What question did this study set out to answer?

Clarify the role of autonomic dysfunction in chronic gastroduodenal disorders and its association with symptoms.

February 14, 2026The American Journal of Gastroenterology5 citations

Autonomic Dysfunction in Gastroduodenal Disorders Evaluated through Multimodal Non-Invasive Physiological Testing

CVChris VargheseTwitter (United States)WZWendy ZhouStanford University AGArmen A. GharibansAuckland Institute of Studies

Key Points

Clarify the role of autonomic dysfunction in chronic gastroduodenal disorders and its association with symptoms.
Prospective observational cohort design
Included 80 patients with chronic gastroduodenal symptoms
Administered autonomic evaluation and gastric emptying scintigraphy
Used body surface gastric mapping for phenotyping
Followed standard criteria for diagnosis and assessments.
Gastroparesis diagnosed in 33.8% of patients
Autonomic dysfunction found in 26.3% of patients, with abnormal BSGM in 25%
Higher prevalence of autonomic dysfunction and abnormal BSGM in gastroparesis cases
Autonomic dysfunction predicted delayed gastric emptying with an odds ratio of 13.8
Associated with worse postprandial distress and higher meal response ratio.

Abstract

Background: Chronic gastroduodenal disorders are highly prevalent and encompass heterogeneous pathophysiology. Autonomic dysfunction may contribute, but its relative contribution to disease pathophysiology and symptoms is unclear. This study aimed to clarify the contributions of autonomic dysfunction in gastroduodenal disorders and symptom associations using multimodal testing, hypothesizing that distinct disorder subgroups would be revealed. Methods: This prospective observational cohort study included 80 patients with chronic gastroduodenal symptoms. Participants underwent expert clinician-led autonomic evaluation, body surface gastric mapping (BSGM; Gastric Alimetry®, New Zealand), and gastric emptying scintigraphy testing. BSGM phenotyping, gastric emptying cut-offs, and autonomic criteria followed standard criteria. Results: Gastroparesis was diagnosed in 27 (33.8%) patients. Autonomic dysfunction was present in 21 (26.3%) patients, and abnormal BSGM in 20 (25%). Autonomic dysfunction and abnormal BSGM were both more prevalent in gastroparesis (51.9% vs. 13.2%, p=0.001; and 44.4% vs. 15.1%, p=0.005, respectively). However, these diagnoses tended not to overlap, with patients having autonomic dysfunction generally exhibiting normal BSGM tests. Autonomic dysfunction independently predicted delayed gastric emptying (OR 13.8, p<0.001) and was associated with earlier meal responses (higher ‘meal response ratio’, p=0.04) and worse postprandial distress symptoms (p<0.05). Conclusions: Autonomic dysfunction independently predicted delayed gastric emptying and revealed a gastroparesis mechanism distinct from gastric myoelectrical impairment. Autonomic dysfunction altered the postprandial gastric motor response and was associated with a greater symptom burden. Multimodal physiological testing including autonomic profiling reveals distinct mechanistic subgroups in patients with chronic gastroduodenal symptoms.

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