Expression of Interest: Gastric Rhythm Mapping Study
Thank you for considering being involved in this study looking at stomach electrical activity in people with and without upper gastrointestinal symptoms. Please fill out the following form to formally express interest in being involved. Filling out this form does not mean that you have to be involved in the study.

Our research team is running studies to look at the electrical activity in the gut because we think that when the stomach’s messages to the muscles are not normal, the gut muscles squeeze at the wrong time, in the wrong order, or not at all. We think that these abnormal messages are linked to things people feel like stomach pain, nausea, being unable to finish meals, and feeling bloated. We are interested in stomach activity in healthy people, in order to create a model of what 'normal' activity looks like. This will be useful to be able to recognise what is abnormal, in people with symptoms related to their digestive tract. Therefore we are enrolling people with and without (healthy controls) symptoms.

This study we will measure your stomach activity in response to a meal, using a non-invasive ECG-like device. Taking part in this study will involve 5 hours of your time. You are able to work from a laptop or read a book during this time.

To participate you must be 18 or older and not be pregnant. If you are in prison or long-term care, or if you have cognitive impairment you cannot participate in this study.

If you suffer from either nausea and vomiting or dyspepsia which started at least 6 months ago you will be in the symptomatic group. This means suffering from either bothersome nausea at least 1 day per week and/or 1 vomiting episode per week or suffering from one of the following problems at least 1 day a week; feeling uncomfortably full after a regular sized meal, being unable to finish a regular sized meal, and/or experiencing pain or burning in your upper or mid abdomen (epigastrium). If these problems are related to an eating disorder or due to self-induced vomiting you are not eligible to participate in this study.

If you are eligible for the study based on your responses below, you will be given some more information to help you make your decision on whether to be involved or not.

If you have any questions about this form or the study, you are welcome to email us at gutresearch@auckland.ac.nz.
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First Name/s *
Last Name *
Sex *
Date of birth *
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Email *
Phone number *
Do any of the following apply to you? Please select those that are relevant. *
Required
Questions about your medical history
Please answer the following questions as best you can.
Have you suffered from any of the following problems for the last 3 months? Tick all that apply *
Required
Did the problems above start at least 6 months ago? *
Have you suffered from any of the following problems for the last 3 months? Tick all that apply *
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Did the problems above start at least 6 months ago? *
Have you been diagnosed with gastroparesis? *
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Have you ever discussed any gut symptoms with your GP?
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Have you been diagnosed with Ehlers-Danlos Syndrome
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Are the problems that you ticked above due to: *
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Have you ever had a gastroscopy / upper GI endoscopy?
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Are you currently pregnant?
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Do you use cannabis? *
What is your Body Mass Index (BMI)? This can be calculated at https://www.heartfoundation.org.nz/wellbeing/bmi-calculator *
As far as you know, do you have or have you had any of the following? *
Yes
No
I'm not sure
History of skin allergies or severe sensitivity to adhesives
Active gastrointestinal (GI) infection
Inflammatory bowel disease
Cannabinoid hyperemesis syndrome
Cyclical vomiting syndrome
Any previous stomach or oesphageal surgery
Oesphageus (gullet), stomach, intestine or bowel cancer
Multiple sclerosis
Parkinson's disease
Hyperthyroidism/Hypothyroidism
Scleroderma
Irritable bowel syndrome (IBS)
What medications do you take? Please provide names of all regular and as required (PRN) medications *
Do you have any allergies? If so, please list them below. *
Information relevant for booking your study visit, if you chose to be involved.
Which of the following days would suit you for your study visit? Please select all that apply. *
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The study visit will likely take place at the University of Auckland campus in Grafton, Auckland. Would you like us to book a carpark for your study visit?
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Do you have any dietary requirements? This may influence which meal we provide on the day of your study visit. *
Where did you hear about this study?
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