Dear Editor,
1.
We thank Dr. Chen and Dr. Wei for their letter. We agree that chronic gastroduodenal disorders must be viewed through a biopsychosocial lens, due to the bidirectional role of the gut‐brain axis. The technical review and consensus process used to develop the Auckland Classification included input from health psychologists and psychological research [1]. We strongly support the recommendation that a psychosocial context layer is valuable when interpreting the Auckland Classification.
The Gastric Alimetry system for Body Surface Gastric Mapping (BSGM) already includes the validated Alimetry Gut‐Brain Wellbeing (AGBW) Survey [2] and its youth counterpart (AGBW‐Y) [3]. These patient‐reported scales are contextualized for patients with chronic gastroduodenal symptoms, enabling a brief assessment of depression, anxiety, and stress. The automated classification system detailed in the Auckland Classification incorporates the AGBW Survey, ensuring that psychological factors are considered during phenotyping. By integrating objective measures of gastric electrophysiology, symptom profiling, and mental health into a single report, Gastric Alimetry provides clinicians with a holistic view of the patient, allowing for more individualized care [4].
The multimodal Gastric Alimetry system therefore offers further insights into the gut‐brain connection, even when myoelectrical activity is normal. This integrated approach defines distinct symptom and psychosocial patterns, enabling the breadth of pathophysiological mechanisms in chronic gastroduodenal disorders to be explored via targeted testing and management.
Additionally, we agree that an abnormal BSGM result should not discount psychosocial concerns. In fact, recent research demonstrates that gastric abnormalities can be associated with specific patterns of psychological distress. For example, the Dysrhythmic Phenotype is associated with higher depression [5] and higher BMI‐Adjusted Amplitude is correlated with worse illness perceptions [6]. This highlights the bidirectional gut‐brain interaction at play and the importance of considering this contextual layer in all patients. Future iterations of the Classification are expected to further define these associations.
We are strong advocates for multidisciplinary care where gastroenterology and psychology work collaboratively. The holistic insights from a Gastric Alimetry test facilitate early, targeted referral to multidisciplinary care. We encourage clinicians to base referrals on the overall presentation of the patient's BSGM results, symptoms, and mental wellbeing.
While our group has extensively explored psychosocial variables such as mental health [5], illness perceptions [6], eating disorders [7], and sleep [8] in relation to BSGM phenotypes, we agree that the additional domains listed by Chen and Wei warrant further exploration. Ultimately, our groups share a common vision, and we welcome further collaboration across gastroenterology and psychology to continue optimizing biopsychosocial care models.
Author Contributions
M.L. wrote the original draft. C.N.A. and G.O.G. edited the draft and provided supervision.
Conflicts of Interest
Greg O'Grady holds intellectual property and grants in gastric electrophysiology and is a Director of the University of Auckland spinout company Alimetry Ltd. Mikaela Law and Christopher N. Andrews are members of Alimetry Ltd.
Linked Articles
This article is linked to Varghese et al. and Chen and Wei papers. To view these articles, visit https://doi.org/10.1111/nmo.70377 and https://doi.org/10.1111/nmo.70404.
Law M., Andrews C. N., and O'Grady G., “Response to: Pairing the Auckland Classification With a Brief Psychosocial Context Layer,” Neurogastroenterology & Motility 38, no. 9 (2026): e70430, 10.1111/nmo.70430.
On behalf of the Auckland Classification Technical Working Group.
Data Availability Statement
Data sharing not applicable to this article as no datasets were generated or analysed during the current study.
References
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
Data sharing not applicable to this article as no datasets were generated or analysed during the current study.