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Wang WJ, Foong D, Calder S, Schamberg G, Varghese C, Tack J, Xu W, Daker C, Carson D, Waite S, Hayes T, Du P, Abell TL, Parkman HP, Huang IH, Fernandes V, Andrews CN, Gharibans AA, Ho V, O’Grady G. Gastric Alimetry Expands Patient Phenotyping in Gastroduodenal Disorders Compared with Gastric Emptying Scintigraphy. Am J Gastroenterol 2024; 119:331-341. [PMID: 37782524 PMCID: PMC10872929 DOI: 10.14309/ajg.0000000000002528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 08/04/2023] [Indexed: 10/03/2023]
Abstract
INTRODUCTION Gastric emptying testing (GET) assesses gastric motility, however, is nonspecific and insensitive for neuromuscular disorders. Gastric Alimetry (GA) is a new medical device combining noninvasive gastric electrophysiological mapping and validated symptom profiling. This study assessed patient-specific phenotyping using GA compared with GET. METHODS Patients with chronic gastroduodenal symptoms underwent simultaneous GET and GA, comprising a 30-minute baseline, 99m TC-labelled egg meal, and 4-hour postprandial recording. Results were referenced to normative ranges. Symptoms were profiled in the validated GA App and phenotyped using rule-based criteria based on their relationships to the meal and gastric activity: (i) sensorimotor, (ii) continuous, and (iii) other. RESULTS Seventy-five patients were assessed, 77% female. Motility abnormality detection rates were as follows: GET 22.7% (14 delayed, 3 rapid), GA spectral analysis 33.3% (14 low rhythm stability/low amplitude, 5 high amplitude, and 6 abnormal frequency), and combined yield 42.7%. In patients with normal spectral analysis, GA symptom phenotypes included sensorimotor 17% (where symptoms strongly paired with gastric amplitude, median r = 0.61), continuous 30%, and other 53%. GA phenotypes showed superior correlations with Gastroparesis Cardinal Symptom Index, Patient Assessment of Upper Gastrointestinal Symptom Severity Index, and anxiety scales, whereas Rome IV Criteria did not correlate with psychometric scores ( P > 0.05). Delayed emptying was not predictive of specific GA phenotypes. DISCUSSION GA improves patient phenotyping in chronic gastroduodenal disorders in the presence and absence of motility abnormalities with increased correlation with symptoms and psychometrics compared with gastric emptying status and Rome IV criteria. These findings have implications for the diagnostic profiling and personalized management of gastroduodenal disorders.
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Affiliation(s)
- William Jiaen Wang
- Gastrointestinal Motility Disorders Unit, Western Sydney University, Australia
- Department of Gastroenterology and Hepatology, Campbelltown Hospital, Australia
- Gastroenterology and Hepatology, Princess Alexandra Hospital, Australia
| | - Daphne Foong
- Gastrointestinal Motility Disorders Unit, Western Sydney University, Australia
| | - Stefan Calder
- Department of Surgery, Auckland City Hospital, New Zealand
- Auckland Bioengineering Institute, University of Auckland, New Zealand
- Alimetry Ltd, Auckland, New Zealand
| | - Gabriel Schamberg
- Department of Surgery, Auckland City Hospital, New Zealand
- Alimetry Ltd, Auckland, New Zealand
| | - Chris Varghese
- Department of Surgery, Auckland City Hospital, New Zealand
| | - Jan Tack
- Translational Research Center for Gastrointestinal Disorders (TARGID), University of Leuven, Belgium
| | - William Xu
- Department of Surgery, Auckland City Hospital, New Zealand
| | - Charlotte Daker
- Department of Gastroenterology, North Shore Hospital, Auckland, New Zealand
| | - Daniel Carson
- Department of Surgery, Auckland City Hospital, New Zealand
| | | | - Thomas Hayes
- Department of Surgery, Auckland City Hospital, New Zealand
| | - Peng Du
- Auckland Bioengineering Institute, University of Auckland, New Zealand
| | - Thomas L. Abell
- Division of Gastroenterology, University of Louisville, KY, USA
| | - Henry P. Parkman
- Gastroenterology Section, Department of Medicine, Lewis Katz School of Medicine, Temple University, USA
| | - I-Hsuan Huang
- Translational Research Center for Gastrointestinal Disorders (TARGID), University of Leuven, Belgium
| | | | | | - Armen A. Gharibans
- Department of Surgery, Auckland City Hospital, New Zealand
- Auckland Bioengineering Institute, University of Auckland, New Zealand
- Alimetry Ltd, Auckland, New Zealand
| | - Vincent Ho
- Gastrointestinal Motility Disorders Unit, Western Sydney University, Australia
- Department of Gastroenterology and Hepatology, Campbelltown Hospital, Australia
| | - Greg O’Grady
- Department of Surgery, Auckland City Hospital, New Zealand
- Auckland Bioengineering Institute, University of Auckland, New Zealand
- Alimetry Ltd, Auckland, New Zealand
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Foong D, Calder S, Varghese C, Schamberg G, Xu W, Daker C, Ho V, Andrews CN, Gharibans AA, O’Grady G. Gastric Alimetry ® Test Interpretation in Gastroduodenal Disorders: Review and Recommendations. J Clin Med 2023; 12:6436. [PMID: 37892572 PMCID: PMC10607701 DOI: 10.3390/jcm12206436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/04/2023] [Accepted: 10/08/2023] [Indexed: 10/29/2023] Open
Abstract
Chronic gastroduodenal symptoms are prevalent worldwide, and there is a need for new diagnostic and treatment approaches. Several overlapping processes may contribute to these symptoms, including gastric dysmotility, hypersensitivity, gut-brain axis disorders, gastric outflow resistance, and duodenal inflammation. Gastric Alimetry® (Alimetry, New Zealand) is a non-invasive test for evaluating gastric function that combines body surface gastric mapping (high-resolution electrophysiology) with validated symptom profiling. Together, these complementary data streams enable important new clinical insights into gastric disorders and their symptom correlations, with emerging therapeutic implications. A comprehensive database has been established, currently comprising > 2000 Gastric Alimetry tests, including both controls and patients with various gastroduodenal disorders. From studies employing this database, this paper presents a systematic methodology for Gastric Alimetry test interpretation, together with an extensive supporting literature review. Reporting is grouped into four sections: Test Quality, Spectral Analysis, Symptoms, and Conclusions. This review compiles, assesses, and evaluates each of these aspects of test assessment, with discussion of relevant evidence, example cases, limitations, and areas for future work. The resultant interpretation methodology is recommended for use in clinical practice and research to assist clinicians in their use of Gastric Alimetry as a diagnostic aid and is expected to continue to evolve with further development.
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Affiliation(s)
- Daphne Foong
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia
| | - Stefan Calder
- Department of Surgery, Auckland City Hospital, Auckland 1023, New Zealand
- Alimetry Ltd., Auckland 1010, New Zealand
- Auckland Bioengineering Institute, University of Auckland, Auckland 1010, New Zealand
| | - Chris Varghese
- Department of Surgery, Auckland City Hospital, Auckland 1023, New Zealand
| | - Gabriel Schamberg
- Alimetry Ltd., Auckland 1010, New Zealand
- Auckland Bioengineering Institute, University of Auckland, Auckland 1010, New Zealand
| | - William Xu
- Department of Surgery, Auckland City Hospital, Auckland 1023, New Zealand
| | - Charlotte Daker
- Department of Gastroenterology, North Shore Hospital, Auckland 0620, New Zealand
| | - Vincent Ho
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia
- Department of Gastroenterology and Hepatology, Campbelltown Hospital, Sydney, NSW 2560, Australia
| | - Christopher N. Andrews
- Division of Gastroenterology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Armen A. Gharibans
- Department of Surgery, Auckland City Hospital, Auckland 1023, New Zealand
- Alimetry Ltd., Auckland 1010, New Zealand
- Auckland Bioengineering Institute, University of Auckland, Auckland 1010, New Zealand
| | - Greg O’Grady
- Department of Surgery, Auckland City Hospital, Auckland 1023, New Zealand
- Alimetry Ltd., Auckland 1010, New Zealand
- Auckland Bioengineering Institute, University of Auckland, Auckland 1010, New Zealand
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