Department of Surgery, University of Auckland, Auckland, New Zealand.
Alimetry Ltd, Auckland, New Zealand; School of Medicine, Western Sydney University, Penrith, Australia.
J Gastrointest Surg. 2024 Mar;28(3):236-245. doi: 10.1016/j.gassur.2023.12.023. Epub 2024 Jan 23.
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.
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.
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).
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.
胃食管反流病患者接受胃底折叠术后仍有 20%存在胃不良反应症状，导致显著发病率，需要进行修正手术。目前缺乏评估持续性术后症状机制的非侵入性技术。本研究旨在使用新型非侵入性体表胃映射（BSGM）设备研究胃底折叠术后患者胃电异常和症状。
纳入既往胃底折叠术且存在持续显著胃十二指肠症状的患者和匹配对照者。采用 Gastric Alimetry（Alimetry Ltd）进行 BSGM，包括高分辨率 64 通道阵列、验证症状记录应用程序和可穿戴式读取器。
共招募了 16 例胃底折叠术后存在显著慢性症状的患者和 16 例匹配对照者。总体而言，16 例患者中有 6 例（37.5%）显示出不稳定胃电活动（n=2）、异常高胃频率（n=3）或高胃幅度（n=1）定义的显著频谱异常。存在频谱异常的患者的患者上消化道疾病症状严重程度评估量表（Patient Assessment of Upper Gastrointestinal Disorders-Symptom Severity Index）评分高于无频谱异常的患者（3.2[范围，2.8-3.6]比 2.3[范围，2.2-2.8]；P=0.024）。此外，16 例患者中有 7 例（43.8%）BSGM 测试结果提示存在肠-脑轴贡献，而无胃电功能障碍。主要胃频率偏差增加和节律指数降低与症状严重程度相关（r>0.40；P<0.05）。
持续性胃底折叠术后症状患者中有相当数量的患者在 BSGM 检测中显示出异常胃功能，与症状严重程度相关。我们的发现加深了对胃底折叠术后障碍的病理生理理解，这可能为药物治疗和修正手术的诊断和患者选择提供信息。
