Gastric Alimetry in the Management of Chronic Gastroduodenal Disorders: Impact to Diagnosis and Health Care Utilization

Abstract

Introduction: Chronic gastroduodenal symptoms are frequently overlapping within existing diagnostic paradigms, and current diagnostic tests are insensitive to underlying pathophysiologies. Gastric Alimetry has emerged as a new diagnostic test of gastric neuromuscular function with time-of-test symptom profiling. This study aimed to assess the impact to diagnosis and health care utilization after the introduction of Gastric Alimetry into clinical care.

Methods: Consecutive data of patients from 2 tertiary centers with chronic gastroduodenal symptoms (Rome-IV defined or motility disorder) having integrated care and Gastric Alimetry testing were evaluated. Changes in diagnoses, interventions, and management were quantified. Pretest and posttest health care utilization was reported. A preliminary management framework was established through experiential learning.

Results: Fifty participants (45 women; median age 30 years; 18 with gastroparesis, 24 with chronic nausea and vomiting syndrome, and 6 with functional dyspepsia) underwent Gastric Alimetry testing. One-third of patients had a spectral abnormality (18% dysrhythmic/low amplitude). Of the remaining patients, 9 had symptoms correlating to gastric amplitude, while 19 had symptoms unrelated to gastric activity. Gastric Alimetry aided management decisions in 84%, including changes in invasive nutritional support in 9/50 cases (18%; predominantly de-escalation). Health care utilization was significantly lower post-Gastric Alimetry testing when compared with the average utilization cost in the year before Gastric Alimetry testing (mean ± SD $39,724 ± 63,566 vs $19,937 ± 35,895, P = 0.037).

Discussion: Gastric Alimetry aided diagnosis and management of patients with chronic gastroduodenal symptoms by enabling phenotype-informed care. The high majority of results aided management decisions, which was associated with reduced health care utilization.

Figure 1.

(a) Flow diagram developed for the application of Gastric Alimetry in the management of gastroduodenal disorders. Patients may have more than 1 phenotype. (b–d) Examples of Gastric Alimetry spectral data, amplitude plots, and symptom burden graphs from the study cohort. (b) Normal spectral analysis; continuous symptom profile: principal gastric frequency 3.01 cpm (range 2.65–3.35); Gastric Alimetry-Rhythm Index (GA-RI) 0.88 (range ≥0.25); body mass index–adjusted amplitude 61.3 ± 17.8 μV (range 22–70 μV). (c) Dysrhythmic profile (GA-RI 0.12; 21.6 μV). (d) Dysrhythmic neuromuscular profile with a sensorimotor symptom profile (GA-RI 0.12; 21.6 μV). (e) High amplitude activity (average 72.1 μV).

Figure 2.

(a) Sankey diagram showing the changes in diagnoses that occurred between gastroparesis/other motility disorder and Rome-IV gastroduodenal disorders vs post–Gastric Alimetry diagnoses (right column). (b) Significant changes in management that were guided by Gastric Alimetry test data, as per the workflow in Figure 1a. (c) Significant changes in invasive (parenteral [PN] or enteral nutrition [EN]) that were achieved because of the changes instituted in Figure 2a, b in tandem with integrated clinical care. CNVS, chronic nausea and vomiting syndrome; FD, functional dyspepsia.

Figure 3.

(a) Pre- and post-Gastric Alimetry (GA) testing patient-level health care utilization cost savings. Total costs incurred per person in the year before and after GA testing per person (P = 0.037). (b) Dumbbell plot of patient-level cost differences pre-GA and post-GA testing. Costs in New Zealand dollars. Each line represents an individual participant with follow-up data available at the major participating center.