ORCID Profile
0000-0002-9139-4740
Current Organisation
The University of Auckland
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Publisher: Cold Spring Harbor Laboratory
Date: 10-08-2022
DOI: 10.1101/2022.08.09.22278607
Abstract: Chronic gastroduodenal disorders including chronic nausea and vomiting syndrome, gastroparesis, and functional dyspepsia, are challenging to diagnose and manage. The diagnostic and treatment pathways for these disorders are complex, costly and overlap substantially however, experiences of this pathway have not been thoroughly investigated. This study therefore aimed to explore clinician and patient perspectives on the current clinical pathway. Semi-structured interviews were conducted between June 2020 and June 2022 with 11 patients with chronic nausea and vomiting syndrome alone or with functional dyspepsia (based on Rome IV criteria) and nine gastroenterologists who treat these conditions. Interviews were recorded, transcribed, and thematically analyzed using an iterative, inductive approach. Five key patient themes were identified: (1) the impacts of their chronic gastroduodenal symptoms, (2) the complexity of the clinical journey, (3) their interactions with healthcare providers, (4) the need for advocacy, and (5) their experience of treatments. Five key clinician themes were also identified: (1) these conditions were seen as clinically complex, (2) there is an uncertain and variable clinical pathway, (3) the nuance of investigations, (4) these conditions were difficult to therapeutically manage, and (5) there are barriers to developing a therapeutic relationship. Findings indicate that both patients and clinicians are dissatisfied with the current clinical care pathways for nausea and vomiting syndromes and functional dyspepsia. Recommendations included the development of more clinically relevant and discriminant tests, standardization of the diagnostic journey, and the adoption of a multidisciplinary approach to diagnosis and treatment.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 20-12-2022
DOI: 10.14309/AJG.0000000000002077
Abstract: Body surface gastric mapping (BSGM) is a new noninvasive test of gastric function. BSGM offers several novel and improved biomarkers of gastric function capable of differentiating patients with overlapping symptom profiles. The aim of this study was to define normative reference intervals for BSGM spectral metrics in a population of healthy controls. BSGM was performed in healthy controls using Gastric Alimetry (Alimetry, New Zealand) comprising a stretchable high-resolution array (8 × 8 electrodes 196 cm 2 ), wearable Reader, and validated symptom-logging App. The evaluation encompassed a fasting baseline (30 minutes), 482 kCal meal, and 4-hour postprandial recording. Normative reference intervals were calculated for BSGM metrics including the Principal Gastric Frequency, Gastric Alimetry Rhythm Index (a measure of the concentration of power in the gastric frequency band over time), body mass index (BMI)–adjusted litude (μV), and fed:fasted litude ratio. Data were reported as median and reference interval (5th and/or 95th percentiles). A total of 110 subjects (55% female, median age 32 years [interquartile range 24–50], median BMI 23.8 kg/m 2 [interquartile range 21.4–26.9]) were included. The median Principal Gastric Frequency was 3.04 cycles per minute reference interval: 2.65–3.35 cycles per minute. The median Gastric Alimetry Rhythm Index was 0.50 reference interval: ≥0.25. The median BMI-adjusted litude was 37.6 μV reference interval: 20–70 μV. The median fed:fasted litude ratio was 1.85 reference interval ≥1.08. A higher BMI was associated with a shorter meal-response duration ( P = 0.014). This study provides normative reference intervals for BSGM spectral data to inform diagnostic interpretations of abnormal gastric function.
Publisher: MDPI AG
Date: 10-10-2023
DOI: 10.3390/JCM12206436
Publisher: Cold Spring Harbor Laboratory
Date: 16-08-2023
DOI: 10.1101/2023.08.14.23294049
Abstract: To develop and validate a set of static and animated pediatric gastroduodenal symptom pictograms. There were three study phases: 1: Co-creation used experience design methods resulting in ten pediatric gastroduodenal symptom pictograms (static and animation) 2: an online survey to assess acceptability, face and content validity and 3: a preference study. Phases 2 and 3 compared the novel paediatric pictograms with existing pictograms used with adult patients. Eight children aged 6-15 years (5 Female) participated in Phase 1, 69 children in Phase 2 (median age 13 years: IQR 9-15), and an additional 49 participants were included in Phase 3 (median age 15: IQR 12-17). Face and content validity were higher for the pediatric and animated pictogram sets compared to pre-existing adult pictograms (78% vs. 78% vs. 61%). Participants with worse gastric symptoms (lower PedsQL-GIS score) had superior comprehension of the pediatric pictograms (χ 2 8 .001). The pediatric pictogram set was preferred by all participants over animation and adult (χ 2 2 .001). The co-creation phase resulted in the symptom concept confirmation and design of ten acceptable static and animated gastroduodenal pictograms with high face and content validity when evaluated with children aged 6 to 18. Validity was superior when children reported more problematic symptoms. Therefore, these pictograms could be used in clinical and research practice to enable standardized symptom reporting for children with gastroduodenal disorders. ▪ Diagnosis of gastroduodenal disorders of the gut-brain interaction (DGBI) in pediatrics is difficult as symptoms often overlap. ▪ Pediatric patients find identifying and distinguishing symptoms difficult. ▪ Validated gastroduodenal symptom pictograms have been found to help adults accurately report their symptoms and have been used effectively to standardize symptom monitoring, including continuous symptom reporting during investigations. ▪ There are no validated pediatric gastroduodenal symptom pictograms. ▪ Co-created a set of ten pediatric gastroduodenal symptom pictograms. ▪ Undertook a face and content validity study to assess the novel pictograms with 118 pediatric participants with a median PedsQL-GIS score of 86.1 (IQR 68.1-90.0). ▪ Designed a novel set of pictograms with face and content validity that were preferred over other sets, enabling acceptable, simple and validated pediatric patient reporting of their gastroduodenal symptoms.
Publisher: MDPI
Date: 08-03-2023
Publisher: Cold Spring Harbor Laboratory
Date: 25-05-2023
DOI: 10.1101/2023.05.18.23290134
Abstract: Gastric emptying testing (GET) assesses gastric motility, however is non-specific and insensitive for neuromuscular disorders. Gastric Alimetry® (GA) is a new medical device combining non-invasive gastric electrophysiological mapping and validated symptom profiling. This study assessed patient-specific phenotyping using GA compared to GET. Patients with chronic gastroduodenal symptoms underwent simultaneous GET and GA, comprising a 30-minute baseline, 99m TC-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. 75 patients were assessed 77% female. Motility abnormality detection rates were: GET 22.7% (14 delayed, 3 rapid) GA spectral analysis 33.3% (14 low rhythm stability / low litude 5 high litude 6 abnormal frequency) combined yield 42.7%. In patients with normal spectral analysis, GA symptom phenotypes included: sensorimotor 17% (where symptoms strongly paired with gastric litude median r=0.61) continuous 30% other 53%. GA phenotypes showed superior correlations with GCSI, PAGI-SYM, and anxiety scales, whereas Rome IV Criteria did not correlate with psychometric scores (p .05). Delayed emptying was not predictive of specific GA phenotypes. GA improves patient phenotyping in chronic gastroduodenal disorders in the presence and absence of motility abnormalities with improved correlation with symptoms and psychometrics compared to gastric emptying status and Rome IV criteria. These findings have implications for the diagnostic profiling and personalized management of gastroduodenal disorders. 1) WHAT IS KNOWN Chronic gastroduodenal symptoms are common, costly and greatly impact on quality of life There is a poor correlation between gastric emptying testing (GET) and symptoms Gastric Alimetry® is a new medical device combining non-invasive gastric electrophysiological mapping and validated symptom profiling 2) WHAT IS NEW HERE Gastric Alimetry generates a 1.5x higher yield for motility abnormalities than GET With symptom profiling, Gastric Alimetry identified 2.7x more specific patient categories than GET Gastric Alimetry improves clinical phenotyping, with improved correlation with symptoms and psychometrics compared to GET
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 30-10-2023
Publisher: Cold Spring Harbor Laboratory
Date: 26-07-2022
DOI: 10.1101/2022.07.25.22278036
Abstract: Body surface gastric mapping (BSGM) is a new non-invasive test of gastric function. BSGM offers several novel and improved biomarkers of gastric function capable of differentiating patients with overlapping symptom-profiles. The aim of this study was to define normative reference intervals for BSGM spectral metrics in a population of healthy controls. BSGM was performed in healthy controls using Gastric Alimetry (Alimetry, New Zealand) comprising a stretchable high-resolution array (8×8 electrodes 196 cm 2 ), wearable Reader, and validated symptom-logging App. The evaluation encompassed a fasting baseline (30 min), 482 kCal meal, and 4-hr postprandial recording. Normative reference intervals were calculated for BSGM metrics including the Principal Gastric Frequency, Gastric Alimetry Rhythm Index (GA-RI a measure of the concentration of power in the gastric frequency band over time), BMI-adjusted litude (µV), and fed:fasted litude ratio (ff-AR). Data are reported as median and reference interval (5 th and/or 95 th percentiles). 110 subjects (55% female, median age 32 (IQR 24 – 50), median BMI 23.8 kg/m 2 (IQR 21.4 – 26.9)) were included. The median Principal Gastric Frequency was 3.04 cpm reference interval: 2.65 – 3.35 cpm. Median GA-RI was 0.50 reference interval: !0.25. Median BMI-adjusted litude was 37.6 µV reference interval: 20-70 µV. The median ff-AR was 1.85 reference interval !1.08. Higher BMI was associated with a shorter meal-response duration (p=0.014). This study provides normative reference intervals for BSGM spectral data that will be used in clinical practice to inform diagnostic interpretations of abnormal gastric function.
Publisher: Wiley
Date: 29-03-2023
DOI: 10.1111/NMO.14556
Abstract: Chronic gastric symptoms are common, however differentiating specific contributing mechanisms in in idual patients remains challenging. Abnormal gastric motility is present in a significant subgroup, but reliable methods for assessing gastric motor function in clinical practice are lacking. Body surface gastric mapping (BSGM) is a new diagnostic aid, employs multi‐electrode arrays to measure and map gastric myoelectrical activity non‐invasively in high resolution. Clinical adoption of BSGM is currently expanding following studies demonstrating the ability to achieve specific patient subgrouping, and subsequent regulatory clearances. An international working group was formed in order to standardize clinical BSGM methods, encompassing a technical group developing BSGM methods and a clinical advisory group. The working group performed a technical literature review and synthesis focusing on the rationale, principles, methods, and clinical applications of BSGM, with secondary review by the clinical group. The principles and validation of BSGM were evaluated, including key advances achieved over legacy electrogastrography (EGG). Methods for BSGM were reviewed, including device design considerations, patient preparation, test conduct, and data processing steps. Recent advances in BSGM test metrics and reference intervals are discussed, including four novel metrics, being the ‘principal gastric frequency’, BMI‐adjusted litude, Gastric Alimetry Rhythm Index™, and fed: fasted litude ratio. An additional essential element of BSGM has been the introduction of validated digital tools for standardized symptom profiling, performed simultaneously during testing. Specific phenotypes identifiable by BSGM and the associated symptom profiles were codified with reference to pathophysiology. Finally, knowledge gaps and priority areas for future BSGM research were also identified by the working group.
Publisher: Wiley
Date: 13-02-2022
DOI: 10.1111/NMO.14331
Abstract: Functional gastroduodenal disorders include functional dyspepsia, chronic nausea and vomiting syndromes, and gastroparesis. These disorders are common, but their overlapping symptomatology poses challenges to diagnosis, research, and therapy. This study aimed to introduce and validate a standardized patient symptom-logging system and App to aid in the accurate reporting of gastroduodenal symptoms for clinical and research applications. The system was implemented in an iOS App including pictographic symptom illustrations, and two validation studies were conducted. To assess convergent and concurrent validity, a erse cohort with chronic gastroduodenal symptoms undertook App-based symptom logging for 4 h after a test meal. In idual and total post-prandial symptom scores were averaged and correlated against two previously validated instruments: PAGI-SYM (for convergent validity) and PAGI-QOL (for concurrent validity). To assess face and content validity, semi-structured qualitative interviews were conducted with patients. App-based symptom reporting demonstrated robust convergent validity with PAGI-SYM measures of nausea (r The continuous patient symptom-logging App demonstrated robust convergent, concurrent, face, and content validity when used within a 4-h post-prandial test protocol. The App will enable standardized symptom reporting and is anticipated to provide utility in both research and clinical practice.
Publisher: Cold Spring Harbor Laboratory
Date: 06-06-2023
DOI: 10.1101/2023.06.05.23290993
Abstract: Electrogastrography (EGG) non-invasively evaluates gastric motility but is viewed as lacking clinical utility. Gastric Alimetry® is a new diagnostic test that combines high-resolution body surface gastric mapping (BSGM) with validated symptom profiling, with the goal of overcoming EGG’s limitations. This study directly compared EGG and BSGM to define performance differences in spectral analysis. Comparisons between Gastric Alimetry BSGM and EGG were conducted by protocolized evaluation of 178 subjects (110 controls 68 nausea and vomiting (NVS) and/or type 1 diabetes (T1D)). Comparisons followed standard methodologies for each test (pre-processing, post-processing, analysis), with statistical evaluations for group-level differences, symptom correlations, and patient-level classifications. BSGM showed substantially tighter frequency ranges vs EGG in controls. Both tests detected rhythm instability in NVS, but EGG showed opposite frequency effects in T1D. BSGM showed an 8x increase in the number of significant correlations with symptoms. BSGM accuracy for patient-level classification was 0.78 for patients v. controls and 0.96 as compared to blinded consensus panel EGG accuracy was 0.54 and 0.43. EGG detected group-level differences in patients, but lacked symptom correlations and showed poor accuracy for patient-level classification, explaining EGG’s limited clinical utility. BSGM demonstrated substantial performance improvements across all domains.
Location: United States of America
Location: United States of America
No related grants have been discovered for Armen Gharibans.