Wang William Jiaen, Foong Daphne, Calder Stefan, Schamberg Gabriel, Varghese Chris, Tack Jan, Xu William, Daker Charlotte, Carson Daniel, Waite Stephen, Hayes Thomas, Du Peng, Abell Thomas L, Parkman Henry P, Huang I-Hsuan, Fernandes Vivian, Andrews Christopher N, Gharibans Armen A, Ho Vincent, O'Grady Greg
medRxiv. 2023 May 25:2023.05.18.23290134. doi: 10.1101/2023.05.18.23290134.
OBJECTIVES: Gastric emptying testing (GET) assesses gastric motility, however is non-specific and insensitive for neuromuscular disorders. Gastric Alimetry® (GA) is a new medical device combining non-invasive gastric electrophysiological mapping and validated symptom profiling. This study assessed patient-specific phenotyping using GA compared to GET. METHODS: Patients with chronic gastroduodenal symptoms underwent simultaneous GET and GA, comprising a 30-minute baseline, 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: 75 patients were assessed; 77% female. Motility abnormality detection rates were: 22.7% (14 delayed, 3 rapid); 33.3% (14 low rhythm stability / low amplitude; 5 high amplitude; 6 abnormal frequency); 42.7%. In patients with normal spectral analysis, included: sensorimotor 17% (where symptoms strongly paired with gastric amplitude; median r=0.61); continuous 30%; other 53%. GA phenotypes showed superior correlations with GCSI, PAGI-SYM, 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. CONCLUSIONS: GA improves patient phenotyping in chronic gastroduodenal disorders in the presence and absence of motility abnormalities with improved correlation with symptoms and psychometrics compared to gastric emptying status and Rome IV criteria. These findings have implications for the diagnostic profiling and personalized management of gastroduodenal disorders. STUDY HIGHLIGHTS: 1) WHAT IS KNOWN Chronic gastroduodenal symptoms are common, costly and greatly impact on quality of lifeThere is a poor correlation between gastric emptying testing (GET) and symptomsGastric Alimetry® is a new medical device combining non-invasive gastric electrophysiological mapping and validated symptom profiling 2) WHAT IS NEW HERE Gastric Alimetry generates a 1.5x higher yield for motility abnormalities than GETWith symptom profiling, Gastric Alimetry identified 2.7x more specific patient categories than GETGastric Alimetry improves clinical phenotyping, with improved correlation with symptoms and psychometrics compared to GET.
目的：胃排空测试（GET）可评估胃动力，但对神经肌肉疾病不具有特异性且不敏感。胃测压仪（GA）是一种新型医疗设备，它结合了非侵入性胃电生理图谱和经过验证的症状分析。本研究使用GA与GET对比，评估了患者特异性表型。 方法：患有慢性胃十二指肠症状的患者同时接受GET和GA检查，包括30分钟的基线检查、锝标记鸡蛋餐以及餐后4小时的记录。结果参考正常范围。在经过验证的GA应用程序中对症状进行分析，并根据其与进餐和胃活动的关系，使用基于规则的标准进行表型分析：i）感觉运动型；ii）持续型；iii）其他型。 结果：共评估了75例患者；其中77%为女性。动力异常检测率分别为：22.7%（14例排空延迟，3例排空迅速）；33.3%（14例节律稳定性低/振幅低；5例振幅高；6例频率异常）；42.7%。在频谱分析正常的患者中，包括：感觉运动型17%（症状与胃振幅密切相关；中位数r = 0.61）；持续型30%；其他型53%。GA表型与胃肠道症状评分指数（GCSI）、餐后不适症状评估量表（PAGI-SYM）和焦虑量表的相关性更好，而罗马IV标准与心理测量评分无相关性（p>0.05）。排空延迟不能预测特定的GA表型。 结论：与胃排空状态和罗马IV标准相比，GA在存在和不存在动力异常的慢性胃十二指肠疾病中改善了患者表型，与症状和心理测量的相关性更好。这些发现对胃十二指肠疾病的诊断分析和个性化管理具有重要意义。 研究亮点：1）已知情况 慢性胃十二指肠症状常见、代价高昂且对生活质量影响极大 胃排空测试（GET）与症状之间相关性较差 胃测压仪（GA）是一种新型医疗设备，它结合了非侵入性胃电生理图谱和经过验证的症状分析 2）新发现 胃测压仪检测动力异常的阳性率比胃排空测试高1.5倍 通过症状分析，胃测压仪识别出的特定患者类别比胃排空测试多2.7倍 与胃排空测试相比，胃测压仪改善了临床表型，与症状和心理测量的相关性更好
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