INTRODUCTION: Gastric emptying testing (GET) assesses gastric motility, however, is nonspecific and insensitive for neuromuscular disorders. Gastric Alimetry (GA) is a new medical device combining noninvasive gastric electrophysiological mapping and validated symptom profiling. This study assessed patient-specific phenotyping using GA compared with GET. METHODS: Patients with chronic gastroduodenal symptoms underwent simultaneous GET and GA, comprising a 30-minute baseline, ^99mTC-labelled egg meal, and 4-hour postprandial recording. Results were referenced to normative ranges. Symptoms were profiled in the validated GA App and phenotyped using rule-based criteria based on their relationships to the meal and gastric activity: (i) sensorimotor, (ii) continuous, and (iii) other. RESULTS: Seventy-five patients were assessed, 77% female. Motility abnormality detection rates were as follows: GET 22.7% (14 delayed, 3 rapid), GA spectral analysis 33.3% (14 low rhythm stability/low amplitude, 5 high amplitude, and 6 abnormal frequency), and combined yield 42.7%. In patients with normal spectral analysis, GA symptom phenotypes included sensorimotor 17% (where symptoms strongly paired with gastric amplitude, median r = 0.61), continuous 30%, and other 53%. GA phenotypes showed superior correlations with Gastroparesis Cardinal Symptom Index, Patient Assessment of Upper Gastrointestinal Symptom Severity Index, and anxiety scales, whereas Rome IV Criteria did not correlate with psychometric scores (P > 0.05). Delayed emptying was not predictive of specific GA phenotypes. DISCUSSION: GA improves patient phenotyping in chronic gastroduodenal disorders in the presence and absence of motility abnormalities with increased correlation with symptoms and psychometrics compared with gastric emptying status and Rome IV criteria. These findings have implications for the diagnostic profiling and personalized management of gastroduodenal disorders.

Background: Gastroparesis and functional dyspepsia are disorders characterized by upper gastrointestinal symptoms and multifaceted etiologies. One of the main therapeutic approaches is accelerating gastric emptying (GE) by means of prokinetic agents. Their efficacy has been demonstrated, although the association between symptom improvement and acceleration of emptying is less clear. Meta‐analyses have found contradictory results. Differences in applied methodology and included trials might drive these contradictions.Objective: To provide a transparent meta‐analysis update to elucidate the association between symptom improvement and acceleration of GE due to gastroprokinetic agents available for long‐term use in patients with gastroparesis.Design: Two approaches from earlier meta‐analyses were executed and compared. One analyzed the relative changes on active treatment versus baseline, the other compared the change from baseline on active treatment versus the change from baseline on placebo. Papers that reported sufficient numerical data for both analyses were selected. Both analyses included the same trials.Results: Overall, both approaches yield the same positive direction of association between symptom improvement and acceleration of emptying (0.291 (−0.391, 0.972), p = 0.4 and 0.453 (0.123, 0.782), p = 0.007 for the active‐only and placebo‐controlled analysis respectively). The association between symptom improvement and GE acceleration for studies using optimal GE tests was either 0.028 (p > 0.9) or 0.463 (p = 0.007), and for sub‐optimal GE tests was either 0.370 (p = 0.4) or 0.052 (p > 0.9) depending on the used meta‐analysis methodology.Conclusions: The applied methodology for GE testing, and the meta‐analysis substantially impacts the conclusion. When considering the clinically relevant outcome of improvement from baseline, symptoms and emptying improve with prokinetics, but no correlation is found between both aspects. When the change over placebo is considered, limiting the analysis to scientifically more rigorous study approaches, changes in emptying rate and symptom improvement are positively associated.

In healthy volunteers, peripheral corticotropin-releasing hormone (CRH) infusion accelerates gastric-emptying rate and increases postprandial gastric response, accompanied by a rise in symptoms, but does not alter gastric sensitivity or meal-induced accommodation. These findings underscore a significant link between stress and dyspeptic symptoms, with CRH playing a pivotal role in mediating these effects.

Our investigation breaks new ground by directly examining the effects of corticotropin-release hormone (CRH) on duodenal alterations, including permeability and immune activation, in healthy subjects. Intriguingly, our findings highlight disparities between ex vivo and in vivo pathways affecting duodenal permeability, offering novel insights into the potential pathophysiology of CRH on the duodenum.

Background: Dyspepsia is a prevalent condition in the general population. Besides organic causes, the differential diagnosis of dyspepsia includes functional dyspepsia (FD) and gastroparesis (GP) which share similar pathophysiological mechanisms and clinical presentation. So far, no study investigated the prevalence of FD and GP in a primary care in Belgium.Methods: Data were obtained from Intego, a Flemish‐Belgian general practice‐based morbidity registration network. From 586,164 patients between 2000 and 2021, we selected patients with ICD‐10 code for FD and GP. Patients with organic gastrointestinal diseases were excluded. We determined demographics and comorbidities of FD/GP. For prevalence and incidence calculation, we included those who consulted their general practitioners at least once in the given year. Pair‐wise comparison was conducted to access the impact of comorbidities on risk of FD/GP.Key Results: Between 2011 and 2021, the prevalence of FD/GP ranged from 1.03% to 1.21%. The incidence of FD/GP ranged from 109 to 142 per 100,000 adults. In total 5242 cases of FD/GP were identified. These cases shared commonly coexisting diagnoses of gastroesophageal reflux disease (18.8%), irritable bowel syndrome (17.1%), and chronic constipation (18.7%). Patients with somatization/anxiety/depression had significantly higher risk of FD/GP, compared to the control (OR 1.38, 95% CI 1.19–1.61, p < 0.01).Conclusions and Inferences: The prevalence (1.03%–1.21%) and incidence (109–142/100,000) of FD/GP in primary care over last decade appear to conflict with epidemiological research in the general population. The discrepancies suggest a potential lack of awareness of FD and GP among physicians and/or patients in Flemish‐Belgium.

For nearly 2 years, the COVID-19 pandemic has continued to pose a major public health crisis. COVID-19 spreads through the generation of aerosols and droplets [1]. A growing number of studies have confirmed that esophagogastroduodenoscopy (EGD) is an aerosol-generating procedure [2] [3]. While numerous approaches to decreasing the amount of aerosol have been reported, most of them may reduce patient comfort and entail additional procedure time and personnel. During the pandemic, a droplet-shielding mouthpiece (B1 mouthpiece, MPC-ST; Fujifilm, Tokyo, Japan) was launched. This device is used similarly to the conventional mouthpiece but has a double sponge with slits incorporated into the mouthpiece orifice, and a transparent plastic drape shield ( [Fig. 1]). To evaluate the efficacy of this modified mouthpiece, we performed a randomized study to quantify aerosol generation. Patients scheduled to undergo standard diagnostic EGDs or through-the-scope balloon dilation, and with negative findings from a polymerase chain reaction (PCR) test for COVID-19, were invited to participate. They were randomly assigned in a 1:1 ratio to receive a conventional or droplet-reduction mouthpiece. Quantification of aerosols (of sizes 0.3, 0.5, 1.0, 3.0, 5.0, and 10 μm) was conducted using a particle counter (Lasair II Particle Counter; Particle Measuring Systems, Boulder, Colorado, United States). Measurements of particle counts occurred immediately before endoscope insertion and 1, 3, 5, and 10 minutes after insertion, if the endoscopy was not terminated, and also 1, 3, 5, 10, and 15 minutes after scope withdrawal. The mouthpiece was removed 2 minutes after completion of the procedure. Aerosol particle counts (per cubic meter) were logarithmically transformed. Data are presented as mean ± SD and significance was set at P < 0.05. Chi-squared and unpaired t tests were used to compare baseline characteristics. A two-way mixed-model analysis was used to test for differences between mouthpiece types over time on number of aerosol particles of each size. The study was approved by the Leuven University Hospitals Ethics Committee, Leuven, Belgium (S65197). A total of 80 EGDs were included. There were no differences in baseline characteristics (Table 1s; available online in Supplementary material) and baseline particle counts (all sizes P = 1.00) of the two groups. During EGD, the use of a modified mouthpiece was associated with significantly lower counts in larger particle sizes 3.0, 5.0, and 10 µm (P = 0.03, P = 0.01, and P < 0.01, respectively), but not for smaller sizes 0.3, 0.5, and 1 µm (P = 0.41, P = 0.09, and P = 0.06, respectively) ( [Fig. 2], Table 2 s). After withdrawal of the endoscope, there were no differences in particle counts for each size over a 15-minute period (for ascending size order: P = 0.30, P = 0.25, P = 0.89, P = 0.65, P = 0.47; P = 0.29, respectively) (Fig. 1 s, Table 3 s). Our findings show that a commercially available mouthpiece, designed to reduce droplet generation during EGD, did not decrease particle counts for smaller sizes (0.3, 0.5, and 1.0 μm), but significantly lowered the numbers of particles of sizes 3, 5, and 10 μm particles during gastroscopy. This is consistent with the fact that larger particles are more easily blocked by personal protection equipment [4]. Accordingly, we believe that the modified mouthpiece helps to partially reduce the spread of particles (≥ 3.0 µm). However, it is does not avoid scattering of aerosols ≤ 1.0 µm. Appropriate personal protective equipment must still be worn to prevent aerosol transmission. ^* Joint first authors. Publication Date: 24 November 2021 (online) © 2021. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany