Body surface gastric mapping facilitates the management of pediatric disorders of gut-brain interaction

Disorders of gut-brain interaction (DGBI) are among the commonest contributors to disease burden in children, yet remain difficult to diagnose and treat, in part because available tests inadequately capture underlying mechanisms or link physiology to symptoms. Body surface gastric mapping (BSGM) is a next-generation, noninvasive electrophysiological technology that records high-resolution gastric slow-wave activity with simultaneous symptom logging. This review summarizes emerging evidence that BSGM may fill a key diagnostic gap in pediatric DGBI. After outlining the burden and multifactorial pathophysiology of pediatric DGBI, we compare alternative investigations-including electrogastrography, gastric emptying scintigraphy, and antroduodenal manometry-and highlight their limitations in pediatrics, including regarding reproducibility, accessibility, invasiveness, and symptom correlation. We then describe BSGM methodology, validated spectral metrics, symptom integration, and standardized testing protocols. Early pediatric studies have demonstrated excellent feasibility, particularly in adolescents, established preliminary normative ranges, and identified phenotypes to distinguish neuromuscular disorders, delayed meal responses, and alternative symptom profiles to help inform targeted care. Concordance with antroduodenal manometry is also discussed. Finally, we outline research priorities, including the need for larger multicenter cohort studies, formalization of pediatric-specific reference intervals, and longitudinal studies assessing treatment responses. BSGM shows potential as a valuable noninvasive diagnostic tool for better characterizing pediatric DGBIs, though further validation is required.