Gastric Alimetry^®impacts the management pathway of chronic gastroduodenal disorders

Abstract

Background Gastric Alimetry is a new diagnostic tool using non-invasive gastric electrical mapping and symptom logging to identify patient subgroups. This study aimed to propose an initial framework for Gastric Alimetry implementation in the routine management of gastroduodenal disorders, and assess its impact on diagnosis and management. Methods Gastric Alimetry using standard tests (30-min fasted, ~480kCal meal, followed by 4-hr postprandial recording with concurrent symptom logging) was applied to patients presenting with gastroduodenal symptoms. Results Overall, 50 patients were evaluated with Gastric Alimetry. The test aided management decisions in 78% of patients (39/50) and aided a change in diagnosis in 40% (20/50), predominantly from a motility disorder to disorders of gut-brain interaction (DGBI). Changes in invasive nutritional support occurred in 18% (9/50). Conclusion Gastric Alimetry impacted care in most patients in this first series. Further work to inform clinical utility is now a priority.

Gastric Alimetry®testing and healthcare economic analysis in nausea and vomiting syndromes

“…7 Several studies have shown high rates of diagnostic testing, acute care presentations and inpatient admissions in NVS patients, which are sustained over multiple years. 7,8,17,31 Investigations are often repeated in a confirmatory fashion, as again shown in the current study, with repeat gastroscopy and abdominal CT rates of 29% and 85% respectively. Patients may therefore also exceed annual recommended radiation limits due to repeated medical imaging.…”

“…For example, Varghese et al recently reported higher average annualised cost savings of NZ$19,787 following the introduction of Gastric Alimetry in a cohort of patients in whom enteral support costs were able to be defined, and which included patients on parenteral nutrition. 17 This study also indicated that Gastric Alimetry may aid in the de-escalation of pharmacological therapy in approximately 20% of cases, potentially contributing additional savings. 17…”

“…A limitation of this study should also be noted that pharmaceutical and nutrition support costs were not included, as it was found these costs could not be as reliably computed in a retrospective data analysis. Nutrition costs may be particularly significant, given other recent studies showing that Gastric Alimetry may aid in the selection of patients for invasive nutrition, 16,17 by more robustly defining patient subgroups with true gastrointestinal neuromuscular disorders from those with gut-brain axis or sensorimotor disorders. 18,28 Given the high costs of nutrition support, which may extend to hundreds of thousands of dollars per year for patients on parenteral nutrition, 36 the cost savings identified in this study could therefore have been underestimated.…”

“…This was also supported by a separate study by Varghese et al, in which it was shown that Gastric Alimetry aided management decisions in >80% of patients. 17 One key advantage of this modality, as opposed to gastric emptying, is to identify underlying neuromuscular disorders, which are well established to occur in NVS, but which have previously been difficult to separate without full thickness tissue biopsies. 5,28,34,35 In addition, the combination of spectral and symptom-based phenotypes cover a broader range of diagnostic possibilities, including gut-brain axis disorders, sensorimotor disorders, and the sequelae of long-term diabetes.…”

“…12,13 This test aids in phenotyping patients into likely disorders related to the gastric neuromuscular dysfunction versus gut-brain dysregulation, as well as assisting in identifying other contributing factors including vagal, sensorimotor or post-surgical mechanisms. 14,15 Early cohort studies have indicated that Gastric Alimetry can significantly reduce costs by decreasing the need for investigations, admissions and nutritional support in NVS patients, [16][17][18] however, more formal healthcare utilisation evaluations are required. patients with NVS, and to estimate the potential health economic impact of implementing Gastric Alimetry testing.…”