Clinical associations of functional dyspepsia with gastric dysrhythmia on electrogastrography: A comprehensive systematic review and meta‐analysis

Abstract

Background: Functional dyspepsia (FD) is a common gastroduodenal disorder, yet its pathophysiology remains poorly understood. Bioelectrical gastric slowwave abnormalities are thought to contribute to its multifactorial pathophysiology. Electrogastrography (EGG) has been used to record gastric electrical activity; however, the clinical associations require further evaluation.Aims: This study aimed to systematically assess the clinical associations of EGG in FD.Methods: MEDLINE, EMBASE, and CENTRAL databases were systematically searched for articles using EGG in adults with FD. Primary outcomes were percentage normal versus abnormal rhythm (bradygastria, normogastria, and tachygastria). Secondary outcomes were dominant power, dominant frequency, percentage coupling, and the meal responses.Results: 1751 FD patients and 555 controls from 47 studies were included. FD patients spent less time in normogastria while fasted (SMD −0.74; 95%CI −1.22 to −0.25) and postprandially (−0.86; 95%CI −1.35 to −0.37) compared with controls. FD patients also spent more fasted time in bradygastria (0.63; 95%CI 0.33-0.93) and tachygastria (0.45; 95%CI 0.12-0.78%). The power ratio (−0.17; 95%CI −0.83-0.48) and dominant frequency meal-response ratio (0.06; 95%CI −0.08-0.21) were not significantly different to controls. Correlations between EGG metrics and the presence and timing of FD symptoms were inconsistent. EGG methodologies were diverse and variably applied. Conclusion:Abnormal gastric slow-wave rhythms are a consistent abnormality present in FD, as defined by EGG and, therefore, likely play a role in pathophysiology. The aberrant electrophysiology identified in FD warrants further investigation, including into underlying mechanisms, associated spatial patterns, and symptom correlations.

The gastric conduction system in health and disease: a translational review

“…Notably, four meta-analyses recently synthesized >200 EGG studies in adults and children (114)(115)(116)(117), with the key finding that despite a heterogeneity of techniques, frequencydefined gastric dysrhythmias were consistently pervasive across a large range of studies in several disorders of gastric function including functional dyspepsia, GERD and chronic nausea and vomiting / gastroparesis. Interestingly, on pooled analyses, frequency instabilities were most prevalent in nausea and vomiting disorders and GERD, followed by functional dyspepsia (Figure 3).…”

“…Interestingly, on pooled analyses, frequency instabilities were most prevalent in nausea and vomiting disorders and GERD, followed by functional dyspepsia (Figure 3). The clear separation between patients and controls indicated that gastric dysrhythmia likely plays some pathophysiological role in all of these disorders (114,115,117). Several questions arise, including whether the gastric dysrhythmias in these distinct but overlapping disorders are the same or different, how dysrhythmias impact motility, what drives them, and how they contribute to gastric symptoms.…”

A novel scalable electrode array and system for non-invasively assessing gastric function using flexible electronics

“…44 It therefore appears that retrograde wave behavior is part of the normal post-prandial gastric repertoire, which would be an important physiological discovery, 45 but this nding requires further scrutiny in dedicated studies before it can be accepted. Gastric electrophysiology has recently been con rmed by meta-analyses to signi cantly deviate from healthy subjects in FD, CNVS, gastro-esophageal re ux disease, and various pediatric disorders with traditional EGG, [11][12][13]46 indicating priority target groups for future clinical studies using BSGM. Additionally, studies suggest that dysrhythmias may also be implicated in a subset of postoperative gastric dysfunction.…”

“…8 EGG measures the bioelectrical slow waves that coordinate gastric motility, and also registers gastric contractile activity through an increase in signal power. 9,10 A substantial literature has been generated to show that EGG abnormalities are consistently prevalent in patients with gastric symptoms, [11][12][13] yet EGG failed to achieve common clinical adoption. Limitations to EGG include its focus on frequency as the predominant measure of abnormality, sensitivity to noise that could lead to misinterpretation of data, and an inability to account for a wide variability in gastric anatomical position.…”

Moxibustion Regulates Gastrointestinal Motility via HCN1 in Functional Dyspepsia Rats

“…GI motor dysfunction, visceral hypersensitivity, Helicobacter pylori infection, gastric acid, depression, central nervous system (CNS) disorders, diet, lifestyle, and body mass index contributes to FD pathogenesis [ 9 – 17 ]. The multifactorial pathogenesis contributes to bioelectrical gastric slow-wave abnormalities in FD patients [ 18 ]. The interstitial cell of Cajal (ICCs) are pacemaker cells that generate electrical slow waves in gastrointestinal (GI) smooth muscles.…”