Flagship 3: Diagnosis and therapy of gastric dysrhythmias

Summary

Contractions of the smooth muscle in the gastrointestinal (GI) tract are regulated and coordinated by electrophysiological events known as slow waves. Despite outstanding potential to treat significant functional GI motility diseases, the clinical use of GI electrophysiological measurements remains in its infancy. This is in stark comparison with the cardiac field, where electro-anatomical mapping, ablation and pacemakers are routinely performed to manage rhythm disorders constituting a multi-billion dollar industry.

Members of Flagship 3 have been instrumental in developing the tools and techniques that have allowed the discovery of complex spatial GI electrical dysrhythmias (see figure below) associated with functional gastric motility disorders (e.g., gastroparesis and chronic unexplained nausea and vomiting). Patients suffering from such disorders lead a poor quality of life and often have symptoms such as chronic nausea, bloating and vomiting.

As the slow wave dysrhythmias in these patients often occur at frequencies similar to the frequency of normal activity, the use of high-resolution spatial recordings provide critical information that can easily be missed with sparse recordings that often only analyse frequency dynamics.

However, existing techniques are highly invasive and the electrodes require direct access to the serosal (outside) surface of the stomach (see figure below). As such, these methods can only be employed in intraoperative studies at a limited number of centres.

To address these limitations, we will develop and validate new technologies that are less invasive and can be routinely used clinically for assessing the functional state of a patient with gastric motility disorders. In particular, we will develop systems for characterising gastric slow wave activity during (i) laparoscopic surgery and (ii) endoscopy.

The team will also work closely with major US based hospitals that treat patients with functional motility disorders, on pre-clinical validation studies.