Body Surface Gastric Mapping Phenotypes and Treatment Escalation in Chronic Gastroduodenal Symptoms
Jarongkorn Sirimongkolkasem, Syed Matthew Kodilinye, Wendy Zhou, John O. Clarke, Leila Neshatian, Linda NguyenABSTRACT
Background
Chronic gastroduodenal symptoms have overlapping mechanisms, but physiologic features of refractory disease remain unclear. We evaluated associations of body surface gastric mapping (BSGM) phenotypes and gastric emptying with treatment escalation.
Methods
We retrospectively studied adults undergoing BSGM at a tertiary center, excluding prior foregut surgery. Patients were classified as Motor Predominant or Non Motor Predominant using Auckland Classification v1.0. Treatment escalation comprised advanced intervention or nutritional support.
Key Results
Among 146 patients (median age, 35 years; 83.6% female), 55 (37.7%) were Motor Predominant and 55/137 (40.1%) had delayed gastric emptying. Escalation occurred in 47 (32.2%), including 44 before BSGM. Delayed emptying was associated with escalation after adjustment for phenotype, age, and sex (OR 8.09, 95% CI: 3.39–19.33). Within delayed emptying, escalation was more frequent with a Motor Predominant phenotype (77.4% vs. 41.7%; Holm‐adjusted p = 0.020), despite similar gastric retention; grouping by any spectral abnormality showed a smaller, nonsignificant difference ( p = 0.088). No statistically significant difference was detected with normal emptying. Among Motor Predominant phenotypes, Dysrhythmia had the strongest observed associations with escalation (OR 4.02, 95% CI: 1.41–11.86) and delayed emptying (OR 6.13, 95% CI: 1.97–21.69) versus the Non Motor Predominant group.
Conclusions and Inferences
Auckland phenotyping more clearly identified a phenotype with more refractory disease among patients with delayed gastric emptying than grouping by any spectral abnormality. Dysrhythmia had the strongest observed association among Motor Predominant phenotypes. Because most escalation preceded BSGM, these findings characterize an established refractory course but cannot predict future escalation. BSGM and gastric emptying testing may provide complementary information.