PHILADELPHIA—Noninvasive, multiple-day, ambulatory recording of gastrointestinal myoelectrical activity can help identify unique pathophysiologic processes that may translate to more individualized treatments for patients with gastric sensorimotor disorders, according to a small study from Mayo Clinic in Jacksonville, Florida.
This study (ACG 2024 abstract P1620) allowed the investigators to capture gastric activity over a longer period of typical, symptom-eliciting patient eating habits, Dr. Lacy said. They recruited participants from adults who were referred for a four-hour, solid-phase, scintigraphic gastric emptying scan (GES). Those enrolled had three wireless motility patches applied to their skin, to be worn for six days. While wearing the patches, participants recorded their mealtimes and bowel movements on an app downloaded to their smartphones.
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Three Activity Groups Detected
In total, 37 participants had data available for at least two days of patch use. Among these patients, who had an average of 4.9 days of data, summing the gastric myoelectrical activity over the recording period found three groups of patients—those with weak, moderate and strong activity. However, there was day-to-day variation in myoelectrical activity, with participants in the weak activity group showing more variation than those in the moderate and strong activity groups.
Differentiating the gastric activity level has implications for treatment selection, when coupled with information on symptoms, according to Dr. Lacy. He gave an example of two patients with symptoms of epigastric fullness and nausea, one of whom had weak activity and the other with strong activity. Dr. Lacy said the former patient would likely respond to a prokinetic agent, while the latter likely needs “an agent that improves gastric accommodation.”
Inconsistencies Between GES and Multiday Testing
Five participants were shown to have delayed gastric emptying (DGE) based on the results of the four-hour GES. Three of those patients had weak activity on the long-term recording, one had moderate activity and one had strong activity. The patient with DGE and strong overall activity had notable day-to-day variation in gastric myoelectrical activity, with the day of the GES being a weaker activity day.
Participants with DGE detected during the GES had weaker gastric meal response than those who did not have DGE detected during the scan. However, during the multiday recording, some patients who were classified as having normal gastric emptying based on the GES displayed a gastric meal response that was similar to that of patients classified as having DGE during the scan. This indicates inconsistencies between the findings from the snapshot GES and multiday evaluation procedures.
These inconsistencies, combined with the day-to-day variation seen in patients’ gastric myoelectrical activity. illustrated to the investigators that “prolonged ambulatory recording of gastrointestinal activity … under real-world conditions” can “[help] to identify unique pathophysiologic processes that may translate into more individualized and effective treatments” for patients with gastric sensorimotor disorders.
Beyond informing treatment decision making, Dr. Lacy told Gastroenterology & Endoscopy News that another advantage of the multiday outpatient monitoring is accessibility. Many patients do not “have ready access to gastric scintigraphy”—and even in those with access, the results often may not be accurate (Dig Dis Sci 2021;66[9]:2897-2906)—but he said the multiday “patches could be sent directly to the patient.”
“Overall,” Dr. Lacy said, “I think that this [multiday monitoring approach] has the potential to distinguish gastric sensorimotor disorders much better and help guide therapy. [It’s] a fascinating area with a lot more interesting information to come.”
Dr. Lacy reported financial relationships with AbbVie, Ardelyx, Gemelli, Ironwood, Salix and Takeda.