Physiology-guided quantitative symptom analysis for gastroduodenal disorders

BackgroundCurrent approaches to symptom-based classifications in gastroduodenal disorders are binary and substantially overlapping. We aimed to develop a standardized and quantitative system for classifying patient-level symptom profiles guided on physiological principles. MethodsA large database (n = 787) of 4.5 h (30 min baseline; 4-h postprandial) Gastric Alimetry (Alimetry, NZ) recordings were used to identify, and quantify distinct symptom patterns based on established gastroduodenal physiology concepts. Tests comprised a standardized meal challenge and symptoms were simultaneously recorded at minimum 15 minute intervals using a 10-point likert scale with pictograms encoded in a validated digital App. Key ResultsSix symptom profiles were defined. The meal change metric was used to define meal-induced and meal-relieved symptom profiles, defined as an increase (+2) or decrease (-2) in the average symptom severity between the first post- and pre-prandial hours of recordings. The continuous profile was defined as a reduced range (<3; i.e., difference between the 95th and 5th percentile symptom severity), and thresholded to the 5th percentile of symptom severity being > 2. The symptom/amplitude correlation metric defined the sensorimotor profile, thresholded when the correlation was >0.5. The symptom/amplitude time lag metric was used to define activity-relieved and post-gastric symptom profiles, defined as negative (< -0.25) or positive (>0.25) average difference between the cumulative distribution functions of the symptom and amplitude curves. Conclusions & InferencesStandardized quantification of symptom profiles in relation to a meal-stimulus and gastric amplitude offer a novel classification scheme based on gastroduodenal physiology.