Predicting symptomatic response to prokinetic treatment using gastric alimetry

Background:  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.
Methods:  Patients with chronic gastroduodenal symptoms taking oral prokinetic agents, regardless of gastric emptying status, were prospectively recruited and underwent BSGM (30 m baseline, 482 kcal standardized meal, 4 h postprandial recording) while off-prokinetic agents. Patients were followed up with daily symptom diaries. A subset was compared to matched patients not taking prokinetic agents. Prokinetic responders were defined based on symptom improvement greater than a minimum clinically important difference methodology.
Key Results:  Forty-two patients (88% female; median age 36; median BMI 26) taking prokinetics were analyzed. 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 nonresponders [n = 3], p = 0.047).
Conclusions:  Gastric Alimetry biomarkers may help in the prediction of prokinetic response in patients with chronic gastroduodenal symptoms. Lower postprandial amplitudes, indicating a reduced meal response, appear to predict benefit, while impaired rhythm stability predicted poorer therapeutic response.