstable gastric myoelectrical activity (Gastric Alimetry Rhythm Index 0.39 vs 0.51, P = .017; and lower average spatial covariance 0.48 vs 0.51, P = .009) compared with controls. Symptomatic patients also had a higher prevalence of peripheral neuropathy (67% vs 6%, P = .001), anxiety/depression diagnoses (27% vs 0%, P = .001), and higher mean hemoglobin A1C levels (76 vs 56 mmol/mol, P < .001). BSGM defined distinct phenotypes in T1D participants including those with markedly unstable gastric rhythms (4/32, 12.5%) and abnormally high gastric frequencies (9/32, 28%). Deviation in gastric frequency was positively correlated with symptoms of bloating, upper gut pain, nausea and vomiting, and fullness (R > 0.35, P < .05). Conclusion Gastric symptoms in people with longstanding T1D correlate with myoelectrical abnormalities on BSGM evaluation, in addition to glycemic control, psychological comorbidities, and peripheral neuropathy. BSGM using Gastric Alimetry identified a range of myoelectrical phenotypes, presenting targets for diagnosis, monitoring, and therapy.
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Affiliation(s)
- William Xu
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Armen A. Gharibans
- Department of Surgery, The University of Auckland, Auckland, New Zealand
- Alimetry Ltd, Auckland, New Zealand
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Stefan Calder
- Department of Surgery, The University of Auckland, Auckland, New Zealand
- Alimetry Ltd, Auckland, New Zealand
| | - Gabriel Schamberg
- Department of Surgery, The University of Auckland, Auckland, New Zealand
- Alimetry Ltd, Auckland, New Zealand
| | - Anthony Walters
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Jia Jang
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Chris Varghese
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Daniel Carson
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Charlotte Daker
- Alimetry Ltd, Auckland, New Zealand
- Department of Gastroenterology, North Shore Hospital, Te Whatu Ora Waitemata, New Zealand
| | | | - Christopher N. Andrews
- Alimetry Ltd, Auckland, New Zealand
- Department of Gastroenterology, University of Calgary, Calgary, Canada
| | - Tim Cundy
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Gregory O’Grady
- Department of Surgery, The University of Auckland, Auckland, New Zealand
- Alimetry Ltd, Auckland, New Zealand
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
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Abstract
Electrogastrography (EGG) is a noninvasive method to study gastric myoelectrical activity in humans. Because frequency characteristics are the most reliable parameters and visual analysis of the EGG recordings is notoriously difficult, automated frequency analysis, especially running spectrum analysis, is often used. However, EGG frequency spectra can be misinterpreted easily. Movement artifacts and noise from various sources can result in abnormal frequency spectra with significant power in the low-frequency and high-frequency range, or even make the EGG completely uninterpretable. Signals that differ from a sinusoid waveform have harmonics in the high-frequency range of the spectrum and may be interpreted as abnormal. Visual inspection of raw signals and frequency spectra remains essential in the analysis of EGG signals. The value of computerized analysis should not be overrated. EGG is an important research tool, but a clinical role still needs to be established.
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Affiliation(s)
- M A Verhagen
- Gastrointestinal Research Unit, Department of Gastroenterology, University Hospital Utrecht, Utrecht, The Netherlands
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Geldof H, van der Schee EJ, van Blankenstein M, Smout AJ, Akkermans LM. Effects of highly selective vagotomy on gastric myoelectrical activity. An electrogastrographic study. Dig Dis Sci 1990; 35:969-75. [PMID: 2384043 DOI: 10.1007/bf01537245] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Changes in gastric myoelectrical activity following highly selective vagotomy were studied in 12 patients by means of electrogastrography (EGG) using cutaneous electrodes. Measurements were made before, 10 days after, and six months after operation. Eight patients undergoing cholecystectomy served as controls. Preoperatively all controls and patients had normal recordings. In the cholecystectomized patients no significant changes were found postoperatively. Ten days after highly selective vagotomy the normal initial postprandial dip in gastric ECA frequency and the subsequent increase in frequency and power were not seen. Tachygastrias were observed in three patients. Six months after operation the normal frequency and power responses to a test meal had returned, but both the fasting and postprandial ECA frequencies were raised significantly. It is concluded that highly selective vagotomy is associated with abnormalities in myoelectrical activity, in particular in the postprandial state, most of which are reversible with time.
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Affiliation(s)
- H Geldof
- Department of Internal Medicine, Erasmus University, Rotterdam, The Netherlands
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Waldhausen JH, Shaffrey ME, Skenderis BS, Jones RS, Schirmer BD. Gastrointestinal myoelectric and clinical patterns of recovery after laparotomy. Ann Surg 1990; 211:777-84; discussion 785. [PMID: 2357140 PMCID: PMC1358137 DOI: 10.1097/00000658-199006000-00018] [Citation(s) in RCA: 88] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The objective of this study was to define the patterns of myoelectric activity that occur throughout the gastrointestinal tract during normal recovery from laparotomy. Electrodes were placed on the stomach, jejunum, and transverse colon of 44 patients undergoing laparotomy. Basal electric rhythms in all areas showed no changes in frequency after operation (up to 1 month). Gastric spike wave activity showed a gradient of increasing activity from fundus to antrum. Antral spike activity was unchanged during the study. Jejunal spike activity was present in the earliest recordings and occurred in 45.9% +/- 3.5% to 59.9% +/- 5.5% of slow waves. Recovery of normal colon discrete and continuous electric response activity occurred on postoperative day 5.9 +/- 1.5. Bowel sounds returned on day 2.4 +/- 0.5 and passage of flatus and stool occurred on day 5.1 +/- 0.2. The myoelectric parameters measured are not absolutely predictive of uneventful recovery from postoperative ileus but they are, as a group, more informative than any currently available clinical criteria.
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Affiliation(s)
- J H Waldhausen
- Department of Surgery, University of Virginia, Health Sciences Center, Charlottesville 22908
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