University of Texas at Austin Dell Medical School Austin, TX
Rima Shobar, MD, MS1, William Brode, MD1, Deepak Agrawal, MD, MPH2, Christopher N. Andrews, MD, MSc3, Mohammad Bashashati, MD1 1University of Texas at Austin Dell Medical School, Austin, TX; 2University of Texas at Austin, Austin, TX; 3University of Calgary Cumming School of Medicine, Calgary, AB, Canada Introduction: Functional dyspepsia is a challenging post-COVID-19 disorder. Body surface gastric mapping (BSGM) is a new modality that records the stomach's electrical activity through the abdominal wall. BSGM differentiates gastric neuromuscular pathologies, disorders of gut-brain interaction, and gastric emptying disorders. To highlight the underlying pathologies of post-acute SARS-CoV-2 dyspepsia (PASCD), BSGM tracings from 3 patients were reviewed.
Case Description/
Methods: BSGM was performed using Gastric Alimetry™ New Zealand test, consisted of a high-resolution 64- electrode array, a symptom-logging App, and a wearable reader device.
Case 1: A 41-year-old female presented 3 months after a mild COVID-19 infection with persistent epigastric pain, nausea, vomiting, and weight loss. EGD was normal. BSGM showed a principal gastric frequency (PGF) of 3.08 (normal: 2.65–3.35 cpm), a BMI-adjusted amplitude (BMI-AA) of 40.4 (normal: 22–70 μV), and a Fed: Fasted Amplitude Ratio (ff-AR) of 3.31 (normal >1.08). Gastric electrical activity (GEA) was significantly associated with gastric pain. BSGM findings were compatible with impaired gastric accommodation. Mirtazapine 15 mg daily resulted in complete resolution of symptoms.
Case 2: A 61-year-old male with a history of severe COVID-19 and prolonged hospital stay presented with persistent nausea, vomiting, and delayed gastric emptying. EGD showed mild reactive gastropathy. BSGM revealed a PGF of 3.51, a BMI-AA of 30.4 and a ff-AR of 1.88. There was no association between symptoms and GEA. Findings were compatible with vagal neuropathy. GI symptoms were relatively controlled with nortriptyline 25 mg daily and ondansetron as needed.
Case 3: A 44-year-old male with long-COVID-19 and small fiber neuropathy presented with heartburn, nausea, vomiting, early satiety, and diarrhea. EGD and colonoscopy were normal apart from a small hiatal hernia. Gastric emptying scintigraphy was normal. BSGM showed a normal PGF of 2.96 and ff-AR of 2.64. The Gastric Alimetry Rhythm Index (GA-RI) was unstable up to 2 hours post-meal, suggesting a gastric neuromuscular disorder. Neuromodulators were ineffective, hence a trial of pyridostigmine was initiated. Discussion: PASCD is associated with autonomic dysfunction, manifesting as vagal nerve injury, neuromuscular abnormalities, or impaired gastric accommodation. BSGM provides a valuable diagnostic approach to identify these discrete pathologies and guide tailored treatment strategies.
Disclosures: Rima Shobar indicated no relevant financial relationships. William Brode indicated no relevant financial relationships. Deepak Agrawal indicated no relevant financial relationships. Christopher Andrews: Abbvie – Advisor or Review Panel Member. Alimetry – Independent Contractor, Stock Options, Stock-privately held company. Avir – Advisor or Review Panel Member. Bausch Health – Advisor or Review Panel Member, Speakers Bureau. Knight Pharma – Advisor or Review Panel Member, Speakers Bureau. Nestle – Grant/Research Support. Nimble Science – Consultant, Stock Options, Stock-privately held company. Pendopharm – Advisor or Review Panel Member. Sanofi/Regeneron – Advisor or Review Panel Member. Takeda – Advisory Committee/Board Member. Mohammad Bashashati indicated no relevant financial relationships.
Rima Shobar, MD, MS1, William Brode, MD1, Deepak Agrawal, MD, MPH2, Christopher N. Andrews, MD, MSc3, Mohammad Bashashati, MD1. P2968 - Post-Acute SARS-COV-2 Dyspepsia (PASCD): The Diagnostic Role of Body Surface Gastric Mapping, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
