S1087 Clinical, Physiologic, and Anatomic Correlations in Younger vs Older Patients With Symptoms of Gastroparesis Undergoing Bio-Electric Therapy

Introduction: Related to insertion of bioelectric devices for severe upper gastrointestinal motility disorders in children and younger and older adults, we obtained clinical and physiologic measurements and full-thickness gastric biopsies. Data on pediatric and young adult patients (age £ 25 year [yr]) is limited compared with older adult cases. This study presents clinical, physiologic, and full thickness gastrointestinal biopsy results from a cohort of pediatric and young adult patients with gastroparesis syndromes compared with older adults undergoing gastric electrical stimulation (GES). Methods: We analyzed 212 patients (39 males, 173 females, median age 43 [ range 2-80 yr], 60 with diabetes mellitus). Baseline 4-hour solid gastric emptying showed 47.6% of patients were delayed and 52.4% were non-delayed. Patients with gastroparesis symptoms underwent a temporary stimulation device trial followed by full-thickness biopsies and other measures during permanent GES placement or related surgeries at 2 affiliated academic hospitals. Histological samples were examined for standardized cellular markers. Validated patient-reported outcomes were assessed at baseline and one-year post-procedure based on a 1-point standardized symptoms scale improvement as success. Results: Younger patients (28 total, 6 males, 22 females, median age 19 [range 2-25 yr], 4 with diabetes mellitus) reported less severe anorexia (3.0 vs 3.5, P = 0.003) and bloating (2.0 vs 3.5, P < 0.001) at baseline but similar nausea and vomiting to older adults (184 total, 33 males, 151 females, median age 46 [range 26-80 yr], 56 with diabetes mellitus). Biopsy results showed fewer CD117 and CD3 cells in younger patients (P = 0.046 and P = 0.03, respectively). Fibrosis was more common in older adults (20% vs 41%, P = 0.048). Among younger patients who improved post-GES, baseline vomiting was worse (3.0 vs 1.5, P = 0.034), with trends indicating higher full-thickness biopsy CD68 and S100 levels in improved patients. Conclusion: Younger patients with severe gastroparesis syndromes have full-thickness gastric biopsy abnormalities and other 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 gastroparesis symptoms undergoing the bio-electric therapy of gastric electrical stimulation to optimize perioperative counselling and postoperative symptom management.