S4495 Post-Acute SARS-COV-2 Dyspepsia (PASCD): The Diagnostic Role of Body Surface Gastric Mapping

Introduction: Functional dyspepsia is a challenging post-coronavirus disease of 2019 (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: 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 woman presented 3 months after a mild COVID-19 infection with persistent epigastric pain, nausea, vomiting, and weight loss. Esophagogastroduodenoscopy (EGD) was normal. BSGM showed a principal gastric frequency (PGF) of 3.08 (normal: 2.65–3.35 cpm), a body mass index-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 man 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 an 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 man 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.