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Huang IH, Calder S, Gharibans AA, Schamberg G, Varghese C, Andrews CN, Tack J, O'Grady G. Meal effects on gastric bioelectrical activity utilizing body surface gastric mapping in healthy subjects. Neurogastroenterol Motil 2024:e14823. [PMID: 38764250 DOI: 10.1111/nmo.14823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 05/01/2024] [Accepted: 05/09/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND Gastric sensorimotor disorders are prevalent. While gastric emptying measurements are commonly used, they may not fully capture the underlying pathophysiology. Body surface gastric mapping (BSGM) recently emerged to assess gastric sensorimotor dysfunction. This study assessed varying meal size on BSGM responses to inform test use in a wider variety of contexts. METHODS Data from multiple healthy cohorts receiving BSGM were pooled, using four different test meals. A standard BSGM protocol was employed: 30-min fasting, 4-h post-prandial, using Gastric Alimetry® (Alimetry, New Zealand). Meals comprised: (i) nutrient drink + oatmeal bar (482 kcal; 'standard meal'); (ii) oatmeal bar alone; egg and toast meal, and pancake (all ~250 kcal). Gastric Alimetry metrics included BMI-adjusted Amplitude, Principal Gastric Frequency, Gastric Alimetry Rhythm Index (GA-RI) and Fed:Fasted Amplitude Ratio (ff-AR). KEY RESULTS 238 participants (59.2% female) were included. All meals significantly increased amplitude and frequency during the first postprandial hour (p < 0.05). There were no differences in postprandial frequency across meals (p > 0.05). The amplitude and GA-RI of the standard meal (n = 110) were significantly higher than the energy bar alone (n = 45) and egg meal (n = 65) (all p < 0.05). All BSGM metrics were comparable across the three smaller meals (p > 0.05). A higher symptom burden was found in the oatmeal bar group versus the standard meal and pancake meal (p = 0.01, 0.003, respectively). CONCLUSIONS & INFERENCES The consumption of lower calorie meals elicited different postprandial responses, when compared to the standard Gastric Alimetry meal. These data will guide interpretations of BSGM when applied with lower calorie meals.
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Affiliation(s)
- I-Hsuan Huang
- Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium
- Department of Gastroenterology and Hepatology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Stefan Calder
- Alimetry Ltd, Auckland, New Zealand
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Armen A Gharibans
- Alimetry Ltd, Auckland, New Zealand
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Gabriel Schamberg
- Alimetry Ltd, Auckland, New Zealand
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Chris Varghese
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Christopher N Andrews
- Alimetry Ltd, Auckland, New Zealand
- Division of Gastroenterology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Jan Tack
- Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium
| | - Greg O'Grady
- Alimetry Ltd, Auckland, New Zealand
- Department of Surgery, University of Auckland, Auckland, New Zealand
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Sadder LS, Brown LS, Roblyer L, Sanghavi R, Ortigoza EB. Antibiotic duration and gastric dysmotility in preterm neonates. J Pediatr Gastroenterol Nutr 2024. [PMID: 38708837 DOI: 10.1002/jpn3.12235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 03/14/2024] [Accepted: 04/15/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVES Prolonged antibiotic use after birth is associated with neonatal feeding intolerance and functional gastrointestinal disorders (FGIDs). A gastric dysrhythmia (tachygastria) with frequencies >4-9 cycles per minute, measured by electrogastrography (EGG), is associated with FGIDs. The relationship between prolonged antibiotic use and % time spent in tachygastria is unknown in preterm infants. We aimed to compare weekly changes in % tachygastria between preterm infants receiving long (>48 h) versus short (≤48 h) courses of antibiotics for early onset sepsis evaluation (initiated at <3 days of life). METHODS This was a longitudinal, prospective cohort study of 88 preterm infants (<34 weeks' gestation) with weekly EGG recordings from the first week of life until 40 weeks' post-menstrual age, discharge, or death. We calculated % of EGG recording time in tachygastria and determined the mean across weekly sessions. A mixed effects model assessed variance in % tachygastria between the short- and long-antibiotic exposure groups across all weeks. RESULTS Baseline characteristics were similar between the two groups. There was no difference in % tachygastria between short and long antibiotic exposure groups across nine postnatal weeks (p = 0.08). CONCLUSIONS Early, prolonged antibiotic exposure among preterm infants may not lead to significant gastric dysrhythmia. Future studies including larger sample sizes and a "no antibiotic" exposure arm are essential in elucidating this potential relationship.
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Affiliation(s)
- Liane Samira Sadder
- Division of Pediatric Gastroenterology, Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas, USA
| | | | - Lindsay Roblyer
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Rinarani Sanghavi
- Division of Pediatric Gastroenterology, Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Eric Brum Ortigoza
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas, USA
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Huang IH, Schol J, Calder S, Gharibans AA, Van den Houte K, Verheyden A, Broeders B, Carbone F, O'Grady G, Tack J. Effects of corticotropin-releasing hormone on gastric electrical activity and sensorimotor function in healthy volunteers: a double-blinded crossover study. Am J Physiol Gastrointest Liver Physiol 2024; 326:G622-G630. [PMID: 38375576 DOI: 10.1152/ajpgi.00298.2023] [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: 12/12/2023] [Revised: 02/06/2024] [Accepted: 02/15/2024] [Indexed: 02/21/2024]
Abstract
Biopsychosocial factors are associated with disorders of gut-brain interaction (DGBI) and exacerbate gastrointestinal symptoms. The mechanisms underlying pathophysiological alterations of stress remain unclear. Corticotropin-releasing hormone (CRH) is a central regulator of the hormonal stress response and has diverse impact on different organ systems. The aim of the present study was to investigate the effects of peripheral CRH infusion on meal-related gastrointestinal symptoms, gastric electrical activity, and gastric sensorimotor function in healthy volunteers (HVs). In a randomized, double-blinded, placebo-controlled, crossover study, we evaluated the effects of CRH on gastric motility and sensitivity. HVs were randomized to receive either peripheral-administered CRH (100 µg bolus + 1 µg/kg/h) or placebo (saline), followed by at least a 7-day washout period and assignment to the opposite treatment. Tests encompassed saliva samples, gastric-emptying (GE) testing, body surface gastric mapping (BSGM, Gastric Alimetry; Alimetry) to assess gastric myoelectrical activity with real-time symptom profiling, and a gastric barostat study to assess gastric sensitivity to distention and accommodation. Twenty HVs [13 women, mean age 29.2 ± 5.3 yr, body mass index (BMI) 23.3 ± 3.8 kg/m2] completed GE tests, of which 18 also underwent BSGM measurements during the GE tests. The GE half-time decreased significantly after CRH exposure (65.2 ± 17.4 vs. 78.8 ± 24.5 min, P = 0.02) with significantly increased gastric amplitude [49.7 (34.7-55.6) vs. 31.7 (25.7-51.0) µV, P < 0.01], saliva cortisol levels, and postprandial symptom severity. Eleven HVs also underwent gastric barostat studies on a separate day. However, the thresholds for discomfort during isobaric distensions, gastric compliance, and accommodation did not differ between CRH and placebo.NEW & NOTEWORTHY In healthy volunteers, peripheral corticotropin-releasing hormone (CRH) infusion accelerates gastric-emptying rate and increases postprandial gastric response, accompanied by a rise in symptoms, but does not alter gastric sensitivity or meal-induced accommodation. These findings underscore a significant link between stress and dyspeptic symptoms, with CRH playing a pivotal role in mediating these effects.
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Affiliation(s)
- I-Hsuan Huang
- Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium
- Department of Gastroenterology and Hepatology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Jolien Schol
- Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium
| | | | | | - Karen Van den Houte
- Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium
| | - Annelies Verheyden
- Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium
| | - Bert Broeders
- Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium
| | - Florencia Carbone
- Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium
| | - Greg O'Grady
- Alimetry, Ltd., Auckland, New Zealand
- Surgical and Translational Research Centre, The University of Auckland, Auckland, New Zealand
| | - Jan Tack
- Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium
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Tomaselli L, Sciullo M, Fulton S, Yates BJ, Fisher LE, Ventura V, Horn CC. Isoflurane anesthesia suppresses gastric myoelectric power in the ferret. Neurogastroenterol Motil 2024; 36:e14749. [PMID: 38316631 PMCID: PMC10922358 DOI: 10.1111/nmo.14749] [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: 03/03/2023] [Revised: 12/14/2023] [Accepted: 01/16/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Gastric myoelectric signals have been the focus of extensive research; although it is unclear how general anesthesia affects these signals, and studies have often been conducted under general anesthesia. Here, we explore this issue directly by recording gastric myoelectric signals during awake and anesthetized states in the ferret and explore the contribution of behavioral movement to observed changes in signal power. METHODS Ferrets were surgically implanted with electrodes to record gastric myoelectric activity from the serosal surface of the stomach, and, following recovery, were tested in awake and isoflurane-anesthetized conditions. Video recordings were also analyzed during awake experiments to compare myoelectric activity during behavioral movement and rest. KEY RESULTS A significant decrease in gastric myoelectric signal power was detected under isoflurane anesthesia compared to the awake condition. Moreover, a detailed analysis of the awake recordings indicates that behavioral movement is associated with increased signal power compared to rest. CONCLUSIONS & INFERENCES These results suggest that both general anesthesia and behavioral movement can affect the signal power of gastric myoelectric recordings. In summary, caution should be taken in studying myoelectric data collected under anesthesia. Further, behavioral movement could have an important modulatory role on these signals, affecting their interpretation in clinical settings.
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Affiliation(s)
- Lorenzo Tomaselli
- Department of Statistics & Data Science, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Michael Sciullo
- UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Stephanie Fulton
- UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Bill J. Yates
- Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA, USA
- Dept. of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Lee E. Fisher
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Physical Medicine & Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Valérie Ventura
- Department of Statistics & Data Science, Carnegie Mellon University, Pittsburgh, PA, USA
- Neuroscience Institute, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Charles C. Horn
- UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Medicine, Division of Hematology/Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Ma Y, Shen J, Zhao J, Yang X, Yang J, Liu Y, Qiao Z, Cao Y. Clinical Efficacy and Mechanism of Transcutaneous Neuromodulation on Functional Dyspepsia. J Clin Gastroenterol 2023; 57:1007-1015. [PMID: 36226998 DOI: 10.1097/mcg.0000000000001775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 09/04/2022] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND AIMS Prokinetics and proton pump inhibitors are first-line drugs for functional dyspepsia (FD) patients. However, no available treatment is effective for most FD patients, and the pathogenesis is still unclear. The purpose of this study was to investigate the therapeutic effect of transcutaneous neuromodulation (TN) on FD and its potential mechanisms. MATERIALS AND METHODS Fifty-seven FD patients were enrolled in the study and randomly divided into 3 groups (TN Neiguan (PC6) group, TN Zusanli (ST36) group, and sham TN group) that received corresponding treatment respectively for 4 weeks. Then, all the patients enrolled received TN PC6 combined with ST36 treatment for another 4 weeks. Dyspepsia symptom questionnaire, Medical outcomes study item short form health survey (SF-36), Hospital Anxiety and Depression Scale were used to assess the severity of symptoms. Gastric accommodation, gastric emptying rate, and related parameters of electrogastrogram were used to assess the pathophysiological mechanism of FD. The possible gastrointestinal hormonal mechanism involved was assessed by detecting serum ghrelin, neuropeptide Y, and vasoactive intestinal peptide. The possible duodenal inflammation mechanism involved was assessed by detecting duodenal mucosa. RESULTS TN treatment reduced the dyspepsia symptom score ( P <0.05) and improved the quality of life. After TN treatment, the gastric accommodation ( P <0.01), the gastric emptying rate ( P <0.01), and the percentages of preprandial ( P <0.05) and postprandial ( P <0.05) gastric slow waves (GSW) were increased. The proportions of preprandial ( P <0.05) and postprandial ( P <0.05) gastric electrical rhythm disorder were reduced. The double acupoint combination therapy further enhanced the therapeutic effect of single acupoint. In addition, the levels of ghrelin ( P <0.001) and neuropeptide Y ( P <0.001) were significantly increased, the level of vasoactive intestinal peptide ( P <0.001) was significantly decreased, and the total number of mast cells ( P <0.001) in the duodenal bulb was significantly decreased after double acupoints combination therapy. CONCLUSIONS TN treatment significantly improves the dyspepsia symptoms of FD patients and their quality of life. TN treatment increases the percentage of normal GSW, reduces the proportion of gastric electrical rhythm disorder, and improves the gastric accommodation and gastric emptying rate. The therapeutic effect of TN may be caused by regulating gastrointestinal hormone secretion and alleviating local inflammatory responses in duodenum. In addition, the improvement of TN on GSW was closely related to the decrease of bradygastria.
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Affiliation(s)
- Yimin Ma
- Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine
| | - Jiaqing Shen
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University
| | - Jing Zhao
- Department of Gastroenterology, Gaochun People's Hospital of Nanjing, Nanjing
| | | | - Jun Yang
- Department of Gastroenterology, Suzhou Ninth People's Hospital, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, China
| | - Yan Liu
- Department of Gastroenterology, Gaochun People's Hospital of Nanjing, Nanjing
| | - Zhenguo Qiao
- Department of Gastroenterology, Suzhou Ninth People's Hospital, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, China
| | - Youhong Cao
- Department of Gastroenterology, Gaochun People's Hospital of Nanjing, Nanjing
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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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O'Grady G, Varghese C, Schamberg G, Calder S, Du P, Xu W, Tack J, Daker C, Mousa H, Abell TL, Parkman HP, Ho V, Bradshaw LA, Hobson A, Andrews CN, Gharibans AA. Principles and clinical methods of body surface gastric mapping: Technical review. Neurogastroenterol Motil 2023; 35:e14556. [PMID: 36989183 PMCID: PMC10524901 DOI: 10.1111/nmo.14556] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/29/2023] [Accepted: 02/12/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND AND PURPOSE Chronic gastric symptoms are common, however differentiating specific contributing mechanisms in individual patients remains challenging. Abnormal gastric motility is present in a significant subgroup, but reliable methods for assessing gastric motor function in clinical practice are lacking. Body surface gastric mapping (BSGM) is a new diagnostic aid, employs multi-electrode arrays to measure and map gastric myoelectrical activity non-invasively in high resolution. Clinical adoption of BSGM is currently expanding following studies demonstrating the ability to achieve specific patient subgrouping, and subsequent regulatory clearances. An international working group was formed in order to standardize clinical BSGM methods, encompassing a technical group developing BSGM methods and a clinical advisory group. The working group performed a technical literature review and synthesis focusing on the rationale, principles, methods, and clinical applications of BSGM, with secondary review by the clinical group. The principles and validation of BSGM were evaluated, including key advances achieved over legacy electrogastrography (EGG). Methods for BSGM were reviewed, including device design considerations, patient preparation, test conduct, and data processing steps. Recent advances in BSGM test metrics and reference intervals are discussed, including four novel metrics, being the 'principal gastric frequency', BMI-adjusted amplitude, Gastric Alimetry Rhythm Index™, and fed: fasted amplitude ratio. An additional essential element of BSGM has been the introduction of validated digital tools for standardized symptom profiling, performed simultaneously during testing. Specific phenotypes identifiable by BSGM and the associated symptom profiles were codified with reference to pathophysiology. Finally, knowledge gaps and priority areas for future BSGM research were also identified by the working group.
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Affiliation(s)
- 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
| | - Chris Varghese
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Gabriel Schamberg
- Department of Surgery, The University of Auckland, Auckland, New Zealand
- Alimetry Ltd, Auckland, New Zealand
| | | | - Peng Du
- Alimetry Ltd, Auckland, New Zealand
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - William Xu
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Jan Tack
- Department of Gastroenterology, University Hospitals, Leuven, Belgium
| | | | - Hayat Mousa
- Division of Gastroenterology, Lustgarten Motility Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Thomas L Abell
- Division of Gastroenterology, Hepatology and Nutrition, University of Louisville, Louisville, Kentucky, USA
| | - Henry P Parkman
- Department of Medicine, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Vincent Ho
- Western Sydney University, Sydney, New South Wales, Australia
| | | | | | - Christopher N Andrews
- Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
| | - 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
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8
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Schamberg G, Calder S, Varghese C, Xu W, Wang WJ, Ho V, Daker C, Andrews CN, O'Grady G, Gharibans AA. Comparison of Gastric Alimetry ® body surface gastric mapping versus electrogastrography spectral analysis. Sci Rep 2023; 13:14987. [PMID: 37696955 PMCID: PMC10495352 DOI: 10.1038/s41598-023-41645-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 08/29/2023] [Indexed: 09/13/2023] Open
Abstract
Electrogastrography (EGG) non-invasively evaluates gastric motility but is viewed as lacking clinical utility. Gastric Alimetry® is a new diagnostic test that combines high-resolution body surface gastric mapping (BSGM) with validated symptom profiling, with the goal of overcoming EGG's limitations. This study directly compared EGG and BSGM to define performance differences in spectral analysis. Comparisons between Gastric Alimetry BSGM and EGG were conducted by protocolized retrospective evaluation of 178 subjects [110 controls; 68 nausea and vomiting (NVS) and/or type 1 diabetes (T1D)]. Comparisons followed standard methodologies for each test (pre-processing, post-processing, analysis), with statistical evaluations for group-level differences, symptom correlations, and patient-level classifications. BSGM showed substantially tighter frequency ranges vs EGG in controls. Both tests detected rhythm instability in NVS, but EGG showed opposite frequency effects in T1D. BSGM showed an 8× increase in the number of significant correlations with symptoms. BSGM accuracy for patient-level classification was 0.78 for patients vs controls and 0.96 as compared to blinded consensus panel; EGG accuracy was 0.54 and 0.43. EGG detected group-level differences in patients, but lacked symptom correlations and showed poor accuracy for patient-level classification, explaining EGG's limited clinical utility. BSGM demonstrated substantial performance improvements across all domains.
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Affiliation(s)
- Gabriel Schamberg
- Department of Surgery, The University of Auckland, Auckland, New Zealand
- Alimetry Ltd, Auckland, New Zealand
| | - Stefan Calder
- Department of Surgery, The University of Auckland, Auckland, New Zealand
- Alimetry Ltd, Auckland, New Zealand
| | - Chris Varghese
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - William Xu
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - William Jiaen Wang
- School of Medicine, Western Sydney University, Sydney, Australia
- Department of Gastroenterology and Hepatology, Campbelltown Hospital, Sydney, Australia
- Department of Gastroenterology and Hepatology, Townsville University Hospital, Townsville, Australia
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Australia
| | - Vincent Ho
- School of Medicine, Western Sydney University, Sydney, Australia
- Department of Gastroenterology and Hepatology, Campbelltown Hospital, Sydney, Australia
| | - Charlotte Daker
- Department of Gastroenterology, North Shore Hospital, Auckland, New Zealand
| | | | - Greg 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
| | - 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.
- Perelman School of Medicine, University of Pennsylvania, Pennsylvania, United States.
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9
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Ji S, Li B, Zhu C, Jiang G, Tang Y, Chen L. Risk assessment model for sleep disturbance based on gastrointestinal myoelectrical activity in middle-aged and elderly people. Front Psychiatry 2023; 14:1183108. [PMID: 37426096 PMCID: PMC10327604 DOI: 10.3389/fpsyt.2023.1183108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 06/05/2023] [Indexed: 07/11/2023] Open
Abstract
Background Sleep disturbance has become a considerable factor affecting the quality of life for middle-aged and elderly people; however, there are still many obstacles to screening sleep disturbance for those people. Given the growing awareness of the association between gastrointestinal function and sleep disturbance, our study aims to predict the risk of sleep disturbance using gastrointestinal electrophysiological signals. Methods The Pittsburgh Sleep Quality Index and gastrointestinal electrophysiological signals of 914 participants in western China were used to establish the model. Demographic characteristics and routine blood test were collected as covariates. Participants were randomly assigned into two sets with a 7:3 ratio for training and validation. In the training set, the least absolute shrinkage and selection operator (LASSO) regression and stepwise logistic regression were used, respectively for variables selection and optimization. To assess the model performance, receiver operator characteristic (ROC) curve, calibration curve and decision curve analysis (DCA) were utilized. Then, validation was performed. Results Thirteen predictors were chosen from 46 variables by LASSO regression. Then, age, gender, percentage of normal slow wave and electrical spreading rate on the pre-meal gastric channel, dominant power ratio on the post-meal gastric channel, coupling percent and dominant frequency on the post-meal intestinal channel were the seven predictors reserved by logistic regression. The area under ROC curve was 0.65 in the training set and 0.63 in the validation set, both exhibited moderate predictive ability. Furthermore, by overlapping the DCA results of two data-sets, there might be clinical net benefit if 0.35 was used as reference threshold for high risk of sleep disturbance. Conclusion The model performs a worthy predictive potency for sleep disturbance, which not only provides clinical evidence for the association of gastrointestinal function with sleep disturbance, but also can be considered as an auxiliary assessment for screening sleep disturbance.
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Affiliation(s)
- Shuming Ji
- Department of Clinical Research Management, West China Hospital, Sichuan University, Chengdu, China
| | - Baichuan Li
- Department of Neurology, Joint Research Institution of Altitude Health, West China Hospital, Sichuan University, Chengdu, China
| | - Chenxing Zhu
- Department of Clinical Research Management, West China Hospital, Sichuan University, Chengdu, China
| | - Guohui Jiang
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Yusha Tang
- Department of Neurology, Joint Research Institution of Altitude Health, West China Hospital, Sichuan University, Chengdu, China
| | - Lei Chen
- Department of Neurology, Joint Research Institution of Altitude Health, West China Hospital, Sichuan University, Chengdu, China
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10
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Varghese C, Schamberg G, Calder S, Waite S, Carson D, Foong D, Wang WJ, Ho V, Woodhead J, Daker C, Xu W, Du P, Abell TL, Parkman HP, Tack J, Andrews CN, O'Grady G, Gharibans AA. Normative Values for Body Surface Gastric Mapping Evaluations of Gastric Motility Using Gastric Alimetry: Spectral Analysis. Am J Gastroenterol 2023; 118:1047-1057. [PMID: 36534985 DOI: 10.14309/ajg.0000000000002077] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 10/06/2022] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Body surface gastric mapping (BSGM) is a new noninvasive test of gastric function. BSGM offers several novel and improved biomarkers of gastric function capable of differentiating patients with overlapping symptom profiles. The aim of this study was to define normative reference intervals for BSGM spectral metrics in a population of healthy controls. METHODS BSGM was performed in healthy controls using Gastric Alimetry (Alimetry, New Zealand) comprising a stretchable high-resolution array (8 × 8 electrodes; 196 cm 2 ), wearable Reader, and validated symptom-logging App. The evaluation encompassed a fasting baseline (30 minutes), 482 kCal meal, and 4-hour postprandial recording. Normative reference intervals were calculated for BSGM metrics including the Principal Gastric Frequency, Gastric Alimetry Rhythm Index (a measure of the concentration of power in the gastric frequency band over time), body mass index (BMI)-adjusted amplitude (μV), and fed:fasted amplitude ratio. Data were reported as median and reference interval (5th and/or 95th percentiles). RESULTS A total of 110 subjects (55% female, median age 32 years [interquartile range 24-50], median BMI 23.8 kg/m 2 [interquartile range 21.4-26.9]) were included. The median Principal Gastric Frequency was 3.04 cycles per minute; reference interval: 2.65-3.35 cycles per minute. The median Gastric Alimetry Rhythm Index was 0.50; reference interval: ≥0.25. The median BMI-adjusted amplitude was 37.6 μV; reference interval: 20-70 μV. The median fed:fasted amplitude ratio was 1.85; reference interval ≥1.08. A higher BMI was associated with a shorter meal-response duration ( P = 0.014). DISCUSSION This study provides normative reference intervals for BSGM spectral data to inform diagnostic interpretations of abnormal gastric function.
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Affiliation(s)
- Chris Varghese
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Gabriel Schamberg
- Department of Surgery, The University of Auckland, Auckland, New Zealand
- Alimetry, Auckland, New Zealand
| | - Stefan Calder
- Department of Surgery, The University of Auckland, Auckland, New Zealand
- Alimetry, Auckland, New Zealand
| | | | - Daniel Carson
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | | | | | - Vincent Ho
- Western Sydney University, Sydney, Australia
| | | | | | - William Xu
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Peng Du
- Alimetry, Auckland, New Zealand
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Thomas L Abell
- Division of Gastroenterology, Hepatology and Nutrition, University of Louisville, Kentucky, USA
| | - Henry P Parkman
- Department of Medicine, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Jan Tack
- Department of Gastroenterology, University Hospitals, Leuven, Belgium
| | | | - Gregory O'Grady
- Department of Surgery, The University of Auckland, Auckland, New Zealand
- Alimetry, Auckland, New Zealand
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Armen A Gharibans
- Department of Surgery, The University of Auckland, Auckland, New Zealand
- Alimetry, Auckland, New Zealand
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
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11
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Broeders BWLCM, Carbone F, Balsiger LM, Schol J, Raymenants K, Huang I, Verheyden A, Vanuytsel T, Tack J. Review article: Functional dyspepsia-a gastric disorder, a duodenal disorder or a combination of both? Aliment Pharmacol Ther 2023; 57:851-860. [PMID: 36859629 DOI: 10.1111/apt.17414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/25/2022] [Accepted: 01/25/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND Functional dyspepsia (FD) is one of the most frequent conditions in gastroenterological outpatient health care. Most recent research in FD has shifted its focus to duodenal pathophysiological mechanisms, although current treatments still focus mainly the stomach. AIM The aim of the study was to provide a comprehensive overview of the pathophysiology of FD focusing on a paradigm shift from gastric towards duodenal mechanisms. METHODS We conducted a literature search in PubMed for studies describing mechanisms that could possibly cause FD. RESULTS The pathophysiology of FD remains incompletely understood. Recent studies show that duodenal factors such as acid, bile salt exposure and eosinophil and mast cell activation correlate with symptom pattern and burden and can be associated with gastric sensorimotor dysfunction. The evolving data identify the duodenum an interesting target for new therapeutic approaches. Furthermore, the current first-line treatment, that is proton pump inhibitors, reduces duodenal low-grade inflammation and FD symptoms. CONCLUSION Future research for the treatment of FD should focus on the inhibition of duodenal mast cell activation, eosinophilia and loss of mucosal integrity.
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Affiliation(s)
- B W L C M Broeders
- Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium
- Faculty of Medicine, KU Leuven, Leuven, Department of Gastroenterology, University Hospitals Leuven, Leuven, Belgium
| | - F Carbone
- Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium
- Faculty of Medicine, KU Leuven, Leuven, Department of Gastroenterology, University Hospitals Leuven, Leuven, Belgium
| | - L M Balsiger
- Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium
| | - J Schol
- Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium
- Faculty of Medicine, KU Leuven, Leuven, Department of Gastroenterology, University Hospitals Leuven, Leuven, Belgium
| | - K Raymenants
- Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium
- Faculty of Medicine, KU Leuven, Leuven, Department of Gastroenterology, University Hospitals Leuven, Leuven, Belgium
| | - I Huang
- Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium
| | - A Verheyden
- Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium
| | - T Vanuytsel
- Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium
- Faculty of Medicine, KU Leuven, Leuven, Department of Gastroenterology, University Hospitals Leuven, Leuven, Belgium
| | - J Tack
- Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium
- Faculty of Medicine, KU Leuven, Leuven, Department of Gastroenterology, University Hospitals Leuven, Leuven, Belgium
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12
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Schamberg G, Varghese C, Calder S, Waite S, Erickson J, O'Grady G, Gharibans AA. Revised spectral metrics for body surface measurements of gastric electrophysiology. Neurogastroenterol Motil 2023; 35:e14491. [PMID: 36409749 DOI: 10.1111/nmo.14491] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 10/17/2022] [Accepted: 10/21/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Electrogastrography (EGG) non-invasively evaluates gastric function but has not achieved common clinical adoption due to several technical limitations. Body Surface Gastric Mapping (BSGM) has been introduced to overcome these limitations, but pitfalls in traditional metrics used to analyze spectral data remain unaddressed. This study critically evaluates five traditional EGG metrics and introduces improved BSGM spectral metrics, with validation in a large cohort. METHODS Pitfalls in five EGG metrics were assessed (dominant frequency, percentage time normogastria, amplitude, power ratio, and instability coefficient), leading to four revised BSGM spectral metrics. Traditional and revised metrics were compared to validate performance using a standardized 100-subject database of BSGM tests (30 min baseline; 4-h postprandial) recorded using Gastric Alimetry® (Alimetry). KEY RESULTS BMI and amplitude were highly correlated (r = -0.57, p < 0.001). We applied a conservative BMI correction to obtain a BMI-adjusted amplitude metric (r = -0.21, p = 0.037). Instability coefficient was highly correlated with both dominant frequency (r = -0.44, p < 0.001), and percent bradygastria (r = 0.85, p < 0.001), in part due to misclassification of low frequency transients as gastric activity. This was corrected by introducing distinct gastric frequency and stability metrics (Principal Gastric Frequency and Gastric Alimetry Rhythm Index (GA-RI)TM ) that were uncorrelated (r = 0.14, p = 0.314). Only 28% of subjects showed a maximal averaged amplitude within the first postprandial hour. Calculating Fed:Fasted Amplitude Ratio over a 4-h postprandial window yielded a median increase of 0.31 (IQR 0-0.64) above the traditional ratio. CONCLUSIONS & INFERENCES The revised metrics resolve critical pitfalls impairing the performance of traditional EGG, and should be applied in future BSGM spectral analyses.
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Affiliation(s)
- Gabriel Schamberg
- Alimetry Ltd, Auckland, New Zealand.,Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Chris Varghese
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Stefan Calder
- Alimetry Ltd, Auckland, New Zealand.,Department of Surgery, The University of Auckland, Auckland, New Zealand
| | | | | | - Greg O'Grady
- Alimetry Ltd, Auckland, New Zealand.,Department of Surgery, The University of Auckland, Auckland, New Zealand.,Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Armen A Gharibans
- Alimetry Ltd, Auckland, New Zealand.,Department of Surgery, The University of Auckland, Auckland, New Zealand.,Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
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13
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Gharibans AA, Hayes TCL, Carson DA, Calder S, Varghese C, Du P, Yarmut Y, Waite S, Keane C, Woodhead JST, Andrews CN, O'Grady G. A novel scalable electrode array and system for non-invasively assessing gastric function using flexible electronics. Neurogastroenterol Motil 2023; 35:e14418. [PMID: 35699340 PMCID: PMC10078595 DOI: 10.1111/nmo.14418] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/29/2022] [Accepted: 05/05/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Disorders of gastric function are highly prevalent, but diagnosis often remains symptom-based and inconclusive. Body surface gastric mapping is an emerging diagnostic solution, but current approaches lack scalability and are cumbersome and clinically impractical. We present a novel scalable system for non-invasively mapping gastric electrophysiology in high-resolution (HR) at the body surface. METHODS The system comprises a custom-designed stretchable high-resolution "peel-and-stick" sensor array (8 × 8 pre-gelled Ag/AgCl electrodes at 2 cm spacing; area 225 cm2 ), wearable data logger with custom electronics incorporating bioamplifier chips, accelerometer and Bluetooth synchronized in real-time to an App with cloud connectivity. Automated algorithms filter and extract HR biomarkers including propagation (phase) mapping. The system was tested in a cohort of 24 healthy subjects to define reliability and characterize features of normal gastric activity (30 m fasting, standardized meal, and 4 h postprandial). KEY RESULTS Gastric mapping was successfully achieved non-invasively in all cases (16 male; 8 female; aged 20-73 years; BMI 24.2 ± 3.5). In all subjects, gastric electrophysiology and meal responses were successfully captured and quantified non-invasively (mean frequency 2.9 ± 0.3 cycles per minute; peak amplitude at mean 60 m postprandially with return to baseline in <4 h). Spatiotemporal mapping showed regular and consistent wave activity of mean direction 182.7° ± 73 (74.7% antegrade, 7.8% retrograde, 17.5% indeterminate). CONCLUSIONS AND INFERENCES BSGM is a new diagnostic tool for assessing gastric function that is scalable and ready for clinical applications, offering several biomarkers that are improved or new to gastroenterology practice.
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Affiliation(s)
- Armen A Gharibans
- Department of Surgery, University of Auckland, Auckland, New Zealand.,Alimetry Ltd, Auckland, New Zealand.,Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Tommy C L Hayes
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Daniel A Carson
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | | | - Chris Varghese
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Peng Du
- Alimetry Ltd, Auckland, New Zealand.,Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | | | | | - Celia Keane
- Department of Surgery, University of Auckland, Auckland, New Zealand.,Alimetry Ltd, Auckland, New Zealand
| | - Jonathan S T Woodhead
- Alimetry Ltd, Auckland, New Zealand.,Maurice Wilkins Centre for Molecular Biodiscovery, The University of Auckland, Auckland, New Zealand
| | - Christopher N Andrews
- Alimetry Ltd, Auckland, New Zealand.,Department of Medicine, University of Calgary, NB Calgary, Alberta, Canada
| | - Greg O'Grady
- Department of Surgery, University of Auckland, Auckland, New Zealand.,Alimetry Ltd, Auckland, New Zealand
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14
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Han X, Zhu H. Endoscopic mucosal electrodes: New directions for recording and regulating gastric myoelectric activity. Front Surg 2023; 9:1035723. [PMID: 36684308 PMCID: PMC9852521 DOI: 10.3389/fsurg.2022.1035723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 11/22/2022] [Indexed: 01/09/2023] Open
Abstract
With the gradual deepening of the study of gastric motility disorders, people increasingly realize that gastric myoelectric activity plays an important role in coordinating gastric function. This article introduces the advantages of endoscopic mucosal electrodes compared with traditional electrodes. Several different types of mucosal electrodes and how to fix the electrodes by endoscope are introduced. Endoscopic mucosal electrodes can record and regulate gastric myoelectric activity, which has great value in the study of gastric motility. Endoscopic mucosal electrode technique refers to the fixation of the electrode in the designated part of the gastric mucosa by endoscope. Through endoscopic mucosal electrodes, on the one hand, we can record gastric myoelectric activity, on the other hand, we can carry out gastric electrical stimulation to interfere with gastric rhythm. Endoscopic mucosal electrodes have higher accuracy than traditional cutaneous electrodes, less trauma and lower cost than serosal electrodes. Endoscopic mucosal electrodes have a good application prospect for diseases such as gastroparesis and obesity.
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15
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Ebara R, Ishida S, Miyagawa T, Imai Y. Effects of peristaltic amplitude and frequency on gastric emptying and mixing: a simulation study. J R Soc Interface 2023; 20:20220780. [PMID: 36596453 PMCID: PMC9810435 DOI: 10.1098/rsif.2022.0780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 12/05/2022] [Indexed: 01/05/2023] Open
Abstract
The amplitude and frequency of peristaltic contractions are two major parameters for assessing gastric motility. However, it is not fully understood how these parameters affect the important functions of the stomach, such as gastric mixing and emptying. This study aimed to quantify the effects of peristaltic amplitude and frequency on gastric mixing and emptying using computational fluid dynamics simulation of gastric flow with an anatomically realistic model of the stomach. Our results suggest that both the increase and decrease in peristaltic amplitude have a significant impact on mixing strength and emptying rate. For example, when the peristaltic amplitude was 1.2 times higher than normal, the emptying rate was 2.7 times faster, whereas when the amplitude was half, the emptying rate was 4.2 times slower. Moreover, the emptying rate increased more than proportionally with the peristaltic frequency. The nearest contraction wave to the pylorus and the subsequent waves promoted gastric emptying. These results suggest the importance of maintaining parameters within normal ranges to achieve healthy gastric function.
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Affiliation(s)
- Rika Ebara
- Graduate School of Engineering, Kobe University, Kobe, Japan
| | - Shunichi Ishida
- Graduate School of Engineering, Kobe University, Kobe, Japan
| | - Taimei Miyagawa
- Graduate School of Science and Technology, Hirosaki University, Hirosaki, Japan
| | - Yohsuke Imai
- Graduate School of Engineering, Kobe University, Kobe, Japan
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16
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O'Grady G, Carbone F, Tack J. Gastric sensorimotor function and its clinical measurement. Neurogastroenterol Motil 2022; 34:e14489. [PMID: 36371709 PMCID: PMC10078602 DOI: 10.1111/nmo.14489] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/24/2022] [Accepted: 10/24/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Gastroduodenal symptoms are highly prevalent, with underlying sensorimotor dysfunction contributing in many patients. Common symptoms include early satiation, postprandial fullness, epigastric bloating, pain or burning, nausea and vomiting, which collectively affect over 7% of adults. However, the clinical evaluation of these symptoms remains challenging, with current tests of gastric function remaining limited in their ability or availability to separate specific patient subgroups or guide-targeted care. PURPOSE In the current edition of Neurogastroenterology & Motility, Silver et al. present new data showing correlations between patterns of intragastric meal distribution and symptom profiles in a large series of patients undergoing gastric emptying scintigraphy. Studies of this type are important, as they motivate understanding beyond existing disease labels, and orient focus toward deeper mechanistic profiling. This brief review provides an overview of gastric sensorimotor function and profiles several current and emerging methods of clinical evaluation. Perspectives are provided on accommodation testing, gastric emptying, measuring gastric myoelectrical activity including new approaches, and antroduodenal manometry. Although gastric physiology is complex, recent progress has been encouraging, with the heterogenous pathophysiology of gastric symptoms continuing to be unraveled, and new techniques for evaluating gastric function and symptoms emerging. CONCLUSIONS AND INFERENCES Ongoing progress will now depend on continuing to accurately profile the underlying mechanisms of gastroduodenal disorders to identify specific disease phenotypes that inform care.
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Affiliation(s)
- Greg 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
| | - Florencia Carbone
- Department of Gastroenterology, University Hospital Leuven (UZ Leuven), Leuven, Belgium
| | - Jan Tack
- Department of Gastroenterology, University Hospital Leuven (UZ Leuven), Leuven, Belgium.,Translational Research Center for Gastrointestinal Diseases (TARGID), department of Chronic Diseases and Metabolism (ChroMeta), University of Leuven, Leuven, Belgium.,Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Rome Foundation, Raleigh, North Carolina, USA
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17
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Calder S, Cheng LK, Andrews CN, Paskaranandavadivel N, Waite S, Alighaleh S, Erickson JC, Gharibans A, O'Grady G, Du P. Validation of noninvasive body-surface gastric mapping for detecting gastric slow-wave spatiotemporal features by simultaneous serosal mapping in porcine. Am J Physiol Gastrointest Liver Physiol 2022; 323:G295-G305. [PMID: 35916432 DOI: 10.1152/ajpgi.00049.2022] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Gastric disorders are increasingly prevalent, but reliable noninvasive tools to objectively assess gastric function are lacking. Body-surface gastric mapping (BSGM) is a noninvasive method for the detection of gastric electrophysiological features, which are correlated with symptoms in patients with gastroparesis and functional dyspepsia. Previous studies have validated the relationship between serosal and cutaneous recordings from limited number of channels. This study aimed to comprehensively evaluate the basis of BSGM from 64 cutaneous channels and reliably identify spatial biomarkers associated with slow-wave dysrhythmias. High-resolution electrode arrays were placed to simultaneously capture slow waves from the gastric serosa (32 × 6 electrodes at 4 mm spacing) and epigastrium (8 × 8 electrodes at 20 mm spacing) in 14 porcine subjects. BSGM signals were processed based on a combination of wavelet and phase information analyses. A total of 1,185 individual cycles of slow waves were assessed, out of which 897 (76%) were classified as normal antegrade waves, occurring in 10 (71%) subjects studied. BSGM accurately detected the underlying slow wave in terms of frequency (r = 0.99, P = 0.43) as well as the direction of propagation (P = 0.41, F-measure: 0.92). In addition, the cycle-by-cycle match between BSGM and transitions of gastric slow wave dysrhythmias was demonstrated. These results validate BSGM as a suitable method for noninvasively and accurately detecting gastric slow-wave spatiotemporal profiles from the body surface.NEW & NOTEWORTHY Gastric dysfunctions are associated with abnormalities in the gastric bioelectrical slow waves. Noninvasive detection of gastric slow waves from the body surface can be achieved through multichannel, high-resolution, body-surface gastric mapping (BSGM). BSGM matched the spatiotemporal characteristics of gastric slow waves recorded directly and simultaneously from the serosal surface of the stomach. Abnormal gastric slow waves, such as retrograde propagation, ectopic pacemaker, and colliding wavefronts can be detected by changes in the phase of BSGM.
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Affiliation(s)
- Stefan Calder
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand.,Alimetry Ltd., Auckland, New Zealand
| | - Leo K Cheng
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Christopher N Andrews
- Alimetry Ltd., Auckland, New Zealand.,Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
| | | | | | | | - Jonathan C Erickson
- Department of Physics-Engineering, Washington and Lee University, Lexington, Virginia
| | - Armen Gharibans
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand.,Alimetry Ltd., Auckland, New Zealand
| | - Gregory O'Grady
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand.,Alimetry Ltd., Auckland, New Zealand
| | - Peng Du
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand.,Alimetry Ltd., Auckland, New Zealand
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18
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Aghababaie Z, Cheng LK, Paskaranandavadivel N, Avci R, Chan CHA, Matthee A, Amirapu S, Asirvatham SJ, Farrugia G, Beyder A, O’Grady G, Angeli-Gordon TR. Targeted ablation of gastric pacemaker sites to modulate patterns of bioelectrical slow wave activation and propagation in an anesthetized pig model. Am J Physiol Gastrointest Liver Physiol 2022; 322:G431-G445. [PMID: 35137624 PMCID: PMC8917929 DOI: 10.1152/ajpgi.00332.2021] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Gastric motility is coordinated by underlying bioelectrical slow waves. Gastric dysrhythmias occur in gastrointestinal (GI) motility disorders, but there are no validated methods for eliminating dysrhythmias. We hypothesized that targeted ablation could eliminate pacemaker sites in the stomach, including dysrhythmic ectopic pacemaker sites. In vivo high-resolution serosal electrical mapping (16 × 16 electrodes; 6 × 6 cm) was applied to localize normal and ectopic gastric pacemaker sites in 13 anesthetized pigs. Radiofrequency ablation was performed in a square formation surrounding the pacemaker site. Postablation high-resolution mapping revealed that ablation successfully induced localized conduction blocks after 18 min (SD 5). Normal gastric pacemaker sites were eliminated by ablation (n = 6), resulting in the emergence of a new pacemaker site immediately distal to the original site in all cases. Ectopic pacemaker sites were similarly eliminated by ablation in all cases (n = 7), and the surrounding mapped area was then entrained by normal antegrade activity in five of those cases. Histological analysis showed that ablation lesions extended through the entire depth of the muscle layer. Immunohistochemical staining confirmed localized interruption of the interstitial cell of Cajal (ICC) network through the ablation lesions. This study demonstrates that targeted gastric ablation can effectively modulate gastric electrical activation, including eliminating ectopic sites of slow wave activation underlying gastric dysrhythmias, without disrupting surrounding conduction capability or tissue structure. Gastric ablation presents a powerful new research tool for modulating gastric electrical activation and may likely hold therapeutic potential for disorders of gastric function.NEW & NOTEWORTHY This study presents gastric ablation as a novel tool for modulating gastric bioelectrical activation, including eliminating the normal gastric pacemaker site as well as abnormal ectopic pacemaker sites underlying gastric dysrhythmias. Targeted application of radiofrequency ablation was able to eliminate these pacemaker sites without disrupting surrounding conduction capability or tissue structure. Gastric ablation presents a powerful new research tool for modulating gastric electrical activation and may likely hold therapeutic potential for disorders of gastric function.
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Affiliation(s)
- Zahra Aghababaie
- 1Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Leo K. Cheng
- 1Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand,2Department of Surgery, Vanderbilt University, Nashville, Tennessee
| | | | - Recep Avci
- 1Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | | | - Ashton Matthee
- 1Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Satya Amirapu
- 3Histology Laboratory, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | | | - Gianrico Farrugia
- 5Division of Gastroenterology and Hepatology and Enteric Neurosciences Program, Mayo Clinic, Rochester, Minnesota
| | - Arthur Beyder
- 5Division of Gastroenterology and Hepatology and Enteric Neurosciences Program, Mayo Clinic, Rochester, Minnesota
| | - Gregory O’Grady
- 1Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand,6Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Timothy R. Angeli-Gordon
- 1Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand,6Department of Surgery, University of Auckland, Auckland, New Zealand
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19
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Abnormalities on Electrogastrography in Nausea and Vomiting Syndromes: A Systematic Review, Meta-Analysis, and Comparison to Other Gastric Disorders. Dig Dis Sci 2022; 67:773-785. [PMID: 33956280 DOI: 10.1007/s10620-021-07026-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/25/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Functional nausea and vomiting syndromes and gastroparesis, collectively grouped as nausea and vomiting syndromes (NVS), are overlapping conditions with incompletely understood pathophysiology. Gastric slow wave abnormalities are thought to contribute. AIMS This study aimed to systematically review and meta-analyze the prevalence of slow wave abnormalities measured by electrogastrography (EGG) in patients with NVS. METHODS MEDLINE, EMBASE, EMBASE classic, and CENTRAL databases were systematically searched for articles using EGG in adults (≥ 18 years) with NVS. EGG metrics of interest were percentage time in bradygastria, normogastria, and tachygastria as well as dominant frequency and dominant power. Outcomes were also compared with functional dyspepsia (FD), gastroesophageal reflux disease (GORD), and control cohorts. RESULTS Seven hundred and sixty NVS patients and 308 controls were included from 24 studies. Overall, 64% of patients had EGG abnormalities. Average percent time in normogastria was low during fasting (50%; 95% CI 40-63%) and fed (53%; 95% CI 41-68%) states in patients, with substantial periods in fasting bradygastria (34.1%; 95% CI 25-47%) and postprandial tachygastria (21%; 95% CI 17-26%). Across gastric disorders, pooling of 84 studies showed a comparably high prevalence of EGG abnormalities in NVS (24 studies; n = 760) and GORD (13 studies; n = 427), compared to FD (47 studies; n = 1751) and controls (45 studies; n = 1027). CONCLUSIONS Frequency-based gastric slow wave abnormalities are prominent in NVS. The strength and consistency of these associations across many studies suggests that gastric dysrhythmia may be an important factor in NVS, motivating the development of more reliable methods for their clinical assessment.
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20
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Xiao HL, Xiao YJ, Wang Q, Chen ML, Jiang AL. Moxibustion Regulates Gastrointestinal Motility via HCN1 in Functional Dyspepsia Rats. Med Sci Monit 2021; 27:e932885. [PMID: 34845181 PMCID: PMC8642983 DOI: 10.12659/msm.932885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background Moxibustion therapy has been found to ameliorate clinical symptoms of functional dyspepsia (FD). We aimed to examine the regulatory effect of moxibustion on the gastrointestinal (GI) motility in FD and explore the underlying mechanism based on the hyperpolarization-activated cyclic nucleotide-gated cation channel 1 (HCN1). Material/Methods Moxibustion therapy was used in FD rats induced by using classic tail-pinch and irregular feeding. Weight gain and food intake were recorded weekly, followed by detecting gastric residual rate (GRR) and small intestine propulsion rate (IPR). Next, western blotting was performed to determine the expression levels of HCN1 in the gastric antrum. qRT-PCR was used to detect HCN1 in the small intestine and hypothalamic satiety center. Double immunolabeling was used for HCN1 and ICCs in gastric antrum and small intestine. Results The obtained results suggested that moxibustion treatment could increase weight gain and food intake in FD rats. The GRR and IPR were compared among the groups, which showed that moxibustion treatment could decrease GRR and increase IPR. Moxibustion increased the expression of HCN1 in the gastric antrum, small intestine, and hypothalamic satiety center. Histologically, the co-expressions of HCN1 and ICCs tended to increase in gastric antrum and small intestine. Meanwhile, HCN channel inhibitor ZD7288 prevented the above-mentioned therapeutic effects of moxibustion. Conclusions The results of the present study suggest that moxibustion can effectively improve the GI motility of FD rats, which may be related to the upregulation of HCN1 expression in gastric antrum, small intestine, and satiety center.
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Affiliation(s)
- Hong-Ling Xiao
- School of Nursing, Second Military Medical University, Shanghai, China (mainland).,School of Nursing, Tianjin University of Chinese Medicine, Tianjin, China (mainland)
| | - Yun-Jiu Xiao
- School of Nursing, Anhui University of Chinese Medicine, Hefei, Anhui, China (mainland)
| | - Qian Wang
- School of Nursing, Anhui University of Chinese Medicine, Hefei, Anhui, China (mainland)
| | - Mei-Ling Chen
- School of Nursing, Anhui University of Chinese Medicine, Hefei, Anhui, China (mainland)
| | - An-Li Jiang
- School of Nursing, Second Military Medical University, Shanghai, China (mainland)
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21
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O'Grady G, Gharibans AA, Du P, Huizinga JD. The gastric conduction system in health and disease: a translational review. Am J Physiol Gastrointest Liver Physiol 2021; 321:G527-G542. [PMID: 34549598 DOI: 10.1152/ajpgi.00065.2021] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Gastric peristalsis is critically dependent on an underlying electrical conduction system. Recent years have witnessed substantial progress in clarifying the operations of this system, including its pacemaking units, its cellular architecture, and slow-wave propagation patterns. Advanced techniques have been developed for assessing its functions at high spatiotemporal resolutions. This review synthesizes and evaluates this progress, with a focus on human and translational physiology. A current conception of the initiation and conduction of slow-wave activity in the human stomach is provided first, followed by a detailed discussion of its organization at the cellular and tissue level. Particular emphasis is then given to how gastric electrical disorders may contribute to disease states. Gastric dysfunction continues to grow in their prevalence and impact, and while gastric dysrhythmia is established as a clear and pervasive feature in several major gastric disorders, its role in explaining pathophysiology and informing therapy is still emerging. New insights from high-resolution gastric mapping are evaluated, together with historical data from electrogastrography, and the physiological relevance of emerging biomarkers from body surface mapping such as retrograde propagating slow waves. Knowledge gaps requiring further physiological research are highlighted.
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Affiliation(s)
- Gregory O'Grady
- Department of Surgery, The University of Auckland, Auckland, New Zealand.,Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Armen A Gharibans
- Department of Surgery, The University of Auckland, Auckland, New Zealand.,Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Peng Du
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Jan D Huizinga
- Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
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22
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Electrogastrography Abnormalities in Pediatric Gastroduodenal Disorders: A Systematic Review and Meta-analysis. J Pediatr Gastroenterol Nutr 2021; 73:9-16. [PMID: 33797449 DOI: 10.1097/mpg.0000000000003140] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Electrogastrography (EGG) is a non-invasive method of measuring gastric electrophysiology. Abnormal gastric electrophysiology is thought to contribute to disease pathophysiology in patients with gastroduodenal symptoms but this has not been comprehensively quantified in pediatric populations. This study aimed to quantify the abnormalities in gastric electrophysiology on EGG in neonatal and pediatric patients.Databases were systematically searched for articles utilizing EGG in neonatal and pediatric patients (≤18 years). Primary outcomes were prevalence of abnormality, percentage of time in normal rhythm, and power ratio. Secondary outcomes were correlations between patient symptoms and abnormal gastric electrophysiology on EGG.A total of 33 articles (1444 participants) were included. EGG methodologies were variable. Pooled prevalence of abnormalities on EGG ranged from 61% to 86% in patients with functional dyspepsia (FD), gastro-esophageal reflux disease (GERD), and type 1 diabetes mellitus (T1DM). FD patients averaged 20.8% (P = 0.011) less preprandial and 21.6% (P = 0.031) less postprandial time in normogastria compared with controls. Electrophysiological abnormalities were inconsistent in GERD. T1DM patients averaged 46.2% (P = 0.0003) less preprandial and similar (P = 0.32) postprandial time in normogastria compared with controls, and had a lower power ratio (SMD -2.20, 95% confidence interval [CI]: -4.25 to -0.15; P = 0.036). Symptom correlations with gastric electrophysiology were inconsistently reported.Abnormalities in gastric electrophysiology were identifiable across a range of pediatric patients with gastroduodenal symptoms on meta-analysis. However, techniques have been inconsistent, and standardized and more reliable EGG methods are desirable to further define these findings and their potential utility in clinical practice.
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