Evaluation of Body Surface Gastric Mapping in a Multidisciplinary Integrated Care Pathway for Chronic Gastrointestinal Symptoms

The intervention will be the Multidisciplinary Integrated Care Clinic Treatment Approach (HREC/2021/QMS/75204). Participants will undergo a multidisciplinary review session for approximately 1 hour prior to receiving their personalised treatment plan by all potential specialists (i.e. gastroenterologist, general practitioner, psychologists, dieticians and physiotherapists). A 12 week structured program is targeted towards patients who have failed to respond to standard medical therapy, and includes both pharmacological and psychological interventions, as well as dietary and exercise consultations as required. Patient care in HREC/2021/QMS/75204 will be tailored to individual needs as identified by the treating multidisciplinary team, which may include: pharmacological management, psychological care (cognitive behaviour therapy / Acceptance and Commitment Therapy/ relaxation techniques / mindfulness), dietician consultation to avoid dietary triggers, and exercise programs including cardiorespiratory, resistance, flexibility, balance, and/or neuromotor training. The intervention by allied health (psychology, diet or exercise physiology) will be 1 hour a week for up to 12 weeks and will be delivered face to face or via telehealth. Adherence will be monitored via clinician assessment notes. The body surface gastric mapping (BSGM) procedure will be performed in accordance with established protocols [Varghese, 2022], within three weeks prior to subjects receiving their personalised treatment plans and will be performed by the clinical scientist. Before the BSGM test, medications affecting gastrointestinal motility will be discontinued for two days, and the intake of caffeine and nicotine will be avoided on the day of the test. An 8x8 electrode array, connected to a wearable reader, will be placed on the epigastric area. The BSGM test will consist of a 30-minute fasting period, a 10 minute test meal, and a subsequent four-hour postprandial period. Patients will be instructed to maintain a comfortable position, limit their movements, and document symptoms using the Gastric Alimetry App [Sebaratnam 2022]. Continuous symptoms like nausea, bloating, upper gut pain, heartburn, stomach burn, and excessive fullness will be recorded at a minimum of 15-minute intervals using 10-point Likert scales. Early satiation will be measured immediately after the meal with a similar scale, while episodic symptoms, such as reflux, belching, and vomiting, will be logged as distinct events [Sebaratnam 2022]. References: - Varghese C, et al. Normative Values for Body Surface Gastric Mapping Evaluations of Gastric Motility Using Gastric Alimetry: Spectral Analysis. Am J Gastroenterol. 2022 Dec 20. doi: 10.14309/ajg.0000000000002077. Epub ahead of print. PMID: 36534985. - Sebaratnam G, et al. Standardized system and App for continuous patient symptom logging in gastroduodenal disorders: Design, implementation, and validation. Neurogastroenterology & Motility 2022;34:e14331