Predicting symptomatic response to prokinetic treatment using Gastric Alimetry

Chronic neurogastroduodenal disorders are challenging to manage, with therapy often initiated on a trial and error basis. Prokinetics play a significant role in management, but responses are variable and have been associated with adverse events, impacting widespread use. We investigated whether body surface gastric mapping (BSGM) biomarkers (using Gastric Alimetry ^® ) could inform patient selection for prokinetic therapy.

Patients with chronic gastroduodenal symptoms taking oral prokinetic, regardless of gastric emptying status, were prospectively recruited and underwent BSGM (30 m baseline, 482 kcal standardised meal, 4 h postprandial recording) whilst off prokinetic. Patients were followed up with daily symptom diaries. A subset was compared to matched patients not taking prokinetics. Prokinetic responders were defined based on symptom improvement greater than a minimum clinically important difference methodology.

42 patients (88% female; median age 36; median BMI 26) taking prokinetics were analysed. Prokinetic prescribing, compared to matched patients, was independent of BSGM metrics (p>0.15). In patients on existing prokinetics (withheld for BSGM), lower amplitudes predicted reduced symptom burden, whereas low rhythm stability predicted a worse symptom burden (p<0.05). In prokinetic-naive patients (i.e. started on a prokinetic during the study), a lower postprandial amplitude predicted responders (mean 37.5±10.6 uV in responders [n=5] vs mean 54.8±6.6 uV among non-responders [n=3], p=0.047).

Gastric Alimetry biomarkers may help in the prediction of prokinetic response in patients with chronic gastroduodenal symptoms. Lower post-prandial amplitudes, indicating a reduced meal response, appear to predict benefit, whilst impaired rhythm stability predicted poorer therapeutic response.