Characterization of gastric dysfunction after fundoplication using body surface gastric mapping.

Dyspepsia Fundoplication Gastric Alimetry Gastroesophageal reflux disease Gastroparesis High-resolution electrogastrography Surgical complications

Journal

Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
ISSN: 1873-4626
Titre abrégé: J Gastrointest Surg
Pays: United States
ID NLM: 9706084

Informations de publication

Date de publication:
Mar 2024
Historique:
received: 23 11 2023
revised: 09 12 2023
accepted: 22 12 2023
medline: 6 3 2024
pubmed: 6 3 2024
entrez: 6 3 2024
Statut: ppublish

Résumé

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.

Sections du résumé

BACKGROUND BACKGROUND
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.
METHODS METHODS
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.
RESULTS RESULTS
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).
CONCLUSION CONCLUSIONS
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.

Identifiants

DOI: 10.1016/j.gassur.2023.12.023 PMID: 38445915
pubmed: 38445915
pii: S1091-255X(23)08752-8
doi: 10.1016/j.gassur.2023.12.023
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

236-245

Informations de copyright

Copyright © 2023. Published by Elsevier Inc.

Auteurs

William Xu (W)

Department of Surgery, University of Auckland, Auckland, New Zealand.

Tim Wang (T)

Department of Surgery, University of Auckland, Auckland, New Zealand.

Daphne Foong (D)

Alimetry Ltd, Auckland, New Zealand; School of Medicine, Western Sydney University, Penrith, Australia.

Gabe Schamberg (G)

Department of Surgery, University of Auckland, Auckland, New Zealand; Alimetry Ltd, Auckland, New Zealand.

Nicholas Evennett (N)

Department of Surgery, University of Auckland, Auckland, New Zealand.

Grant Beban (G)

Department of Surgery, University of Auckland, Auckland, New Zealand.

Armen Gharibans (A)

Alimetry Ltd, Auckland, New Zealand; Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States.

Stefan Calder (S)

Alimetry Ltd, Auckland, New Zealand; Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand.

Charlotte Daker (C)

Alimetry Ltd, Auckland, New Zealand; Department of Gastroenterology, North Shore Hospital, Auckland, New Zealand.

Vincent Ho (V)

School of Medicine, Western Sydney University, Penrith, Australia; Department of Gastroenterology and Hepatology, Campbelltown Hospital, Campbelltown, Australia.

Greg O'Grady (G)

Department of Surgery, University of Auckland, Auckland, New Zealand; Alimetry Ltd, Auckland, New Zealand; Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand. Electronic address: greg.ogrady@auckland.ac.nz.

Classifications MeSH