Gastroesophageal reflux disease (GERD) is common and often medically refractory. Abnormal gastric myoelectrical function may contribute to pathogenesis. This prospective observational study with matched controls assessed if myoelectrical abnormalities measured using body surface gastric mapping were correlated with reflux measured by 24 hr pH testing, and symptom severity. Gastric Alimetry® was performed simultaneously on patients undergoing 24 hr pH testing for investigation of reflux symptoms, with a standardised 4.5 hr test and validated symptom logging. Data were segmented into 15-minute epochs. Forty subjects were recruited (mean age 46.5 years, 60% female): 20 undergoing pH testing (12 with GERD and 8 symptomatic patients without), and 20 controls. GERD patients displayed lower gastric rhythm stability measured by the Gastric Alimetry® Rhythm-Index (GA-RI) when compared with controls (p=0.011), but not with non-GERD patients (p=0.605). Lower gastric rhythm stability measured by GA-RI was associated with increased esophageal acid exposure (DeMeester score; r=−0.46, p=0.042). Periods of decreased gastric rhythm stability measured by GA-RI were not temporally correlated with reflux (r=0.08, p=0.182), or heartburn severity (r=0.04, p=0.309), but were correlated with nausea (r=−0.22, p<0.001) and excessive fullness (r=−0.28, p<0.001). We demonstrated that gastric rhythm instability is associated with increased symptom severity and overall acid exposure in GERD patients. While there was no temporal link between rhythm instability and heartburn found, rhythm instability was temporally associated with increased nausea and fullness. GA-RI offers an emerging biomarker of concurrent gastric neuromuscular dysfunction in patients with GERD.
Varghese et al. (Thu,) studied this question.
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