Clinical utility of Gastric Alimetry® in the management of intestinal failure patients with possible underlying gut motility disorders

Abstract

Summary: Background/Aims: Gut dysmotility is an increasingly common contributor to intestinal failure. However, differentiating true cases of severe dysmotility requiring intensive nutritional support from other causes of symptoms (e.g., gut-brain or visceral hypersensitivity disorders) is clinically challenging. Reliable motility tests are not widely accessible and may be non-contributory, while transit studies can be labile and insensitive for neuromuscular pathologies. Methods: Gastric Alimetry® (Alimetry, New Zealand) is a new test of gastric function that was recently shown to define patient subgroups with neuromuscular dysfunction in chronic nausea and vomiting syndromes. Here, we report the first application of Gastric Alimetry to a cohort of adult patients established on PN for a possible GI motility disorder. Results: Ten patients with diagnostic uncertainty were evaluated, nine on PN, one recently weaned due to a line infection. Gastric Alimetry evaluation was found to contribute to management decisions in all 10 cases, with clinical diagnoses being updated in 6/10, primarily to refocus on disorders of gut-brain interaction in subjects with normal tests. Changed management based on test results facilitated successful weaning of PN in 6/9 patients at median 5 months of follow-up, due to effective targeted pharmacological therapy and integrated care. Conclusions: These data support the role of Gastric Alimetry in the work-up of possible intestinal failure patients with suspected motility disorders, with utility in diagnosis and management. Test results facilitated gut rehabilitation, reduced PN dependence, and therefore reduced healthcare costs (estimated at >NZ$100,000 per PN patient per year in nutritional support alone).

Keywords

• Intestinal failure
• Parenteral nutrition
• Body surface gastric mapping
• Enteral feeding
• Dysmotility