Findings in younger versus older patients with the symptoms of gastroparesis undergoing gastric electrical stimulation

Abstract

Objectives: Bioelectric devices such as gastric electrical stimulation (GES) are used to treat severe upper gastrointestinal motility disorders in both younger and older patients. We compared clinical, physiologic, quality of life, and full-thickness gastric biopsy results between younger and older patients undergoing GES.

Methods: We analyzed 245 patients (45 males, 200 females; median age 42 [range 2-80 years] 47.6% with delayed solid gastric emptying and 52.4% nondelayed). All patients underwent temporary GES trials, followed by full-thickness gastric biopsies and physiologic assessments during permanent GES placement. Histologic evaluation used standardized cellular markers. Validated patient-reported outcomes were assessed at baseline and 1 year, with a 1-point improvement as clinical success.

Results: Younger patients (n = 37; 9 males, 28 females; median age 17 [range 2-25 years]); reported less severe anorexia (3.0 vs. 3.5, p = 0.005) and bloating (2.0 vs. 3.5, p < 0.001) at baseline, while nausea and vomiting severity were similar to 208 older adults. Biopsy analysis showed fewer CD3+ and CD8+ cells in younger patients (p = 0.032 and p = 0.002) and fibrosis was more common in older adults (41.2% vs. 16.1%, p = 0.008).

Conclusion: Younger patients with gastroparesis (Gp) syndromes have full-thickness gastric biopsy abnormalities and clinical measures that are similar, but not identical to older patients. These findings indicate the need for broader use of tissue analysis and other clinical measures in severely symptomatic patients with Gp symptoms undergoing the bio-electric therapy of gastric electrical stimulation to optimize perioperative counseling and postoperative symptom management.

Keywords: electrogastrography (EGG); full‐thickness gastric biopsies (FTBx); gastric emptying tests (GET); gastroparesis‐like syndrome (GLS); interstitial cells of Cajal (ICC).